FREE SHIPPING over $40
OVER 10000 FIVE-STAR REVIEWS
5% OFF ALL SUBSCRIPTIONS
100% HAPPINESS GUARANTEE
Analyze Diet
0
Equine veterinary journal2026; doi: 10.1002/evj.70193

Venous blood lactate concentration as a predictor of intestinal viability in horses with acquired indirect inguinal hernia.

Abstract: Background: Acquired indirect inguinal hernia represents a life-threatening emergency. Therapeutic decision-making largely depends on intestinal viability, for which specific predictive parameters (such as venous lactate) have not been evaluated.Objectives: Investigating the predictive performance of venous blood lactate and other laboratory results on intestinal viability in horses with acquired indirect inguinal hernias.Study designRetrospective multicentre observational study.Methods: Seventy-four horses diagnosed with acquired indirect inguinal hernia (treated surgically) at two referral hospitals between 2007 and 2025 were classified considering intraoperative intestinal viability using Freeman's grading score. Group comparisons regarding laboratory results at admission were performed. Normality was assessed (Kolmogorov-Smirnov) and results are presented as mean ± standard deviation when its assumption was met, and median [interquartile range] when not. T-test or Mann-Whitney U-test were performed as appropriate. Receiver operating characteristic curve analysis and logistic regression modelling were evaluated.Results: Seventy-four horses were included. Intestinal viability was confirmed in 39 horses (53%), and non-viability in 35 horses (47%). Survival to discharge was significantly higher in the viable group (92% [36/39] vs. 74% [26/35]; p = 0.036). Venous blood lactate concentrations were significantly higher in the non-viable group (4.9 [3.2, 8.6] mmol/L vs. 1.6 [1.2-2.9]; p Main limitationsRetrospective design, incomplete availability of clinical variables, moderate sample size.Conclusions: Venous blood lactate could predict intestinal devitalisation in horses with acquired inguinal hernias and assist preoperative decision-making.
© 2026 The Author(s). Equine Veterinary Journal published by John Wiley & Sons Ltd on behalf of EVJ Ltd.
Get Full Text
Publication Date: 2026-05-19 PubMed ID: 42153396DOI: 10.1002/evj.70193Google 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.

In horses with an acquired indirect inguinal hernia, higher lactate levels in a routine venous blood sample were linked to a greater likelihood that the trapped intestine was not viable. Using this quick test may help veterinarians make earlier, better-informed surgical decisions and discuss prognosis with owners.

What problem the study addressed and why it matters

  • Acquired indirect inguinal hernia in horses is a surgical emergency because small intestine becomes trapped and may lose its blood supply, leading to tissue death.
  • Timely decisions about surgery, resection, and prognosis hinge on whether the intestine is still viable, but reliable preoperative predictors are limited.
  • Venous blood lactate is an accessible, fast test that reflects tissue hypoperfusion and anaerobic metabolism; its value specifically for predicting intestinal viability in this condition had not been evaluated.

Study design and how the authors evaluated the question

  • Design: Retrospective, multicentre observational study conducted at two referral hospitals (2007–2025).
  • Population: 74 horses with acquired indirect inguinal hernia that underwent surgery.
  • Reference standard for outcome: Intraoperative assessment of intestinal viability using Freeman’s grading score (a standardized system based on serosal color, motility, mesenteric vasculature, and bleeding response).
  • Grouping: Horses were classified as having viable or non-viable intestine at surgery.
  • Index tests: Admission laboratory variables with a primary focus on venous blood lactate; other routine lab results were also examined.
  • Statistics:
    • Normality tested with Kolmogorov–Smirnov; data expressed as mean ± SD or median [IQR] as appropriate.
    • Between-group comparisons used t-test or Mann–Whitney U-test, depending on distribution.
    • Predictive performance assessed via receiver operating characteristic (ROC) analysis.
    • Logistic regression modeling was used to explore the association between laboratory variables (notably lactate) and intestinal non-viability.

