2 year old, Standardbred trotter, male.
History
Colic signs were notificed early in the morning, with severe pain and sweating. Pain was only temporally and minimally influenced by administration of anti-inflammatory drugs. No previous colic episodes were reported; the horse was regularly dewormed and was in training.
Clinical examination
The horse was moderately depressed, pawing and striving to lay down in lateral recumbency; the abdomen was distended. T°C 38.7, HR 88 bpm, RR 20 rpm, PCV 47%, TPP 7.8, WBC 22.600/uL, blood pH 7.37, BE 3.4 mmol/L. No gut motility was detected on auscultation. On rectal examination, caecal distention was palpable and on the medial side of the caecum a smooth, elastic painful mass was present; some small intestinal distended loops were also felt. Five litres of gastric reflux pH 6,5 were removed. Based on clinical signs and history, the horse was submitted to exploratory laparotomy.
Treatment
At laparotomy the caecum appeared distended, with edematous, thickened and congested wall (Fig.1, 2).
Fig.1 
Fig.2
Careful exploration revealed a 720° clockwise caecal rotation at its base; the medial caecal band was thickened. Ileum and ascending colon showed no abnormalities, apart from a moderate distension of the most distal portion of the small intestine. (Fig. 4). After gas decompression, the caecum was de-rotated and repositioned.
Fig.3
The caecal serosa after de-rotation progressively decongested and resumed a pink color.
In the recovery box the horse needed a long time to get up. One hour post operatively fluid therapy was started (2 lt hypertonic saline solution and 6 lt Lactate Ringer solution) Two hours post operatively the horse was able to resume standing position. Thirty-six hours post op the horse developed abdominal pain, profuse sweating with absence of peristalsis, leucopenia, increased PCV and low TPP. During the subsequent 2 hours, clinical symptoms worsened abruptly and the horse was submitted to euthanasia.