Colonic Torsion / Large Colon Volvulus

Colonic torsion, also known as large colon volvulus, is one of the most serious and life-threatening forms of colic in horses, characterized by rotation of the large colon on its mesenteric axis that strangulates blood supply to the intestinal wall. The equine large colon, a massive organ measuring 10 to 12 feet in length and capable of holding 80 gallons of material, is attached only at its base near the cecum, allowing significant mobility that can become catastrophic when rotation occurs. When the colon twists 180 degrees or more, blood vessels in the mesentery become occluded, cutting off both arterial supply and venous drainage. This strangulating obstruction creates a rapidly deteriorating emergency that requires immediate surgical intervention to offer any chance of survival.

Large colon volvulus accounts for approximately 10 to 15 percent of horses presenting for colic surgery and represents one of the leading causes of colic-related death in horses. This devastating condition can affect horses of any age, breed, or sex, though certain populations demonstrate elevated risk. Broodmares face particularly high susceptibility, with the postpartum period representing the highest risk time. Large-bodied horses may have conformational factors that increase vulnerability. Changes in management, diet, or activity level that affect colonic contents or motility can precipitate volvulus in predisposed individuals.

The impact of large colon volvulus on equine health is profound and frequently fatal despite aggressive treatment. When the colon twists, tissue damage begins immediately and progresses rapidly. The colonic wall becomes edematous, hemorrhagic, and devitalized within hours. Mucosal barrier function fails, allowing bacteria and endotoxins to enter the bloodstream. Systemic inflammatory response syndrome and endotoxemic shock develop quickly. Even with immediate surgical correction, extensive intestinal damage may necessitate euthanasia or result in postoperative death. The severity of this condition cannot be overstated, making rapid recognition and referral absolutely essential.

With immediate surgical intervention before extensive intestinal compromise occurs, some horses with large colon volvulus can survive and return to function. Reported survival rates vary considerably but generally range from 35 to 65 percent for horses reaching surgery, significantly lower than many other surgical colic conditions. Factors influencing survival include duration of volvulus before correction, degree of rotation, extent of intestinal compromise, and systemic status at surgery. Understanding this condition's presentation and urgency enables horse owners and primary care veterinarians to make the rapid decisions necessary to maximize any chance of survival.

The primary causes of large colon volvulus relate to the unique anatomy of the equine large colon and factors that promote abnormal movement and rotation. The horse's large colon hangs freely within the abdomen, attached only at its base where it connects to the cecum. This arrangement allows significant mobility necessary for normal digestive function but creates vulnerability to positional abnormalities and rotation. Changes in colonic weight from gas accumulation, feed accumulation, or alterations in ingesta character can shift the organ's center of gravity. Disrupted motility patterns may create the momentum necessary for rotation. Once initiated, even partial rotation tends to progress as accumulating gas further distends the colon.

While large colon volvulus does not demonstrate direct genetic predisposition, certain breed-related factors may influence susceptibility indirectly. Large-bodied breeds with spacious abdominal cavities may have more room for abnormal colonic movement. Some breed lines may possess gastrointestinal anatomical variations affecting colonic mobility or attachment. Conformational factors influencing abdominal wall tone could affect colonic support. Draft and warmblood crosses may be overrepresented in some studies, though confounding factors make definitive breed associations difficult to establish. The condition occurs across all breed types.

Environmental and management factors significantly influence large colon volvulus risk. Dietary changes that alter fermentation patterns and gas production can affect colonic buoyancy and predispose to displacement and rotation. Changes in exercise patterns, particularly sudden restrictions in activity, may affect gut motility. The periparturient period in mares creates multiple risk factors including changes in abdominal space, hormonal influences, and altered feeding patterns. Hospitalization for other conditions creates stress and management changes that may contribute. Weather changes affecting water intake and feed consumption patterns have been associated with increased colic risk including volvulus.

Risk factors for large colon volvulus encompass reproductive, management, and individual patient factors. Broodmares face dramatically elevated risk, with parturition and the early postpartum period representing the highest risk time. The sudden change in abdominal space following foaling, combined with hormonal changes and altered feeding, creates conditions favorable for colonic displacement and rotation. Large body size increases the mechanical forces involved if the colon becomes mobile. History of previous colic episodes or colonic abnormalities may indicate underlying susceptibility. Horses with recent diet changes, altered exercise patterns, or other management disruptions face elevated risk during transition periods.