Key results

  • Sample: 74 horses; 39 (53%) had viable intestine, 35 (47%) had non-viable intestine at surgery.
  • Outcome: Survival to discharge was higher when intestine was viable (92%, 36/39) than when non-viable (74%, 26/35), with a statistically significant difference (p = 0.036).
  • Primary finding: Venous blood lactate concentrations at admission were significantly higher in the non-viable group compared with the viable group.
    • Non-viable: 4.9 [3.2, 8.6] mmol/L
    • Viable: 1.6 [1.2, 2.9] mmol/L
    • The between-group difference was statistically significant (exact p-value not reported in the abstract).
  • Analytical performance: ROC analysis and logistic regression were performed to quantify predictive ability; the abstract supports venous lactate as a useful predictor, though detailed metrics (e.g., AUC, optimal cut-offs, adjusted odds ratios) were not reported.

How to interpret the findings

  • Clinical meaning: Elevated venous lactate on admission increases the likelihood that strangulated intestine is devitalized in horses with acquired indirect inguinal hernia.
  • Pathophysiology link: Strangulation compromises blood flow, causing anaerobic metabolism and lactate accumulation that is detectable in systemic venous blood.
  • Prognostic signal: The strong association between intestinal viability and survival underscores why an early indicator like lactate can be valuable for triage and owner communication.
  • Comparative context: While peritoneal (abdominocentesis) lactate is often emphasized in colic workups, this study indicates that a simple venous lactate—faster and easier to obtain—has meaningful predictive value in this specific condition.

Practical implications for veterinarians

  • At admission, measure venous lactate promptly in any horse suspected of having an acquired indirect inguinal hernia.
  • Interpret higher lactate values as a red flag for possible intestinal non-viability, prompting expedited surgical intervention and preparation for potential resection.
  • Use lactate alongside the full clinical picture (pain severity, cardiovascular status, ultrasound, rectal findings) rather than as a stand-alone decision tool.
  • Discuss prognosis and costs with owners early, noting that non-viability is associated with lower survival to discharge.

Strengths and limitations

  • Strengths:
    • Multicentre cohort spanning many years, reflecting real-world referral caseloads.
    • Use of an intraoperative grading system (Freeman’s score) as the reference standard for viability.
    • Application of appropriate statistical tests and predictive modeling approaches (ROC, logistic regression).
  • Limitations:
    • Retrospective design with potential for selection and information bias.
    • Incomplete availability of some clinical variables in the record.
    • Moderate sample size limiting precision, subgroup analyses, and comprehensive multivariable adjustment.
    • Lack of reported diagnostic thresholds, AUC values, or adjusted effect sizes in the abstract limits bedside calibration.
    • Venous lactate can be influenced by systemic factors (shock, dehydration, duration of colic), not solely intestinal viability.

What this means for practice right now

  • In suspected acquired indirect inguinal hernia, a markedly elevated venous lactate should heighten concern for devitalized intestine and accelerate surgical timelines.
  • Normal or only mildly elevated lactate lowers the likelihood of non-viability but does not exclude it; continue comprehensive assessment and do not delay surgery when clinical signs dictate.
  • Intraoperative findings remain definitive; preoperative lactate refines risk estimation and owner discussions rather than replacing surgical evaluation.

Future directions and unanswered questions

  • Prospective validation to determine optimal venous lactate cut-off values and to report diagnostic accuracy metrics (AUC, sensitivity, specificity, likelihood ratios).
  • Multivariable models incorporating clinical exam, imaging, and time from onset to presentation to define independent predictive value of lactate.
  • Serial lactate measurements (clearance over time) to assess whether trends improve prediction of viability and outcomes.
  • External validation across additional centers and geographic regions to confirm generalizability.

Cite This Article

APA
Rivero-García R, Andreu-Vázquez C, Fuentes-Romero B, Fernández-Hernández P, Rodríguez-Pozo ML, Sebastián IA, Soto ST, Gallardo MM, Iglesias-García M. (2026). Venous blood lactate concentration as a predictor of intestinal viability in horses with acquired indirect inguinal hernia. Equine Vet J. https://doi.org/10.1002/evj.70193

