Decision for surgery

Based on the clinical impression and the current knowledge of the clinical variables (rectal examination, abdominal distention, abdominal fluid, intractable pain) most likely to differentiate between medical and surgical cases, three decision trees are provided as a guide to making the management decision in a horse with abdominal pain. Prior elimination of horses with limited life expectancy because of age or function or where financial constraints are present is understood. It must be emphasized that most of the information presently available originates from referral centers where the prevalence of surgical candidates is much higher than in general practice. This would influence the accuracy of the clinician in identifying horses with a surgical lesion or estimating survival (positive predictive value).