Large Colon: Left Dorsal Displacement
BASIC INFORMATION  of moderate pain, but severe pain may
DEFINITION
• Displacement or entrapment of the
large colon within the nephrosplenic
space (between the spleen and the left
kidney)
• Some clinicians include displacement
of the large colon lateral to the spleen.
SYNONYM(S)
Nephrosplenic entrapment, renosplenic
entrapment
EPIDEMIOLOGY
SPECIES, AGE, SEX
• No age predisposition has been
reported, and left dorsal displacement
of the large colon (LDDLC) has been
reported in horses of all ages, includ-
ing weanlings.
• Some studies have reported that geld-
ings are predisposed, but other studies
have reported no sex predisposition.
GENETICS AND BREED PREDISPOSI-
TION  Clinical experience suggests that
larger breed horses are predisposed.
There have been no reported cases of
LDDLC in ponies or Miniature Horses.
RISK FACTORS  A deep nephrosplenic
space may predispose horses to LDDLC.
CLINICAL PRESENTATION
HISTORY, CHIEF COMPLAINT
• Clinical signs of LDDLC are variable
depending on the tension on the
nephrosplenic ligament, pull on the
mesentery, distension of the large
colon, and secondary gastric disten-
sion. Most affected horses show signs
occur. Some horses may have chronic
displacement with little gas distension
and little to no signs of discomfort.
• Horses frequently have decreased to
absent fecal production and may have
abdominal distension. In some horses,
the visible distension is confined to
the area of the left paralumbar fossa.
PHYSICAL EXAM FINDINGS
• Because LDDLC is generally a non-
strangulating obstruction, affected
horses are cardiovascularly stable.
• Physical examination findings may
include tachycardia, abdominal disten-
sion, decreased or absent borborygmi,
and signs of dehydration.
• As distension becomes more severe,
compromise to the cardiovascular
system and respiratory system are pos-
sible. With chronicity or severe disten-
sion, ischemia of the entrapped region
of the left colons may occur, and clin-
ical signs and physical examination
will reflect the associated cardiovascu-
lar compromise.
ETIOLOGY AND PATHOPHYSIOLOGY
• It is likely that changes in motility or
gas distension of the large colon result
in abnormal migration of the pelvic
flexure.
• The left large colon may migrate
lateral to the spleen and dorsally until
it reaches the nephrosplenic space or
the pelvic flexure may migrate crani-
ally and then back caudally to pass
through the nephrosplenic space from
cranial to caudal.
• Frequently, the left colon rotates 180
degrees such that the left dorsal colon
is ventral to the left ventral colon.
DIAGNOSIS 
DIFFERENTIAL DIAGNOSIS
• Other causes of moderate abdominal
pain: Simple or nonstrangulating
obstructions of the gastrointestinal
tract such as feed or sand impaction,
enterolithiasis, large colon tympany,
other large colon displacements, large
intestinal intraluminal obstructions,
small colon impactions, and ileal
impactions
• Other causes of large intestinal disten-
sion on examination per rectum: Feed
or sand impaction, enterolithiasis,
large colon tympany, other large colon
displacements, large colon volvulus,
and other intraluminal obstructions
INITIAL DATABASE
• Typical findings on examination per
rectum are distended large colon
caudal to the nephrosplenic space and
compressed within the nephrosplenic
space.
• Other findings may include gas disten-
sion (sometimes marked) of the cecum
and ventromedial displacement of the
spleen. Palpation of the nephrosplenic
space may be difficult, especially with
severe distension of the large colon
and in large-breed horses. It is impor-
tant to remember that with severe dis-
tension of the large colon from any
cause (eg, impaction, enterolithiais,
tympany), the bands of the large colon
may course toward the nephrosplenic
space and mimic LDDLC.
• Nasogastric reflux is present in up to
43% of horses with LDDLC. This may
330 Large Colon: Left Dorsal Displacement

FIGURE 1  Diagram showing left dorsal displacement of the colon (caudal view). (From The Equine Colic CD 2007. The Glass Horse Project
LLC and University of Georgia Research Foundation Inc. Used with permission.)

FIGURE 2  Diagram showing left dorsal displacement of the colon (left lateral view). (From The Equine Colic CD 2007. The Glass Horse
Project LLC and University of Georgia Research Foundation Inc. Used with permission.)
Large Colon: Left Dorsal Displacement Large Colon: Nonstrangulating Infarction 331
be caused by pressure on the duode-
num or tension on the mesentery asso-
ciated with LDDLC.