Publication

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

Researcher Affiliations

Rivero-García, Raquel
  • Universidad Europea de Madrid, Faculty of Biomedical and Health Sciencies, University Veterinary Teaching Hospital, Madrid, Spain.
Andreu-Vázquez, Cristina
  • Universidad Europea de Madrid, Faculty of Biomedical and Health Sciencies, University Veterinary Teaching Hospital, Madrid, Spain.
Fuentes-Romero, Beatriz
  • Universidad Europea de Madrid, Faculty of Biomedical and Health Sciencies, University Veterinary Teaching Hospital, Madrid, Spain.
Fernández-Hernández, Pablo
  • Veterinary Teaching Hospital, Universidad de Extremadura, Cáceres, Spain.
Rodríguez-Pozo, María Luisa
  • AniCura San Vicente Hospital Veterinario, Alicante, Spain.
Sebastián, Ignacio Aguilar
  • AniCura San Vicente Hospital Veterinario, Alicante, Spain.
Soto, Salvador Termes
  • AniCura San Vicente Hospital Veterinario, Alicante, Spain.
Gallardo, Mercedes Martínez
  • Universidad Europea de Madrid, Faculty of Biomedical and Health Sciencies, University Veterinary Teaching Hospital, Madrid, Spain.
Iglesias-García, Manuel
  • Universidad Europea de Madrid, Faculty of Biomedical and Health Sciencies, University Veterinary Teaching Hospital, Madrid, Spain.

