Feeling for Answers: Rectal Palpation and Intestinal Lesions in Colic
About this episode
A rectal exam is one of the oldest tools in the equine colic workup, but we rarely stop to ask a blunt question: how accurate is abdominal palpation per rectum at telling small intestinal disease from large intestinal disease when it truly counts? We sit down with Drs. Mary Hallsten and George Elane to dig into the data behind rectal palpation, using surgical findings as the gold standard so we can compare what we feel with what is actually happening inside the abdomen.
We unpack why their study matters for everyday decision making, especially for the horses that keep hurting despite sedation and may need referral or exploratory surgery. You’ll hear what it means to have high sensitivity but extremely low specificity, and why that combination can still be clinically useful while also being easy to overinterpret. We also talk about why accuracy may look better than older reports, including improvements in veterinary education, palpation models, cadaver wet labs, and better correlation between anatomy and hands-on findings.
Then we zoom out to the diagnostic hierarchy. Heart rate, lactate, PCV, and age track with non-survival, while a “correct” rectal exam finding does not, which reframes rectal palpation as one important but subjective test that works best when paired with objective physiology. Finally, we address the part everyone thinks about but doesn’t always say out loud: rectal exams carry real safety risk, and the right choice depends on help, restraint, environment, and the horse in front of you.
If you work with horses and want a clearer, more evidence-based way to use rectal palpation in equine colic triage, listen through and share this with a colleague. Subscribe for more, and leave a rating and review to help other veterinarians find the show.
JAVMA article: https://doi.org/10.2460/javma.25.12.0837
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