The pathophysiology of large colon volvulus involves rapid progression from initial rotation through vascular occlusion to complete intestinal devitalization. When the colon begins to rotate on its mesenteric axis, blood vessels in the mesentery become progressively twisted and compressed. Initially venous return is impaired while arterial flow continues, causing intense congestion and edema in the colonic wall. As rotation progresses or increases in degree, arterial supply also becomes occluded. The colonic wall rapidly becomes ischemic, hemorrhagic, and necrotic. Mucosal integrity fails, allowing translocation of bacteria and endotoxins into the peritoneal cavity and systemic circulation. Endotoxemic shock develops within hours. Without surgical correction, complete intestinal necrosis and rupture occur, resulting in fatal peritonitis. The speed of this deterioration underlies the extreme urgency required in management.

Early warning signs of large colon volvulus may be minimal before the sudden onset of severe colic, or the condition may develop as progression from a displacement. Some horses show subtle discomfort or behavioral changes in the hours preceding acute volvulus, possibly reflecting developing colonic dysfunction. Mild colic signs from simple displacement may suddenly intensify when rotation occurs and vascular compromise develops. Horses in high-risk periods, particularly postpartum mares, should be monitored closely for any signs of abdominal discomfort. However, many cases present abruptly without recognized prodromal signs, emphasizing the importance of rapid response once severe symptoms appear.

Common symptoms of large colon volvulus include sudden onset of severe colic that rapidly becomes violent and unrelenting. Affected horses typically demonstrate marked pain that is disproportionate to other clinical findings and poorly responsive to even potent analgesic medications. Unlike mild colics where pain waxes and wanes, volvulus produces persistent, escalating distress reflecting ongoing vascular compromise and intestinal damage. Horses may throw themselves down, roll violently, and injure themselves in attempts to relieve the intense discomfort. Profuse sweating develops quickly. Anorexia is complete, with no interest in food or treats.

Behavioral changes in horses with large colon volvulus reflect the severity of pain and rapidly developing systemic illness. Extreme restlessness progresses to violent behavior including repeated throwing to the ground and dangerous rolling. Conversely, as shock develops, some horses become profoundly depressed and unresponsive. Frequent posturing as if to urinate without production indicates referred abdominal pain. Excessive lip curling, yawning, and repetitive behaviors may be observed. Mental status deterioration from the initial bright, responsive state to dull, obtunded, and eventually unresponsive accompanies cardiovascular collapse. The behavioral pattern often shifts from violent to depressed as the condition progresses.

Physical signs of large colon volvulus demonstrate the serious nature of the condition and help differentiate it from less critical problems. Heart rate elevation is typically marked, often exceeding 60 to 80 beats per minute initially and potentially reaching 100 or higher as shock develops. Mucous membranes rapidly progress from pale through congested red to toxic dark red, purple, or muddy gray coloration. Capillary refill time prolongs beyond normal and eventually becomes difficult to detect as peripheral perfusion fails. Cold extremities and muscle tremors indicate cardiovascular collapse. Gut sounds are typically absent throughout the abdomen. Progressive abdominal distension develops as gas accumulates in the strangulated colon.

Symptom progression in large colon volvulus follows a rapid downward trajectory. Pain initially intensifies despite analgesic administration, with horses showing increasingly violent behavior. Cardiovascular parameters deteriorate progressively as endotoxemia develops. Abdominal distension becomes visible and palpable. Nasogastric reflux may develop as secondary ileus affects the remainder of the gastrointestinal tract. The transition from violent pain to depression often indicates advanced cardiovascular collapse rather than improvement. Some horses show brief apparent improvement before final deterioration. The overall picture is one of rapidly progressive crisis requiring emergent intervention.

Emergency symptoms requiring immediate surgical referral include any signs suggesting strangulating obstruction. Severe unrelenting pain unresponsive to potent analgesics indicates serious pathology. Heart rate persistently above 60 beats per minute with toxic-appearing mucous membranes reflects circulatory failure. Progressive abdominal distension demonstrates ongoing gas accumulation in obstructed bowel. Sweating, cold extremities, and muscle tremors indicate shock. Complete absence of gut sounds throughout the abdomen suggests intestinal crisis. Any horse with these findings requires immediate transport to a surgical facility without delay for repeated medical treatment attempts. Minutes matter when volvulus is suspected.

