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Nephrosplenic Entrapment as a Cause of Colic

My gelding recently had a nephrosplenic entrapment. Treated successfully with rolling. What can be done to prevent this? Are there any early warning signs that I may have missed? How often does this recur?
-DG, Pennsylvania

Dear DG,

This question caught my eye because my own horse was diagnosed with this several years ago. Fortunately his resolved with another form of conservative treatment—administration of phenylephrine and lunging exercise. It sounds like your horse recovered with rolling under general anesthesia. Horses that don’t respond to either of these medical methods require surgery to correct the condition. Before we get into success rates, prognosis and recurrence though, let’s start at the beginning.

What is a nephrosplenic entrapment? The prefix nephro means kidney (don’t worry if you thought “reno” meant kidney – it does, too. Isn’t science fun?!), while splenic refers to the spleen. Since the spleen is on the left side of the body, we’re talking about the left kidney and the left colon. In fact, the other name for this condition is left dorsal displacement of the colon.

The Merck Veterinary Manual explains the situation well, saying:

“There is a natural space between the dorsal [top] aspect of the spleen and left kidney. This space is bounded by the renosplenic ligament, a strong band of tissue that connects the spleen with the fibrous capsule of the left kidney. This ligament provides a ‘shelf’ over which the large colon can be displaced.”

In order to be displaced however, the colon needs to have another problem such as have more gas than usual, have less motility than usual . . . something that would cause it to move into this natural space. Therefore, anything you can do to ensure the normal health and function of the hindgut may help reduce your horse’s risk for developing this condition. That could mean making sure his diet consists primarily of forage, not grain, then meeting his nutrient requirements with a multi-vitamin/mineral supplement or ration balancer. It could also mean adding digestive support that includes probiotics, prebiotics, yeast or other ingredients proven to assist in proper digestion.

As far as prognosis goes, I found an article that provided these recovery numbers:

• Up to 90% success following phenylephrine and lunging exercise
• Up to 74% success following rolling (under general anesthesia)
• Up to 93% short-term survival (survival to discharge home) following surgical correction

Recurrence may occur in approximately 8% of cases, making these horse candidates for obliteration of the nephrosplenic space.

Unfortunately, there are no early warning signs for nephrosplenic ligament entrapment, just the “usual” colic signs: abdominal pain, reduced fecal output, elevated heart rate, etc. While every horse owner should observe their horse closely for colic and contact their veterinarian at the first sign of a problem, horses with a history of a previous serious condition like this need extra close attention paid to them since the outcome is better the sooner treatment is begun.

Lydia F. Gray, DVM, MA SmartPak Staff Veterinarian and Medical Director Dr. Lydia Gray has earned a Bachelor of Science in agriculture, a Doctor of Veterinary Medicine (DVM), and a Master of Arts focusing on interpersonal and organizational communication. After “retiring” from private practice, she put her experience and education to work as the American Association of Equine Practitioner’s first-ever Director of Owner Education. Dr. Gray continues to provide health and nutrition information to horse owners through her position at SmartPak, through publication in more than a dozen general and trade publications, and through presentations around the country. She is the very proud owner of a Trakehner named Newman that she actively competes with in dressage and combined driving. In addition to memberships in the USDF and USEF, Dr. Gray is also a member of the Illinois Dressage and Combined Training Association (IDCTA). She is a USDF “L” Program Graduate and is currently working on her Bronze Medal. Find Dr. Gray on Google+

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10 comments on “Nephrosplenic Entrapment as a Cause of Colic
  1. Tabatha says:

    I think that is what was causeing my 10yr Paint gelding to colic April-Nov.2011. He saw a lot of the some sign when he would colic: verry gassy, dark yellow urin, trouble urinating, rolling, bitting his left side. In the spring and summer he was limmited to 4hrs in the field(verry green rich covery grass)and brought in to a dry lot that is aound a half an acer was fed some hay and got a small handfull of grain. After many vet exams and power pack dewormer(no visal sign of worm) we still did not know the cause of the colic. I have since took him off the grain and he has 8-9hrs out in the field and gets hay at night. Do you think it sounds like he had Nephrosplenic Entrapment? He gets little exercise now that winnter has set in. During spring and summer I rode him only a few times. I live in MO and our weather changes every week; I am worried that by riding him on a warmer day mite cuase colic when the next day drops 20 degrees. What can I do to keep him sound?

