FREE SHIPPING over $40
OVER 9000 FIVE-STAR REVIEWS
5% OFF ALL SUBSCRIPTIONS
100% HAPPINESS GUARANTEE
Analyze Diet
0
Home / Equine Research Bank / Equine Vet J / Risk factors for equine strangulating lipoma colic: An inter...
Equine veterinary journal2025; doi: 10.1111/evj.70104

Risk factors for equine strangulating lipoma colic: An international, case-control study.

Abstract: Obstruction by strangulating lipoma (SLO) is one of the most common causes of small intestinal strangulation in horses and is fatal without surgery. Current knowledge of risk factors for SLO is limited to horse signalment features. To date, other risk factors have not been investigated. Objective: To investigate horse- and management-level risk factors for SLO using a population of healthy horses as controls. Methods: Matched, case-control study. Methods: A prospective, international multicentre study was conducted in the UK and USA between January 2022 and May 2024. Cases were horses with SLO confirmed at exploratory laparotomy at the four participating hospitals. Three controls per case were randomly selected, matched on clinic and time. Conditional logistic regression was used to identify associations between variables and the risk of SLO. Results: Data from 55 SLO cases (UK, n = 42; USA, n = 13) and 167 matched controls were analysed. In a final multivariable model, increased age (odds ratio [OR]: 1.15; 95% confidence intervals [95% CI]: 1.04-1.28; p = 0.008) and particular breeds (Pony, Welsh Section D/Cob, American Quarter Horse/American Paint Horse/Appaloosa/Arabian) were at increased risk of SLO (OR: 1.53; 95% CI: 1.10-2.15; p = 0.012). SLO was more likely in horses with a prior history of laminitis (OR: 10.94; 95% CI: 2.21-54.13; p = 0.003) or increased stabling in the previous 4 weeks (OR: 6.79; 95% CI: 1.96-23.54; p = 0.003). Management strategies to maintain optimal weight and address equine metabolic syndrome were protective (OR: 0.19, 95% CI: 0.39-0.94; p = 0.041). Conclusions: Potential for selection and recall bias by horse owners. Conclusions: This study adds to knowledge of the epidemiology of SLO and has identified new risk factors which may be modifiable. Strategies to prevent endocrine-associated laminitis, including weight management in high-risk groups, should be considered to minimise SLO risk.
© 2025 The Author(s). Equine Veterinary Journal published by John Wiley & Sons Ltd on behalf of EVJ Ltd.
Get Full Text
Publication Date: 2025-10-08 PubMed ID: 41062921DOI: 10.1111/evj.70104Google 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.
LinkedInCopy
  • Journal Article

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.

Risk factors including age, breed, history of laminitis, and recent stabling conditions influence the likelihood of horses developing strangulating lipoma colic (SLO), a serious intestinal obstruction. Management practices that address weight and equine metabolic syndrome may reduce this risk.

Study Background and Objective

  • Strangulating lipoma obstruction (SLO) is a leading cause of intestinal strangulation in horses and requires surgical intervention for survival.
  • Prior research mainly focused on basic horse characteristics (signalment) without investigating other potential risk factors.
  • The goal of this study was to identify both horse-related and management-related risk factors for SLO by comparing affected horses with healthy controls.

Study Design and Methodology

  • The research was a prospective, international multicentre matched case-control study conducted between January 2022 and May 2024.
  • Cases: 55 horses diagnosed with SLO confirmed during exploratory surgery, recruited from four hospitals in the UK and USA.
  • Controls: 167 healthy horses matched by clinic location and time, selected randomly at a ratio of three controls per case.
  • Data Collection: Information was gathered about horse demographics, history (such as prior laminitis), stabling, and management practices.
  • Statistical Analysis: Conditional logistic regression was used to identify variables associated with increased or decreased risk of developing SLO.