Physical examination in suspected large colon volvulus must be conducted rapidly to avoid delaying life-saving surgical intervention. Vital parameter assessment reveals the characteristic pattern of strangulating obstruction with elevated heart rate often exceeding 80 beats per minute, abnormal mucous membrane color ranging from congested to toxic, prolonged capillary refill time, and often elevated respiratory rate. Auscultation typically reveals absent gut sounds in all quadrants. The degree of pain and poor response to analgesics provides crucial clinical information. The examining veterinarian must quickly determine that the presentation represents a surgical emergency requiring immediate referral rather than a condition amenable to medical management.

Diagnostic tests in large colon volvulus serve to confirm the severity of the situation and prepare for surgery rather than to delay intervention while awaiting definitive diagnosis. Rectal examination is essential and may reveal characteristic findings including tight bands of distended colon converging toward the mesenteric root, though examination can be difficult in a violent horse. Gas-distended colon may be palpable extending toward the pelvic inlet. Nasogastric intubation assesses for reflux and decompresses the stomach before anesthesia. Blood work including packed cell volume, total protein, and lactate concentration provides prognostic information about systemic status. Markedly elevated lactate levels correlate with tissue hypoxia and carry negative prognostic implications.

Advanced diagnostics are often limited by time constraints in true large colon volvulus cases, though certain modalities may provide useful information if immediately available. Transabdominal ultrasound can visualize colonic wall thickness and assess for peritoneal fluid, both of which have prognostic significance. Severely thickened colonic wall suggests prolonged ischemia and compromised viability. Large amounts of serosanguinous peritoneal fluid indicate serious intestinal compromise. Abdominocentesis provides peritoneal fluid for analysis; hemorrhagic fluid with elevated nucleated cell counts suggests intestinal devitalization. However, decisions to proceed with surgery should not await diagnostic results if clinical presentation strongly suggests strangulating obstruction.

Differential diagnosis for the acute presentation of large colon volvulus includes other surgical colic conditions causing severe unrelenting pain. Cecal torsion produces similar cardiovascular compromise and emergency presentation. Small intestinal strangulation causes comparable shock but typically with more prominent nasogastric reflux. Colonic rupture produces acute cardiovascular collapse with characteristic peritoneal fluid changes. Severe enterocolitis can cause endotoxemic shock mimicking surgical colic. The specific diagnosis often becomes clear only at surgery, but the decision to operate should be based on the emergency nature of the presentation rather than awaiting diagnostic certainty about the exact cause.

Emergency treatment for large colon volvulus begins immediately upon suspicion and continues through surgical preparation and rapid transport to a referral facility. Pain management using potent analgesics such as detomidine combined with butorphanol attempts to control violent behavior and allow initial assessment, though response is typically inadequate. Intravenous fluid therapy begins immediately using large-bore catheters, with hypertonic saline for rapid volume expansion followed by high-rate isotonic crystalloids. Nasogastric decompression prevents gastric rupture during transport. The primary veterinarian's role centers on patient stabilization and coordination of immediate transport to a surgical facility, not attempting definitive treatment on the farm.

Medical management has no role in treating large colon volvulus. This strangulating obstruction cannot resolve without surgical correction, and any delay in referral while attempting medical treatment directly reduces survival chances. Unlike simple displacements that may occasionally resolve with rolling or exercise, a rotated colon with vascular compromise will not correct spontaneously. Aggressive fluid therapy addresses shock but does not treat the underlying problem. Every minute spent on medical management attempts is a minute of progressive intestinal damage. The only appropriate response to suspected large colon volvulus is immediate referral for surgical intervention.

Surgical intervention represents the only treatment for large colon volvulus and must occur as quickly as possible to offer any chance of success. Surgery is performed through a ventral midline celiotomy under general anesthesia after rapid cardiovascular stabilization. The surgeon identifies the volvulus, decompresses the gas-distended colon through trocarization, and corrects the rotation. Assessment of colonic viability after correction determines the next steps. If the colon demonstrates return of normal color and arterial pulsation, the abdomen is lavaged and closed with intensive postoperative monitoring. When large sections of colon have become irreversibly damaged, resection with anastomosis may be attempted, though the extensive nature of the equine large colon makes this technically challenging. Cases with complete colonic devitalization are not survivable, and humane euthanasia during surgery may be necessary.