References

This article includes 39 references
  1. Schumacher J, Perkins J. Inguinal herniation and rupture in horses.. Equine Vet Educ 2010;22(1):7–12.
    doi: 10.2746/095777309x473google scholar: lookup
  2. Kovac M, Aliev R, Ippolitova T, Tambur Z. Equine acquired inguinal herniation—diagnosis and treatment in 62 cases.. Vet Glas 2018;72(1):22–34.
    doi: 10.2298/vetgl171228006kgoogle scholar: lookup
  3. Baranková K, de Bont MP, Simon O, Meulyzer M, Boussauw B, Vandenberghe F. Non‐surgical manual reduction of indirect inguinal hernias in 89 adult stallions.. Equine Vet Educ 2022;34(9):e385–e392.
    doi: 10.1111/eve.13494google scholar: lookup
  4. Mendoza FJ, Pérez‐Ecija A, Estepa JC. Inguinal‐scrotal herniation and torsion of the large colon in an adult Andalusian stallion: a case report.. Vet Med (Praha) 2010;55(6):281–284.
    doi: 10.17221/2993-vetmedgoogle scholar: lookup
  5. Merezova J, Zert Z, Kabes R, Ottova L. Analysis of clinical and perioperative findings in 576 horses subjected to surgical treatment of colic.. Vet Med (Praha) 2008;53(1):29–42.
    doi: 10.17221/1933-vetmedgoogle scholar: lookup
  6. Góss GC, Azevedo MS, Duarte CA, Mozzaquatro FD, Pradella GD, Taschetto PM. Omentum as non‐strangulated inguino‐scrotal hernia content in stallion.. Braz J Vet Res Anim Sci 2021;73(2):423–430.
    doi: 10.1590/1678-4162-12139google scholar: lookup
  7. Alves GES, Santos RL, Henry M, Ribeiro AG, Rothschild CM. Acquired bilateral inguinal hernia in a stallion.. Equine Vet Educ 2000;12(5):256–259.
    doi: 10.1111/j.2042-3292.2000.tb00053.xgoogle scholar: lookup
  8. François I, Lepage OM, Schramme MC, Salciccia A, Detilleux J, Grulke S. Clinical findings, surgical techniques, prognostic factors for short‐term survival and long‐term outcome in horses with acquired inguinal hernias: ninety‐eight cases (2005‐2020).. Vet Surg 2024;53(3):468–476.
    doi: 10.1111/vsu.14023google scholar: lookup
  9. 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.
    doi: 10.2746/0425164054529409google scholar: lookup
  10. Weaver AD. Acquired incarcerated inguinal hernia: a review of 13 horses.. Can Vet J 1987;28(4):195–199.
  11. Muñoz E, Argüelles D, Areste L, San‐Miguel L, Prades M. Retrospective analysis of exploratory laparotomies in 192 Andalusian horses and 276 horses of other breeds.. Vet Rec 2008;162(10):303–306.
    doi: 10.1136/vr.162.10.303google scholar: lookup
  12. Muhammad‐Salman W, Arroyo E, Tibary A. Diagnostic approach to equine testicular disorder.. Vet Sci 2024;11(6):243.
    doi: 10.3390/vetsci11060243google scholar: lookup
  13. Van der Velden MA. Surgical treatment of acquired inguinal hernia in the horse: a review of 51 cases.. Equine Vet J 1988;20(3):173–177.
    doi: 10.1111/j.2042-3306.1988.tb01491.xgoogle scholar: lookup
  14. Mezerova J, Zert Z, Kabes R, Ottova L. Analysis of therapeutic results and complications after colic surgery in 434 horses.. Vet Med (Praha) 2008;53(1):12–28.
    doi: 10.17221/1934-vetmedgoogle scholar: lookup
  15. Freeman DE, Schaeffer DJ, Cleary OB. Long‐term survival in horses with strangulating obstruction of the small intestine managed without resection.. Equine Vet J 2014;46(6):711–717.
    doi: 10.1111/evj.12216google scholar: lookup
  16. Verhaar N, Geburek F. Real‐time ancillary diagnostics for intraoperative assessment of intestinal viability in horses—looking for answers across species. Vet Surg 2025;54(4):648–664.
    doi: 10.1111/vsu.14248google scholar: lookup
  17. Farrell A, Kersh K, Liepman R, Dembek KA. Development of a colic scoring system to predict outcome in horses. Front Vet Sci 2021;8:697589.
    doi: 10.3389/fvets.2021.697589google scholar: lookup
  18. Latson KM, Nieto JE, Beldomenico PM, Snyder JR. Evaluation of peritoneal fluid lactate as a market of intestinal ischaemia in equine colic. Equine Vet J 2005;37(4):342–346.
    doi: 10.2746/0425164054529319google scholar: lookup
  19. Taschetto PM, Pradella GD, Berlingieri MA, Leiria PAT, Skupien JA, Lübeck I. Using peritoneal and blood lactate as predictor of condition type, surgical referral and prognosis in equine colic cases. Arq Bras Med Vet Zootec 2023;75(4):591–598.
    doi: 10.1590/1678-4162-12859google scholar: lookup
  20. Peloso JG, Cohen ND. Use of serial measurements of peritoneal fluid lactate concentration to identify strangulating intestinal lesions in referred horses with colic. J Am Vet Med Assoc 2012;240(10):1208–1217.
    doi: 10.2460/javma.240.10.1208google scholar: lookup
  21. Barros AMC, Camargo MM, Nichi M, Belli CB. Blood and peritoneal lactate in equine colic: application in emergency care and construction of a decision tree. Arq Bras Med Vet Zootec 2024;76(5):e13210.
    doi: 10.1590/1678-4162-13210google scholar: lookup
