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Ingesta-associated choledocholithiasis in horses: 2 cases and literature review.
Abstract: Equine ingesta-associated choledocholithiasis is a rare cause of morbidity and mortality. We describe here the clinical, gross, histologic, and microbiologic features of this condition in 2 horses and compare the features to 2 previous cases. Case 1 was a 4-y-old Thoroughbred mare with colic. Case 2 was an 18-y-old American Paint Horse mare with colic, chronic weight loss, and inappropriate mentation. Both had elevated biochemical markers of hepatocellular injury and cholestasis and were euthanized given a poor prognosis. Case 1 had a well-formed 5-cm choledocholith surrounding a piece of hay, and had chronic neutrophilic cholangiohepatitis, bridging fibrosis, and extrahepatic obstruction. Case 2 had an ill-formed choledocholith with occasional hay fragments, wood stick, and twigs, and had regionally extensive hepatocellular necrosis with mild neutrophilic cholangiohepatitis and bridging fibrosis. Enterococcus casseliflavus and Escherichia coli were isolated in both cases; Clostridium spp. were also isolated from case 2. All 4 reported cases had increased activity of cholestatic enzymes, hyperbilirubinemia, portal inflammation, and bridging fibrosis. Colic, pyrexia, leukocytosis with neutrophilia, and elevated hepatocellular enzyme activity were documented in 3 cases. Foreign material in all 4 cases was plant origin (choledochophytolithiasis), including hay (n = 2), sticks/twigs (n = 2), and grass awns (n = 1). Ingesta-associated choledocholithiasis may be considered as a cause of colic, pyrexia, and elevated cholestatic biomarkers in horses.
Publication Date: 2023-05-26 PubMed ID: 37232550PubMed Central: PMC10331394DOI: 10.1177/10406387231177251Google Scholar: Lookup The Equine Research Bank provides access to a large database of publicly available scientific literature. Inclusion in the Research Bank does not imply endorsement of study methods or findings by Mad Barn.
- Review
- Case Reports
- Journal Article
- Biochemistry
- Biomarkers
- Case Reports
- Clinical Examination
- Clinical Pathology
- Clinical Study
- Clinical Symptoms
- Colic
- Comparative Study
- Diagnosis
- Disease Diagnosis
- Disease Etiology
- Disease Treatment
- Enzymes
- Equine Diseases
- Equine Health
- Euthanasia
- Histopathology
- Horses
- Infection
- Inflammation
- Liver Function
- Microbiology
- Mortality
- Necropsy
- Pyrexia
- Review
- Veterinary Medicine
- Veterinary Research
Summary
This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.
The research article discusses a rare disease in horses known as “ingesta-associated choledocholithiasis”, providing details on two observed cases and comparing them to previous ones. This disease, indicated by the formation of a stone-like object in the bile ducts due to ingestion of foreign materials, can lead to severe symptoms in horses, often with poor prognosis.
Research Cases Details
- Case 1: This involved a 4-year-old Thoroughbred mare presenting with colic symptoms. Upon evaluating, the veterinarians found a 5-cm choledocholith (bile duct stone) enveloping a piece of hay. The horse demonstrated elevated biomarkers for liver cell damage and bile duct obstruction, and suffered from neutrophilic cholangiohepatitis, an inflammation of the liver and bile ducts, and bridging fibrosis, a form of advanced liver scarring.
- Case 2: This case involved an 18-year-old American Paint Horse mare also showing colic signs, along with long-term weight loss and abnormal mental behavior. The horse had an irregularly formed choledocholith containing fragments of hay, a wooden stick, and twigs. Like the first case, this horse also had heightened biochemical markers of hepatocellular injury and cholestasis, and was found to have extensive hepatocellular necrosis, a form of liver damage, with mild neutrophilic cholangiohepatitis and bridging fibrosis.
Microbiological Findings and Comparisons
Bacterial cultures of both cases indicated the presence of certain bacterial species known to cause infections in the bile duct. Furthermore, both cases were compared with two other cases outlined in literature previously. The resultant similarities included:
- Increased activity of cholestatic enzymes and high bilirubin levels, indicating a bile flow obstruction from the liver.
- Portal inflammation and bridging fibrosis, suggesting severe liver tissue damage.
- Colic symptoms, fever, leukocytosis with neutrophilia, or the increase in white blood cells especially neutrophils, and elevated hepatocellular enzyme activity, observed in three out of four cases.
- Foreign material found in all instances was of plant origin, suggesting ingestion of these materials led to the formation of bile duct stones.
Conclusion
The researchers suggest that ingesta-associated choledocholithiasis should be recognized among the potential causes of colic, fever, and heightened cholestatic biomarkers in horses, despite its rarity. The condition carries with it a notable risk of severe morbidity and mortality due to serious damage to the liver and bile ducts. The foreign plant material ingestion seems to be a key factor in stone formation, thus, monitoring and managing the horse’s diet can play a crucial role in the prevention of this disease.
Cite This Article
APA
Linn-Peirano SC, Hepworth-Warren K, Kinsella H, Diaz-Campos D, Brenseke BM, Cianciolo RE, Schroeder E, Schreeg ME.
(2023).
Ingesta-associated choledocholithiasis in horses: 2 cases and literature review.
J Vet Diagn Invest, 35(4), 417-424.
https://doi.org/10.1177/10406387231177251 Publication
Researcher Affiliations
- College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA.
- College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA.
- College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA.
- College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA.
- College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA.
- Jerry M. Wallace School of Osteopathic Medicine, Campbell University, Buies Creek, NC, USA.
- College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA.
- Zoetis, Parsippany, NJ, USA.
- College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA.
- College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA.
- College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA.
MeSH Terms
- Horses
- Animals
- Female
- Choledocholithiasis / veterinary
- Choledocholithiasis / complications
- Colic / complications
- Colic / veterinary
- Cholangitis / veterinary
- Fibrosis
- Fever / complications
- Fever / veterinary
- Horse Diseases / pathology
Conflict of Interest Statement
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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Citations
This article has been cited 1 times.- Baradaran-Seyed Z, Eslampanah M. Concurrent multi-systemic eosinophilic epitheliotropic disease and choledocholithiasis in a 15-year-old mixed-breed mare. Vet Res Forum 2025;16(5):305-308.
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