Supportive care during and after surgery addresses the severe systemic derangements accompanying large colon volvulus. Intensive intravenous fluid therapy continues throughout surgical and postoperative periods to maintain blood pressure and tissue perfusion. Plasma transfusion replaces proteins lost through damaged intestinal walls. Antibiotic therapy targeting gram-negative organisms and anaerobes combats endotoxemia. Anti-inflammatory medications including flunixin meglumine help manage endotoxin effects, though prolonged use carries risk of additional gastrointestinal complications. Lidocaine infusion may support cardiovascular function and promote gut motility recovery. Continuous monitoring for complications including laminitis, with cryotherapy application to hooves, protects against this devastating secondary problem.

Rehabilitation following successful large colon volvulus surgery requires extended time and intensive management. Horses that survive surgery face a lengthy recovery period, typically three to six months before return to any significant work. The immediate postoperative focus involves combating ongoing endotoxemia and restoring cardiovascular stability. Gut function recovery may take days to weeks, with careful attention to ileus management. Gradual reintroduction of feeding begins only after intestinal function returns. Incision care prevents surgical site complications. Laminitis prevention and monitoring continue throughout recovery. Progressive activity begins with stall rest and hand walking, advancing to turnout and eventually work only with veterinary clearance.

Treatment decision factors in large colon volvulus include the duration of clinical signs before surgery, cardiovascular status, intraoperative findings, and practical considerations. Cases reaching surgery quickly with preserved colonic viability carry better prognosis. Horses in profound shock before surgery face significant anesthetic risk. The decision to continue with resection versus euthanasia depends on the extent of intestinal compromise, the horse's overall status, and owner wishes regarding intensive postoperative care requirements. Financial commitment for treatment and recovery is substantial. Realistic discussions of guarded prognosis help owners make informed decisions.

Recovery timeline for horses surviving large colon volvulus surgery extends over months and requires intensive management. The immediate postoperative period, typically spanning several days to weeks, focuses on combating endotoxemia, maintaining cardiovascular stability, and re-establishing gastrointestinal function. Ileus commonly persists for days following surgery, requiring nasogastric decompression and prokinetic therapy. Return to enteral feeding may take a week or more. Complete recovery to normal function, if achieved, typically requires three to six months of gradual rehabilitation. Some horses never return to previous performance levels due to complications or ongoing digestive dysfunction.

Post-treatment care and monitoring following large colon volvulus surgery demands specialized intensive care facilities during the initial period. Continuous monitoring of vital parameters guides fluid therapy adjustments and identifies developing complications. Serial blood work tracks inflammatory markers, organ function, and electrolyte balance. Nasogastric intubation checks for reflux indicating persistent ileus. Abdominal ultrasound monitors for fluid accumulation and intestinal function recovery. Incision surveillance detects early signs of infection or dehiscence. Aggressive laminitis prevention includes continuous hoof cooling and regular monitoring for digital pulses and sensitivity. Nutritional support addresses the challenges of prolonged inability to receive enteral feeding.

Prognosis factors for large colon volvulus heavily influence expected outcomes. Duration of volvulus before surgical correction represents the most critical determinant, with cases corrected within hours carrying better prognosis than those with prolonged strangulation. Degree of rotation correlates with severity of vascular compromise. Extent of colonic damage at surgery directly determines viability of correction versus need for resection or euthanasia. Preoperative cardiovascular status affects anesthetic survival and recovery. Development of complications including laminitis, peritonitis, adhesions, or incisional problems worsens prognosis. Published survival rates for large colon volvulus vary but generally range from 35 to 65 percent for horses reaching surgery, significantly lower than many other surgical colic diagnoses.

Long-term soundness outlook for large colon volvulus survivors depends on the presence of complications and residual effects. Horses that recover without major complications may eventually return to athletic function, though many are used for less demanding purposes than before. Chronic digestive dysfunction may persist, requiring permanent dietary modifications. Adhesion formation following abdominal surgery can cause recurring colic episodes. Laminitis occurring as a complication frequently results in permanent lameness limiting future use. Many volvulus survivors are retired to breeding or pasture rather than returning to active competition. Survival with return to good quality of life represents a significant achievement given the severity of the initial condition.

