Rectal Palpation
Equine

Indications for performing this procedure:  Rectal palpation should be performed on any horse with a history of colic, suspected gastrointestinal disease, abdominal pain, chronic weight loss, fever of unknown origin or chronic diarrhea.


Examination:  Rectal examination is most safely performed in stocks to protect both the examiner and the horse from injury.  In the absence of stocks, a stall door or hay bales may be used as a barrier between patient and examiner.  Hobbles, twitch, or sedation also may be necessary in particularly fractious animals.  The examiner should wear a protective plastic exam glove that is well lubricated.  Lidocaine may be added to the lubricant to ease the discomfort during the exam.  In very sensitive animals, an epidural anesthetic may be given to decrease sensitivity to the presence of hand and arm during the examination.


Structures that may be identified in a normal animal:  It is important to note, all palpable structures should be assessed for size, mobility, wall tension, thickness, edema, presence of taut attached mesentery, and distention with gas, fluid or ingesta.  Below is a list of palpable structures in a normal horse.


Some abnormalities that may be palpated per rectum:

  Enteroliths/Fecaliths:  In the averaged sized horse, distention of the right dorsal colon due to enteroliths may be palpated.  This requires the full extension of the arm into the abdomen.  In the transverse colon, enteroliths may be bumped with the finger tips, but not grasped.

  Impaction of the Pelvic Flexure:  The pelvic flexure will appear as a firm doughy mass identified by finger pressure.  The impaction may be quite large and fill the left colon causing the entire pelvic flexure to move to the right side of the abdomen.

  Obstruction of the Large Colon:  Tympany of bowel proximal to the obstruction may be appreciated upon palpation.  Extreme distention of the large colon with gas plus the presence of taut bands that are painful upon retraction suggest volvulus, torsion or malposition.

  Spleen:  The caudodorsal aspect of the spleen is usually palpable per rectum.  Nodules or surface irregularities suggests neoplasia.  

  Intussusception:  Intussusceptions have been described to feel like sausages within the intestinal tract.  The bowel will appear thickened and turgid.

  Obstruction/Strangulation of the small bowel:  The bowel will be distended proximal to the obstruction.  Loops of bowel may be pushed into the pelvic inlet effectively limiting further evaluation of the abdomen.  Loops of small intestine are not normally palpated and may be distinguished from the rest of the tract by their position and the presence or absence of bands and sacculations.

  Alterations in Rectal Mucosa:  In various disorders of the distal gastrointestinal tract, the rectal/colonic mucosa may be thickened or friable, and nodules may be palpated, suggesting either inflammatory conditions or neoplasia.


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