When Valerie Frederick’s 20-year-old Friesian stallion, Hannibal, began showing signs of serious digestive issues, her primary care veterinarian referred him to the University of Florida Large Animal Hospital for specialty care. After the initial consultation, Hannibal was diagnosed with a rare form of colic that had caused severe chronic gastric dilation. Although generally colic is a condition that is easy to treat, Hannibal’s case proved resistant to treatment or medical management, prompting Dr. Todd Holbrook, a Board-Certified Large Animal Internal Medicine specialist at the University of Florida to recommend surgical intervention. Dr. Holbrook's collaboration with Dr. David Freeman, a renowned equine surgeon at the University of Florida, was pivotal to Hannibal’s case. On the advice of Dr. Holbrook and his team, Dr. Freeman performed a four-hour-long procedure that he had developed specifically for challenging colic cases, successfully removing the impaction from Hannibal’s stomach.
Following the surgery, Hannibal required several days of post-operative care, including intravenous nutritional support and a gradual reintroduction of feed. Because of his condition, Hannibal will have continued dietary restrictions and will be fed a pelleted ration through a slow feeder, with no hay or grazing to prevent any impaction from reoccurring.
Both Dr. Holbrook and Dr. Freeman played a crucial role in Hannibal's treatment, underscoring the importance of collaboration and specialized care in managing complex conditions.
Dr. Freeman: Surgical access to the stomach is always a challenge but especially so in such a large horse with a heavy impacted stomach and with adhesions to that stomach that further restricted access. The other major challenge is recurrence of the gastric impaction, which is why the recommended diet is low in forage and high in low fiber components. It is also fed soaked in water to soften and hasten gastric emptying. Client education on dietary management was handled well by Dr. Holbrook.
Dr. Holbrook: Recurrence of the gastric impaction after surgery was a big concern. He returned frequently for repeat gastroscopy associated with a variety of feed changes. Another one of our internists worked with an equine nutritionist/internist at Cornell to design a low bulk, calorie-dense diet that coupled with a slow-release pellet feeder has not resulted in the recurrence of his gastric impaction.
Dr. Freeman: Dr. Holbrook was responsible for the diagnostic procedures, medical and supportive treatment, and aftercare, including long-term follow-up assessment and care. My contribution was to support his role and do the surgery in the manner that we both thought would produce the best result.
Dr. Holbrook: After consulting with Dr. Freeman, Hannibal underwent abdominal surgery to remove most of his stomach contents. We continued to rinse his stomach for an additional 48 hours until it was completely empty. A follow-up gastroscopy showed severe grade 4 gastric ulcers, which gradually improved with medical treatment.
Dr. Freeman: I think one of the main factors is the owner’s willingness to approve the surgery and commitment to the aftercare. Teamwork between two services, medicine and surgery, was crucial as both provided expertise in their areas that led to a favorable outcome.
Dr. Holbrook: Firstly, the dedication of his owner was certainly pivotal in his outcome. From my perspective, I believe the most critical factor in his successful treatment was the collaborative effort of our hospital team in his overall care.
The success of Hannibal's case highlights the critical role of collaboration between the animal owner, primary care veterinarian, and a veterinary specialist known as the Triad of Care. Thanks to their expertise and collaborative efforts, Dr. Holbrook and Dr. Freeman provided Hannibal with exceptional care from diagnosis through post-operative recovery.
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