Key Findings

  • Age: Older horses had a higher risk, with a 15% increase in odds of SLO per year of age.
  • Breed Risk: Certain breeds including Ponies, Welsh Section D/Cob, American Quarter Horse, American Paint Horse, Appaloosa, and Arabian showed significantly increased risk (53% higher odds).
  • History of Laminitis: Horses with prior laminitis had markedly higher SLO risk, approximately 11 times greater odds.
  • Recent Stabling: Increased time spent stabled in the preceding four weeks was associated with nearly 7-fold greater risk of SLO.
  • Protective Factors: Management approaches focused on maintaining optimal weight and controlling equine metabolic syndrome reduced SLO risk by about 81%.

Interpretation and Implications

  • The study advances understanding by identifying modifiable management factors beyond inherent horse characteristics.
  • The strong association with laminitis and stabling suggests endocrine health and exercise/movement may contribute to SLO development.
  • Weight management and preventive strategies against endocrine-linked laminitis could lower SLO occurrence, especially in high-risk breeds and older horses.
  • Clinicians and owners should consider these risk factors when developing preventive care plans.
  • There is recognition of potential biases such as selection and recall bias in owner-reported data, which could influence results.

Limitations and Recommendations for Future Research

  • Potential biases from owner recall and case selection may affect the generalizability of findings.
  • Further studies could explore causal mechanisms linking endocrine disease, stabling, and SLO.
  • Investigations into how modifications in management practices can effectively reduce SLO incidence are warranted.
  • More diverse geographical and larger sample studies could enhance understanding across different equine populations.

Conclusions

  • This study identifies older age, specific breeds, laminitis history, and recent increased stabling as risk factors for strangulating lipoma colic in horses.
  • Management targeting weight control and metabolic health shows promise in reducing SLO risk.
  • Preventative approaches tailored to high-risk horses should be considered to improve equine health outcomes.

Cite This Article

APA
Gillen A, Hassel D, Gonzalez S, Savage V, Bauck A, Freeman D, Archer DC. (2025). Risk factors for equine strangulating lipoma colic: An international, case-control study. Equine Vet J. https://doi.org/10.1111/evj.70104

Publication

Equine veterinary journal
ISSN: 2042-3306
NlmUniqueID: 0173320
Country: United States
Language: English

Researcher Affiliations

Gillen, Alexandra
  • Philip Leverhulme Equine Hospital, University of Liverpool, Cheshire, UK.
Hassel, Diana
  • Colorado State University Veterinary Teaching Hospital, Colorado State University, Fort Collins, Colorado, USA.
Gonzalez, Sam
  • Colorado State University Veterinary Teaching Hospital, Colorado State University, Fort Collins, Colorado, USA.
Savage, Victoria
  • Three Counties Equine Hospital, Gloucestershire, UK.
Bauck, Anje
  • College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA.
Freeman, David
  • College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA.
Archer, Debra C
  • Philip Leverhulme Equine Hospital, University of Liverpool, Cheshire, UK.