    • SmartPak SmartPak says:

      Hi Tabatha-Since there is no one sign or collection of signs that specifically points to nephrosplenic ligament entrapment as the cause for a horse’s colic, it is very important to stay in close contact with your veterinarian. The only way to diagnose NSE is by rectal examination, response to treatment and possibly ultrasound. Your veterinarian can also advise you if there are management and diet changes you can make to reduce your horse’s risk of colic, such as adding heated water buckets and an electrolyte supplement, or providing more hay and a digestive supplement.

  2. Mary L. Brennan DVM says:

    My gelding also had this problem and responded well to the Phenylephredrine, however continued to experience mild colic episodes. Drug therapy did not help so by process of elimination figured out that the hay was the cause. It was the same hay that had been fed for several months, nothing had changed. None of the other horses were reacting to or ill from the hay. On analysis there were a few aflotoxins present in the hay. The final diagnosis was a sensitivity to certain molds and/or their aflotoxins. Research suggests that some horses can become sensitized after ingesting comtaminated hay, reacting the next time when re-exposed. Don’t know how many cases are caused by something like this but thought it might be helpful. This same horse started to have the same problem this year but caught it quicker and changed the hay. The only hay that seems to grow the mold that affects him is orchard grass either pure or a mix. I considered one of the hay steamers but don’t have the room or time for the continual cooking of the hay for each feeding. Also don’t know if his reaction is due the to mold or the aflotoxin it produces.

  3. Pam Skinner says:

    Several years ago one of my geldings developed “colic like symptoms” it was winter and very cold. My horses have heated water available and are fed hay am and pm. I took the horse the the local vet and they did a rectal and said he had the above (at that time, never heard of this). We were sent to SLC where surgery could be performed if necessary. He was given Phenylephredrine, and moved around. He seemed to be better. Spent the night and then came home, all better.
    Since, that time, he has had a couple of “mild” colic symptoms. Lays down gets up and seems a bit uncomfortable and then has been OK. Nothing for a year now (yipee).
    I have added “slow feeders” to my hay management (grass hay only). Though I cannot keep hay in front of my horses 24/7 (just ate till they dropped :-)), it does allow them to eat for longer. Also, added Plantium performance (mineral-vit supplement), Smart digest, and Parelli Essentials. I also have Redmond free choice salt which I add sunflower seeds to in order to encourage salt intake. My mare spends hours picking out the sunflower seeds. I have 4 horses all in herd with 24/7 turnout. They all seem to be doing VERY well.
    Thanks so much for the information.

  4. Tammy Clayton says:

    My 7 year old gelding was just diagnosed with the above today. I too had never heard of this before. We did the drug and lunge therapy today in the very hot weather we are having. He is pretty wore out now. We feed Equine Choice Probiotics. The vet mentioned that some horses can get gassy on probiotics. Has anyone else discovered this?

