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Life sciences · Journal article
Equine Veterinary Education · October 6, 2026
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Summary Choledocholithiasis is an uncommon cause of biliary obstruction in horses and carries a guarded prognosis when medical management fails. This report describes the successful surgical treatment and long‐term outcome of a 9‐year‐old Thoroughbred gelding that presented with acute colic secondary to obstructive choledocholithiasis. Transabdominal ultrasonography identified multiple choledocholiths, likely within the common bile duct, prompting exploratory ventral midline celiotomy because of progressive, severe abdominal pain. Manual lithotripsy was performed by digitally fragmenting choledocholiths and advancing the fragments through the major duodenal papilla into the duodenum. A concurrent pelvic flexure impaction was resolved by enterotomy, and an excisional liver biopsy was collected for histopathology and bacterial culture. Postoperatively, the horse recovered uneventfully from general anaesthesia and was managed with systemic antimicrobials and gastrointestinal protectants. Histopathology was consistent with chronic cholestasis without evidence of neoplasia or infectious disease, and bacterial culture of the liver was negative. Follow‐up ultrasonography at 6 weeks demonstrated resolution of bile duct obstruction, with no evidence of residual choleliths or ductal dilation. Six months after surgery, the horse had returned to full athletic function with normal serum biochemical values. This case demonstrates that manual lithotripsy may provide a successful surgical alternative for horses with obstructive choledocholithiasis when medical management is unsuccessful.