Grant Funding

  • Arden and Claudia Sims Lipoma Foundation

References

This article includes 50 references
  1. Archer DC, Cullen M, Ireland JL, Mair TS, the INCISE collaboration. The international colic surgery audit (INCISE‐2): patient and operative features and benchmarks.. Equine Vet Educ 2022;36(13):35.
  2. Mair TS, Smith LJ. Survival and complication rates in 300 horses undergoing surgical treatment of colic. Part 1: short‐term survival following a single laparotomy.. Equine Vet J 2005;37(4):296–302.
  3. Blikslager AT, Bowman KF, Haven ML, Tate LP, Bristol DG. Pedunculated lipomas as a cause of intestinal obstruction in horses: 17 cases (1983–1990).. J Am Vet Med Assoc 1992;201(8):1249–1252.
  4. Edwards GB, Proudman CJ. An analysis of 75 cases of intestinal obstruction caused by pedunculated lipomas.. Equine Vet J 1994;26(1):18–21.
  5. Abutarbush SM, Carmalt JL, Shoemaker RW. Causes of gastrointestinal colic in horses in western Canada: 604 cases (1992 to 2002).. Can Vet J 2005;46(9):800–805.
  6. Proudman CJ, Edwards GB, Barnes J. Factors affecting long‐term survival of horses recovering from surgery of the small intestine.. Equine Vet J 2005;37:360–365.
  7. Garcia‐Seco E, Wilson DA, Kramer J, Keegan KG, Branson KR, Johnson PJ. Prevalence and risk factors associated with outcome of surgical removal of pedunculated lipomas in horses: 102 cases (1987‐2002).. J Am Vet Med Assoc 2005;226(9):1529–1537.
  8. Freeman DE, Schaeffer DJ. Age distributions of horses with strangulation of the small intestine by a lipoma or in the epiploic foramen: 46 cases (1994‐2000).. J Am Vet Med Assoc 2001;219(1):87–89.
  9. Edwards J. Mechanism of intestinal strangulation by equine lipoma.. J Comp Pathol 2010;143(4):334.
  10. Archer DC, Proudman CJ. Epidemiological clues to preventing colic.. Vet J 2006;172(1):29–39.
  11. Gillen A, Archer D. Epidemiology of colic: current knowledge and future directions.. Vet Clin North Am Equine Pract 2023;39:157–174.
  12. Newkirk K, Chameroy K, Em T. Pituitary lesions, obesity, and mesenteric lipomas in insulin‐resistant horses.. Open J Vet Med 2014;4(9):190–196.
  13. Carslake HB, Pinchbeck GL, McGowan CM. Equine metabolic syndrome in UK native ponies and cobs is highly prevalent with modifiable risk factors.. Equine Vet J 2021;53:923–934.
  14. Muno JGL, Geor R. Prevalence and risk factors for hyperinsulinaemia in clinically normal horses in central ohio.. J Vet Intern Med 2009;23(4):101–106.
  15. Pleasant RS, Suagee JK, Thatcher CD, Elvinger F, Geor RJ. Adiposity, plasma insulin, leptin, lipids, and oxidative stress in mature light breed horses.. J Vet Intern Med 2013;27:576–582.
  16. Dohoo IMW, Stryhn H. Veterinary epidemiologic research. Prince Edward Island: AVC Inc; 2003. p. 706.
  17. Schlesselman JJ. Case control studies. Oxford: Oxfod University Press; 1982.
  18. Clayton D. Statistical models in epidemiology. Oxford: Oxford University Press; 1993. p. 178–183.
  19. Archer DC, Pinchbeck GL, French NP. Risk factors for epiploic foramen entrapment colic in a UK horse population: a prospective case‐control study. Equine Vet J 2008;40(4):405–410.
  20. Suthers JM, Pinchbeck GL, Proudman CJ, Archer DC. Risk factors for large colon volvulus in the UK. Equine Vet J 2013;45:558–563.
  21. Jadhav A, Pramod D, Ramanathan K. Comparison of performance of data imputation methods for numeric dataset. Applied Articifial Intelligence 2019;33:913–933.
  22. Kleinbaum DG, Kupper LL, Muller KE. Applied regression analysis and other multivariable methods. 2nd ed. Surrey: PWS‐KENT Publishing Company; 1988.
  23. Cureton E. Rank‐biserial correlation. Psychometrika 1956;21:287–290.
  24. Richard M. Efficiency testing of prediction markets: martingale approach, likelihood ratio and Bayes factor analysis. Risk 2021;9:31.
  25. Tinker MK, White NA, Lessard P. Prospective study of equine colic risk factors. Equine Vet J 1997;29(6):454–458.
  26. Cohen ND, Peloso JG. Risk factors for history of previous colic and for chronic, intermittent colic in a population of horses. J Am Vet Med Assoc 1996;208:697–703.
