A 15-year-old polo pony gelding was presented to Cornell Ruffian Equine Specialists for colic. A 270° colon volvulus was corrected surgically. No complications were reported. Five days post-op, the pony developed soft stool, increased intestinal sounds, tachycardia (70 bpm), dark pink mucous membranes, and a prolonged capillary refill time (2.5 sec). The top differential at this time was Clostridium difficile colitis. The gelding was transferred to Cornell Equine and Farm Animal Hospital in Ithaca, NY for treatment in an isolation unit.

On arrival, the pony was dull, ataxic, and tachycardic (64bpm) with bright pink mucous membranes and a toxic gum line. Reduced intestinal sounds were noted. Treatment was initiated and the gelding began passing formed stools within 24 hours of admission. Treatment focused on resolving a concurrent endotoxemia and related sequelae, most notably septic thrombophlebitis of the right facial artery. Multiple plasma and hetastarch transfusions were required to manage the panhypoproteinemia (total protein 3.8g/dL, albumin 1.6g/dL, globulin 2.2 g/dL) with edema, highly suspected to be a result of a colitis, although inflammatory bowel disease and lymphoma could not be ruled out.

After four days of treatment, the gelding developed hemorrhagic colitis. The only change in management was the addition of firocoxib treatment 24 hours earlier. Abdominal ultrasound revealed edematous, thickened loops of right ventral colon. Although the right dorsal colon was normal on ultrasound, the primary differential in this case was an atypical presentation of firocoxib-induced ulcerative colitis. It was suspected that the initial episode of colitis had a similar etiology as no infectious agents were identified. Appropriate doses of flunixin were administered by the rDVM; however, right dorsal colitis has occasionally been reported to occur with therapeutic dosing. non-steroidal anti-inflammatory drug (NSAID) treatment was discontinued and the pony was discharged after two weeks when completely recovered.

This report will describe the etiology and clinicopathologic findings associated with NSAID-induced colitis in horses and briefly review colonic volvulus.