  5. Lindsey Ryon says:

    My 17 y/o Thoroughbred gelding recently suffered a severe Nephrosplenic Entrapment about a month ago and had to be put down. This year he coliced three times. Once in January (a gas colic), once in June (a NSE), and recently in November (a NSE). I had pretty solid knowledge of my guy before I bought him as far as health history, etc. Of course any type of Colic is scary, so when I experienced his first one with me (in January 2013) I started thinking about supplements and anything I could do to be proactive or preventative for his overall health since he was getting older. Once I was financially stable, he was put on SmartDigest in May 2013 to help with digestion. He has always been fed senior feed with beetpulp and whatever supplements he is on at that time. He had his first NSE in June 2013 (maybe not quite enough time for the supplement to be helpful). Fortunately we were able to resolve this colic at home with fluids, a 10-minute bumpy trailer ride and 3 poops! From June until November we had a great few months of getting back into a good working routine. Around mid-November I was able to catch him at an early point of the colic (and knowing it was a different feeling this time that we couldn’t resolve this at home) and took him to UGA for treatment. They did three separate phenylephrine treatments and were only able to walk (not jog) him since his colon was so tight with gas it would burst. None of the three treatments worked, so my last option (financially) was a flank surgery. When they opened his flank, his colon was already burst and there was no other choice but to put him down. Now… buy ALL means I am NOT blaming your product. I am a very active customer of SmartPak and I love your products whether it’s supplements, clothes, dog food, etc. However, I have been extremely curious as to why him being on SmartDigest wasn’t very helpful for him, knowing the past two colics were digestive issues? Is there any way of knowing that a supplement isn’t really beneficial to your horse? Like people and other animals, we all lack different nutrients according to our diets and overall living. Since he was only on turnout (with LITTLE grass) 6 hours a day, I thought the digestive supplement would help with regularity. Correct me if I misunderstood the purpose of the SmartDigest supplement. I guess I am trying to find out answers or learn from something I could’ve done differently with his maintenance (rather than blaming something I was already doing, if that makes sense?) Thanks and sorry so long!

    • SmartPak SmartPak says:

      Hi Lindsey, I want to start by saying how terribly sorry we are to hear of your loss. As horse owners and lovers ourselves, we know how special horses are in our lives. It sounds like you were very conscientious with your horse’s management, and hopefully I can provide some information that will bring clarity to the role of supplements for horses with digestive issues, especially a complex case like reoccurring nephrosplenic entrapment. Unfortunately, nephrospleic entrapment is a particular type of colic that is not very well understood, in that leading experts are still unsure why some horses develop this condition. That being said, as horse owners what we can do is try and help reduce our horses’ risk of colic wherever possible. A large part of this is, of course, excellent management like it sounds you were providing, as well as nutritional supplements where appropriate. SmartDigest Ultra does provide ingredients that have been shown to help reduce digestive upset, and would be an appropriate addition to the overall management and nutrition program for a horse with a history of digestive disturbance. We wish we could say there is a way to 100% prevent colic in horses, but unfortunately sometimes even when we do everything right, colic can still happen. Please know how sorry we are for your loss, and that our thoughts are with you. – Dr. Lydia Gray

  6. Laura Slack says:

    My 28 year old thoroughbred gelding passed away in February after bleeding out from the administration of pheylephrine to treat NSE. It was the first time he had ever had any form of colic in the nearly 11 years that I owned him. He had been on Ultra Elite Digest for about 5 years. He also was on senior feed. I’m not blaming the vet, but he made the possibility of hemorrhage sound so minute that I agreed to have him administer the medication without pursuing other options for treatment. So of course now I wonder if I had refused to administer the meds and tried rolling instead, would my horse still be alive. Maybe. Maybe not. I would not have opted to do surgery as recovery would have been difficult. However two long trailer rides (one to try and get things moving in his gut and the second ride to the equine hospital) didn’t help, so maybe rolling wouldn’t have helped either. It’s always so hard to decide what’s the best way to treat your horse. You just want to do what’s best for them. I just wish I would have made a different choice for my guy.

  7. Jessica Howsam says:

    My gelding was diagnosed with NSE after starting on a probiotic (Probios). I have reported it to the manufacturer as an adverse event. I encourage everyone else who has experienced NSE after feeding a probiotic supplement to do the same. The only way to get more research, sufficient labeling and awareness that there is a correlation between NSE and probiotic is to report it as an adverse event. The more individuals who report these cases, which manufacturers are required to report to the government, the more likely it is that a change will be made to protect horses from this sort of side effect.

  8. Mark Bradley says:

    My friends horse had to be put to sleep sfter volic caused by Nephrosplenic Entrapment.
    I accept the cause of this is not known but can Nephrosplenic Entrapment on the balance of probabilities result accidental injury ie physical inury or trauma caused by an accident

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