  27. Scantlebury CE, Archer DC, Proudman CJ, Pinchbeck GL. Management and horse‐level risk factors for recurrent colic in the UK general equine practice population. Equine Vet J 2015;47(2):202–206.
  28. de Laat MA, Reiche DB, Sillence MN, McGree JM. Incidence and risk factors for recurrence of endocrinopathic laminitis in horses. J Vet Intern Med 2019;33:1473–1482.
  29. de Laat MA, Sillence MN, Reiche DB. Phenotypic, hormonal, and clinical characteristics of equine endocrinopathic laminitis. J Vet Intern Med 2019;33:1456–1463.
  30. Frank N. Equine metabolic syndrome. Vet Clin North Am Equine Pract 2011;27:73–92.
  31. Frank N. Endocrine disorders and laminitis. Equine Vet Educ 2013;25:152–162.
  32. Andersen CJ, Fernandez ML. Dietary strategies to reduce metabolic syndrome. Rev Endocr Metab Disord 2013;14:241–254.
  33. Gillen A, Hassel D, Gonzalez S, Mudge D, Savage V, Wood AD. Epidemiological investigation of strangulating lipoma obstruction and abdominal lipomata in horses requiring laparotomy: a prospective international study. Equine Vet J 2025.
  34. Gillen A, Archer D, Ireland J, Rocchigiani G. Characterising equine abdominal lipomata: can histological features improve the understanding of pathogenesis and risk?. Equine Vet J 2025.
    doi: 10.1111/evj.14483google scholar: lookup
  35. Superchi P, Beretti V, Sabbioni A. Relationship among BCS and fat thickness in horses of different breed, gender and age. Annu Res Rev Biol 2013;4:354–365.
  36. Dart AJ, Snyder JR, Pascoe JR, Farver TB, Galuppo LD. Abnormal conditions of the equine descending (small) colon: 102 cases (1979‐1989). J Am Vet Med Assoc 1992;200:971–978.
  37. Selim SEK, Jaakkola S, Selim S, Elo K, Karikoski N, Boston R. Relationships among body condition, insulin resistance and subcutaneous adipose tissue gene expression during the grazing season in mares. PLoS One 2015;10(5):e0125968.
  38. Polzer J, Slater MR. Age, breed, sex and seasonality as risk factors for equine laminitis. Prev Vet Med 1997;29:179–184.
  39. Farkas N, Wong J, Bethel J, Monib S, Frampton A, Thomson S. A systematic review of symptomatic small bowel lipomas of the jejunum and ileum. Ann Med Surg 2020;58:52–67.
  40. Vrshni Menaka R, Siva Nathan MMR. A large mesenteric lipoma: an uncommon etiology of small bowel obstruction. Malays J Med Health Sci 2020;16:319–321.
  41. Gandini M, Freeman DE, Giusto G. Hypothesis on the pathophysiology of small intestinal strangulation by a pedunculated lipoma. Equine Vet Educ 2021;34(4):207–214.
  42. Cohen N. Epidemiology of colic. Equine acute abdomen; New Jersey: John Wiley and Sons Inc.; 2014.
  43. Cohen ND. Epidemiology of colic. Vet Clin North Am Equine Pract 1997;13(2):191–201.
  44. Cohen ND. Epidemiology of colic. The equine acute abdomen; New Jersey: John Wiley and Sons Inc..; 2017.
  45. Cohen ND. The John Hickman memorial lecture: colic by numbers. Equine Vet J 2003;35:343–349.
  46. Hudson JM, Cohen ND, Gibbs PG, Thompson JA. Feeding practices associated with colic in horses. J Am Vet Med Assoc 2001;219:1419–1425.
  47. McCarthy HE, French NP, Edwards GB, Poxton IR, Kelly DF, Payne‐Johnson CE. Equine grass sickness is associated with low antibody levels to Clostridium botulinum: a matched case‐control study. Equine Vet J 2004;36:123–129.
  48. Pearce N. Analysis of matched case‐control studies. BMJ 2016;352:i969.
  49. Choi BC, Pak AW. A catalog of biases in questionnaires. Prev Chronic Dis 2005;2(1):A13.
  50. Schmier JK, Halpern MT. Patient recall and recall bias of health state and health status. Expert Rev Pharmacoecon Outcomes Res 2004;4:159–163.

Citations

This article has been cited 1 times.
  1. Nocera I, Cingottini D, Di Franco C, Sala G, Bindi F, Spadari A, Rinnovati R, Vitale V, Jose-Cunilleras E, Sgorbini M. In-Depth Analysis of the Prognostic Factors Associated with Short-Term Outcome in Equine Colic Patients: Multicentric Retrospective Study. Animals (Basel) 2026 Feb 5;16(3).
    doi: 10.3390/ani16030496pubmed: 41681477google scholar: lookup
Subscribe to our newsletter
Join 99,002 horse owners like you who receive our email updates on horse health and nutrition.