The patient, a four year-old Quarter Horse gelding, presented with a week-long history of mild, persistent colic responsive to analgesic therapy. Physical examination was unremarkable, and both gastrointestinal and non-gastrointestinal differential diagnoses for chronic colic were investigated. Abdominal radiographs revealed a sand accumulation in the patient’s cranioventral abdomen, leading to a diagnosis of sand colic. Although abdominal radiographs are considered the most useful diagnostic tool for sand colic, a well-established imaging protocol for evaluating abdominal radiographs for sand does not exist. The amount and clinical significance of sand accumulations is therefore difficult to determine. The patient was treated with psyllium hydrophila mucilloid administered via nasogastric tube every 24 hours for a total of four treatments. While hospitalized, the patient’s clinical signs improved, and the gelding has shown no signs of colic since discharge.