Management practices for preventing large colon volvulus focus on reducing factors associated with abnormal colonic mobility and displacement. Maintaining consistent feeding schedules with forage-based diets supports healthy gastrointestinal function. Avoiding abrupt dietary changes that might alter fermentation patterns and gas production reduces one potential trigger. Regular exercise and turnout promote normal gut motility. Broodmares warrant particularly attentive management during the periparturient period when risk is highest. Monitoring for early colic signs allows intervention before displacement progresses to volvulus. While many cases occur without identifiable preventable factors, optimizing overall gastrointestinal health represents prudent risk reduction.

Nutritional prevention strategies support normal colonic function and reduce conditions that might predispose to volvulus. High-quality forage should form the dietary foundation, with hay or pasture comprising the majority of intake. Grain meals, if necessary, should be divided into multiple small feedings. Avoiding feeds that produce excessive gas helps prevent colonic distension that might predispose to displacement and rotation. Fresh, clean water available at all times maintains hydration and normal intestinal content consistency. Salt supplementation encourages water intake. Broodmares in late pregnancy may benefit from slightly reduced meal sizes to prevent excessive colonic fill while maintaining adequate nutrition.

Exercise and conditioning considerations help maintain gut function that may reduce volvulus risk. Regular physical activity promotes intestinal motility. Horses maintained in consistent work programs appear to have lower overall colic risk. Turnout allowing free movement provides natural exercise. When stall rest becomes necessary, hand walking maintains some gut stimulation. Broodmares in late pregnancy benefit from continued appropriate exercise rather than excessive confinement. Postpartum mares should return to regular turnout as soon as safely possible. Avoiding extended immobility helps prevent gut stasis that could predispose to displacement.

Environmental factors relevant to volvulus prevention include management during high-risk periods. Broodmares require close monitoring during late pregnancy and especially the early postpartum period, with immediate veterinary attention for any colic signs. Changes in management should be introduced gradually. Weather-related alterations in water intake or feed consumption should be anticipated and addressed proactively. Hospitalized horses benefit from vigilant monitoring and proactive gut support. Housing should allow natural movement and social interaction. Transportation stress should be minimized when possible, with attention to hydration and feed management during travel.

Special considerations for broodmares recognize their dramatically elevated risk for large colon volvulus. Late pregnant mares should be monitored closely for any colic signs. The immediate postpartum period represents the highest risk time, with studies documenting significantly elevated volvulus rates in recently foaled mares. Attending foaling when possible allows immediate recognition of postpartum complications. Mares showing any colic signs in the days following foaling warrant urgent veterinary evaluation with a high index of suspicion for volvulus. Management changes associated with foaling should be minimized when possible. Breeding operations should have emergency plans for rapid surgical referral.

Daily management for horses at elevated volvulus risk or those recovered from surgery emphasizes consistent routine and close monitoring. Feeding practices should maintain regular schedules with multiple small forage-based meals throughout the day. Water availability and intake should be monitored closely. Observation for any signs of colic must be vigilant, with owners and caretakers trained to recognize subtle early indicators. Minimizing unnecessary management changes reduces stress-related digestive disturbances. Broodmares during the periparturient period require particularly attentive daily observation. Maintaining detailed records helps identify patterns that might indicate increased individual risk.

Housing and turnout considerations for at-risk horses balance movement benefits against monitoring needs. Maximum turnout consistent with safety allows natural movement supporting gut function. Broodmares approaching foaling may benefit from housing arrangements that allow close observation while maintaining some freedom of movement. Social housing with compatible companions reduces stress when not contraindicated by safety concerns. Horses recovering from volvulus surgery require carefully controlled activity progression. Paddock and pasture surfaces should be safe and appropriate for the horse's condition and activity level.

Exercise modifications depend on the individual horse's status and history. Horses identified as being at elevated risk but without prior episodes benefit from regular, consistent exercise that maintains gut motility. Postpartum mares should resume normal turnout and activity as soon as safely possible following recovery from foaling. Post-surgical patients require extended controlled exercise with veterinary-guided progression over months. Some volvulus survivors may be appropriate only for light use permanently. Return to demanding athletic pursuits requires careful assessment and carries ongoing risk considerations.

Monitoring and ongoing care for horses with volvulus history or elevated risk requires heightened vigilance. Any sign of colic, however mild, warrants immediate veterinary evaluation given the potential for rapid deterioration. Broodmares should have attending staff aware of the high-risk postpartum period. Emergency contact information and transportation arrangements must be current and accessible. Understanding that prior volvulus or high-risk status means any colic could be serious enables appropriate rapid response. Regular veterinary examinations provide opportunities to discuss ongoing management and address concerns.