• Blood work is frequently normal.
Some clinicians believe that a rela-
tively low PCV in the face of dehydra-
tion indicates sequestration of red
blood cells within the spleen associ-
ated with LDDLC.
• Abdominocentesis may result in
splenic blood (packed cell volume >
peripheral blood) in up to 25% of
horses with LDDLC.
• Ultrasonography (percutaneous): In
horses with LDDLC, gas within the
large colon will obscure the caudodor-
sal aspect of the spleen. The ability to
image the kidney adjacent to the
spleen does not appear as accurate as
gas obscuring the caudodorsal aspect
of the spleen. In some cases of LDDLC,
it is possible to obtain an image of the
kidney adjacent to the spleen, and in
many cases of other sources of colic,
it is not possible to obtain the same
image.
• If ischemic damage has occurred,
blood work and abdominal fluid may
be altered.
TREATMENT  • Recurrence rates ranging from 3% to
THERAPEUTIC GOAL(S)
• Correction of the displacement
• Supportive care
ACUTE GENERAL TREATMENT
• If pain and distension are not severe,
medical management is frequently
attempted, and good success rates
have been reported. The two main
methods for medical management are
administration of phenylephrine and
rolling the horse under general anes-
thesia.
○ The administration of phenyleph-
rine at 3 to 6 µg/kg/min for 15
minutes results in splenic contrac-
tion and a dramatic decrease in the
size of the spleen. During adminis-
tration, horses should be monitored
for reflex bradycardia, and adminis-
tration should be discontinued
if bradycardia becomes severe.
Horses are given phenylephrine
and walked, jogged, or lunged to
encourage the colon to come out of
the nephrosplenic space.
○ Horses can be rolled under general
anesthesia. They should be anesthe-
tized, placed in right lateral recum-
bency, and rolled over their back
into left lateral recumbency. While
in dorsal recumbency, horses can
be jostled to encourage the colon
to come out of the nephrosplenic
space. The administration of phen-
ylephrine and manipulation per
rectum in conjunction with rolling
has also been described.
• Surgical exploration is recommended
for horses that present with severe
pain or that are unresponsive to
attempts at medical management. Sur-
gical exploration may also be recom-
mended in horses with severe gas
distension because of the potential for
increased complications associated
with medical management.
POSSIBLE COMPLICATIONS
21% have been reported.
• Reported complications of medical
management have included rupture
and displacement or volvulus of the
large colon.
RECOMMENDED MONITORING
If medical treatment is pursued, horses
should be monitored for signs of unre-
lenting pain, nasogastric reflux, progres-
sive abdominal distension, and systemic
deterioration (climbing heart rate, cardio-
vascular compromise).
PROGNOSIS AND
OUTCOME  EDITORS: TIM MAIR and CERI SHERLOCK
Prognosis is good to excellent.
PEARLS &
CONSIDERATIONS 
COMMENTS
• Diagnosis of LDDLC is based on
examination per rectum and ultra­
sonography.
• Medical management of horses with
LDDLC can be very successful.
• Multiple methods of surgical preven-
tion of recurrence are available.
PREVENTION
• In cases of recurrent LDDLC, surgical
prevention of recurrence may be
recommended.
• Multiple methods of laparoscopic and
hand-assisted laparoscopic closure of
the nephrosplenic space have been
reported. Complications appear rare.
• Other methods of surgical prevention
include closure of the nephrosplenic
space via a rib resection, colopexy,
and large colon resection. However,
these procedures are not preferred
because of an increased frequency
and severity of complications associ-
ated with these procedures and longer
lay-up time after surgery.
SUGGESTED READING
Johnston JK, Freeman DE: Diseases and
surgery of the large colon. Vet Clin North
Am Equine Pract 13(2):317, 1997.
Rakestraw PC, Hardy J: Large intestine. In
Auer JA, Stick JA (eds). Equine surgery, ed
3, St Louis, 2006, Saunders Elsevier, pp
436–478.
Rocken M, Schubert C, Mosel G, et al: Indica-
tions, surgical technique, and long-term
experience with laparoscopic closure of the
nephrosplenic space in standing horses. Vet
Surg 34:637, 2005.
Sullins KE: Diseases of the large colon. In
Colohan PT, Merritt AM, Moore JN, et al
(eds). Equine medicine and surgery, St
Louis, 1999, Mosby, pp 741–768.
AUTHOR: KIRA L. EPSTEIN