  22. Delesalle C, Dewulf J, Lefebvre RA, Schuurkes JAJ, Proot J, Lefere L. Determination of lactate concentrations in blood plasma and peritoneal fluid in horses with colic by an accusport analyzer. J Vet Intern Med 2007;21(2):293–301.
    doi: 10.1111/j.1939-1676.2007.tb02963.xgoogle scholar: lookup
  23. Henderson ISF. Diagnostic and prognostic use of L‐lactate measurement in equine practice. Equine Vet Educ 2013;25(9):468–475.
    doi: 10.1111/eve.12033google scholar: lookup
  24. Ludwig EK, Hobbs KJ, McKinney‐Aguirre CA, Gonzalez LM. Biomarkers of intestinal injury in colic. Animals 2023;13(2):227.
    doi: 10.3390/ani13020227google scholar: lookup
  25. Edner AH, Nyman GC, Essén‐Gustavsson B, Moore JN, Owen R, Lumsden JH. Metabolism before, during and after anaesthesia in colic and healthy horses. Acta Vet Scand 2007;49:34.
    doi: 10.1186/1751-0147-49-34google scholar: lookup
  26. Parra‐Moyano LA, Cedeño A, Darby S, Johnson JP, Gomez DE, Stefanovski D. Blood and peritoneal lactate, ratio and difference and peritoneal lactate to total solids ratio for detection of intestinal strangulating obstructions in horses. J Vet Intern Med 2025;39(4):e70121.
    doi: 10.1111/jvim.70121google scholar: lookup
  27. Wormstrand BH, Ihler CF, Diesen R, Krontveit RI. Surgical treatment of equine colic‐ a retrospective study of 297 surgeries in Norway 2005–2011. Acta Vet Scand 2014;56:38.
    doi: 10.1186/1751-0147-56-38google scholar: lookup
  28. Mickevičienė I, Mikalauskienė D, Miknienė Z. The prognostic importance of physiological and biochemical parameters in horses afflicted with colic. Open Vet J 2024;14(8):1801–1807.
    doi: 10.5455/ovj.2024.v14.i8.8google scholar: lookup
  29. Hosmer DW, Lemeshow S, Sturdivant RX. Applied logistic regression. 1st ed. Hoboken, NJ: Wiley; 2013.
    doi: 10.1002/9781118548387google scholar: lookup
  30. Mutlu Ş, Buluş H, Yavuz A, Turhan VB, Öztürk B, Kiliç NA. The role of the lactate level in determining the risk rates of small bowel resection in incarcerated hernias. Ulus Travma Acil Cerrahi Derg 2020;26(4):593–599.
    doi: 10.14744/tjtes.2020.02500google scholar: lookup
  31. Martin E, Sarkan K, Viall A, Hostetter S, Epstein K. Clinicopathologic parameters of peritoneal fluid as predictors of gastrointestinal lesions, complications and outcomes in equine colic patients: a retrospective study. Animals (Basel) 2024;15(1):12.
    doi: 10.3390/ani15010012google scholar: lookup
  32. Ambe PC, Kang K, Papadakis M, Zirngibl H. Can the preoperative serum lactate level predict the extent of bowel ischemia in patients presenting to the emergency department with acute mesenteric ischemia?. Biomed Res Int 2017;1:1–5.
    doi: 10.1155/2017/8038796google scholar: lookup
  33. Long AE, Southwood LL, Morris TB, Brandly JE, Stefanovski D. Use of multiple admission variables better predicts intestinal strangulation in horses with colic than peritoneal or the ratio of peritoneal: blood l‐lactate concentration. Equine Vet J 2024;56(3):437–448.
    doi: 10.1111/evj.13977google scholar: lookup
  34. Akin T, Ozden S, Birben B, Erkus YO, Yuksel BC, Tikici D. Can bowel necrosis be predicted with inflammatory markers in incarcerated inguinal hernia?. Turk J Clin Lab 2021;3(1):341–345.
    doi: 10.18663/tjcl.906748google scholar: lookup
  35. Furr MO, Lessard P, White IINA. Development of a colic severity score for predicting the outcome of equine colic. Vet Surg 1995;24(2):97–101.
    doi: 10.1111/j.1532-950x.1995.tb01302google scholar: lookup
  36. Van Den Boom R, Butler CM, Sloet van Oldruitenborgh‐Oosterbaan MM. The usability of peritoneal lactate concentration as a prognostic marker in horses with severe colic admitted to a veterinary teaching hospital. Equine Vet Educ 2010;22:420–425.
    doi: 10.1111/j.2042-3292.2010.00093.xgoogle scholar: lookup
  37. Tennent‐Brown BS, Wilkins PA, Lindborg S, Russell G, Boston RC. Sequential plasma lactate concentrations as prognostic indicators in adult equine emergencies. J Vet Intern Med 2010;24(1):198–205.
    doi: 10.1111/j.1939-1676.2009.0419.xgoogle scholar: lookup
  38. Yamout SZ, Nieto JE, Beldomenico P, DeChant JE, Lejeune S, Snyder JR. Peritoneal and plasma D‐lactate concentrations in horses with colic. Vet Surg 2011;40:817–824.
    doi: 10.1111/j.1532-950x.2011.00859.xgoogle scholar: lookup
  39. Urbanavičius L, Pattyn P, de Putte DV, Venskutonis D. How to assess intestinal viability during surgery: a review of techniques. World J Gastrointest Surg 2011;3(5):59–69.
    doi: 10.4240/wjgs.v3.i5.59google scholar: lookup

Citations

This article has been cited 0 times.
Subscribe to our newsletter
Join 106,294 horse owners like you who receive our email updates on horse health and nutrition.