Quality of life and use considerations for volvulus survivors acknowledge both the severity of the initial condition and the potential for meaningful recovery. Many horses surviving volvulus surgery enjoy comfortable lives, though often in less demanding roles than before. Chronic digestive sensitivity may require ongoing dietary attention. Horses that developed laminitis face permanent soundness limitations. The goal of management focuses on maintaining comfort and preventing recurrence. For horses experiencing recurrent complications despite optimal management, quality of life discussions with veterinary input guide decisions about continued care. Survival from large colon volvulus represents a significant achievement, and many survivors provide years of companionship even when athletic careers end.

High-risk breeds for large colon volvulus cannot be definitively identified because this condition does not demonstrate clear breed predisposition based on available evidence. Any horse of any breed can develop large colon volvulus given appropriate predisposing circumstances. However, certain breed-related characteristics may influence population-level risk. Large-bodied breeds including warmbloods and draft crosses may have conformational factors affecting colonic mobility. Some studies suggest Thoroughbreds may be overrepresented, though confounding factors including management and use make interpretation difficult. Arabian horses with different body conformations might have varying anatomical risk factors. The most significant risk factor, broodmare status during the periparturient period, crosses all breed boundaries.

Use and discipline considerations affect large colon volvulus risk primarily through associated management and reproductive factors. Broodmares face dramatically elevated risk, making breeding operations particularly relevant populations regardless of breed involved. Performance horses undergoing intensive management with dietary fluctuations and travel stress may face somewhat elevated risk. Horses recovering from general anesthesia for any reason warrant monitoring for post-anesthetic colic including volvulus. No specific discipline appears uniquely associated with volvulus risk when reproductive status and management factors are controlled. The overwhelming risk factor of broodmare status during and after foaling transcends all breed and discipline categories.

Genetic testing and breeding recommendations are not applicable to large colon volvulus as this condition lacks hereditary basis. However, breeders should be acutely aware of the elevated risk broodmares face during late pregnancy and the postpartum period. Emergency planning for rapid surgical referral should be part of every breeding operation. Mares with history of volvulus or severe colic complications may warrant particularly careful monitoring during subsequent pregnancies, though data on recurrence risk in previously affected mares is limited. Selection for overall robust constitution may indirectly support gastrointestinal health. Management practices during the breeding cycle remain far more important than genetic factors in volvulus risk.

Commonly co-occurring conditions with large colon volvulus reflect both predisposing factors and the severe systemic consequences of this condition. Colonic displacement frequently precedes volvulus, with simple positional abnormality progressing to rotation. Endotoxemia develops rapidly and universally once vascular compromise occurs, triggering systemic inflammatory response. Laminitis represents a devastating complication occurring in many volvulus cases, caused by endotoxin-mediated damage to hoof laminar tissues. Cardiovascular shock with multiple organ dysfunction develops as the condition progresses. Post-operative complications including peritonitis, adhesions, and incisional problems affect many surgical survivors. Protein-losing enteropathy results from severe intestinal damage.

Conditions with similar symptoms requiring differentiation from large colon volvulus include other causes of acute severe colic. Cecal torsion produces comparable cardiovascular compromise and emergency presentation. Small intestinal strangulation from various causes presents with more prominent nasogastric reflux but similar shock. Gastric rupture or intestinal rupture causes acute cardiovascular collapse. Severe colitis can produce endotoxemic shock mimicking surgical colic. Uterine rupture or torsion in periparturient mares presents with abdominal pain requiring differentiation. The specific diagnosis often becomes clear only at surgical exploration, emphasizing that decisions to operate should be based on emergency presentation rather than precise pre-surgical diagnosis.

Potential complications of large colon volvulus are numerous and often life-threatening. Intestinal rupture before or during surgery results in fatal peritonitis. Cardiovascular collapse during anesthesia induction reflects the severity of preoperative shock. Inability to restore viable colon at surgery necessitates euthanasia in many cases. Anastomotic failure following large colon resection causes fatal peritonitis. Post-operative ileus may persist for extended periods. Incisional complications including infection, dehiscence, and hernia formation occur commonly. Laminitis affects many survivors and may cause permanent lameness. Adhesion formation can cause chronic or recurrent colic. The high complication rate underscores the extremely serious nature of large colon volvulus.