Last fall my horse developed an abcess on the side of his barrel on the left side in his rib cage area.  The vet thinks he must have gotten a foreign object possibly a splinter of wood imbedded and an infection developed.

The vet has now opened it up 4 times, cleaned it out inside, flushed it, installed drains, did ultra sounds, antibiotics, and I've flushed the drain twice a day, let it close up and each time it has reoccurred.  Tues night it was looking great, the holes were both closed, it was getting flatter (scar tissue has developed). I was soooo happy and felt we finally had licked this thing.

 Last night I got to the barn after work and it was dripping pus, bulging with infection - gave him bute, cleaned it, put swat all around it to keep the flies away, and vaseline below to keep the pus from scalding him.  I called my vet again and am waiting to talk to him.  I suggested in my message that perhaps he could speak to some other vets for advice, suggestions, etc  -

has anyone on here seen this time of thing, any suggesitons are much appreciated as this has been going on since Oct and I want my horse healthy!

Abcesses can be very stubborn, hopefully your vet cultured some of the puss from the wound to make sure that the antibiotic you were using was effective at killing the bug.  The germs can become resistant, especially if you are fighting this thing for a long time, using the same antibiotic. Make sure you finish the whole round of antibiotic and administer it regularly, and that your horse either ingests all of it, or is injected with the full dose.  Maybe your vet will have to get more agressive with opening up the wound.  At least it's on his side, that's easy to doctor.  Hoof abcesses are awful and dirty.   My horse got a foreign body abcess in her neck (wood from itching on the barn) and it was a real bear to get rid of. 

Amanda

It's very important to not let an abscess heal or plug up until the inside is really done healing, think inside out not outside in.  I take a hose and flush these things twice daily until they run clear for 10 minutes with the high pressure water.  Then "fill" the hole with Ichthammol, it's a smelly black drawing salve.  A little fly spray and away they go.

If your abscess is closing too fast then a small amount of infection is trapped and allowed to fester.  Also firmly massaging the borders will break-up the pockets outlying on the edges of the original site.  Think about a bunch of grapes, you want to smash every grape so the juice can run out...even on the ends of the bunch.  A sterile tool can also be used to enter the wound and pop these pockets, only allow your vet to do this.

What type of antibiotic are you using and what delivery system?  Please tell me that for each of the four cycles you haven't used the same meds.

Does the wound smell?  Swell?  Itch?

Sorry, I didn't see that you already stated that the wound had been cultured.  Have it done again though, perhaps through all the fussing new germs have come into play.   If the vet never removed the object through all this, it's logical to believe that it is still in there.  Wood does not show up on x ray, so maybe that's it.  Good luck with the bill, but if you can get the mess cleared up for good, it will probably be cheaper in the long run than having the local vet mess with it multiple times.

Huntseat I think you have the right idea

He's only given antibiotics one time as he felt they wouldn't reach the area - will insist on them this time as it did seem to heal better.  They were in powder form and my horse will eat anything so he had them for the full 5 days. maybe he needs them for longer.

I've been flushing it twice a day when the drain was in and for about a week afterwards, but not as agressively as you suggest. And when it seemed to stop draining, I let it heal and close up.  I will print out your info and try that approach as it sounds very logical. 

 no smell or itch. Rico has left the drain alone and haven't noticed him ever messing with it.  His attitude has been great the whole time and I can tell he feels good as he runs all over the pasture kicking up his heels. 

Tues night, it looked great, the hole had closed up, it was still lumpy from scar tissue, but mostly flat.  Last night - it was dripping pus (hole had reopened) and it was huge again with infection... 

When the vet opens it up, he flushes it with a liter of fluids, puts a drain in and then I flush it 2x a day with diluted betadine for about 2 weeks.  I like the advice HuntSeat gave and will massage the area to break up the pus pockets, make sure the vet gives me stronger antibiotics and for a longer time period, also try hot compresses on the area and pack it with Icthamol.  I will let you guys know how  it progresses.   I am determined to get this thing healed. 

The 2 ultra sounds have shown the area inside that is the problem area, but it's never that large - maybe about the size of a half dollar....   

Dunoir, it shouldn't be lumpy when it heals!  I stick with the rinsing until it is almost 100% healed, no hole left.  The drain tube may be allowing infection to travel deep into the wound, also a drain tube needs to be stitched in and that indicates healing from outside in which we know isn't correct.  I'd bypass the drain tube all together and let the body handle this one.  The opening should be wide so that it won't heal too fast.

Talk things over with your vet and let him know that you intend to have this be the LAST round in the fight with this abscess.  Best advice is to keep it clean with frequent flushing with blasts of water from the hose (set to clean the concrete...your not rinsing the site you're blasting it!).  It may hurt until the site numbs up but once he realizes the routine he shouldn't fight you.  (Thankfully I have stocks inside my barn.)  I'd give more than 5 days of antibiotics if your vet recommends them...although my vet doesn't use antibiotics with abscesses because they can cause the healing process to go too fast and then you'll have trapped pockets and flare-ups (which is what you've had.)

It may take weeks but before you know it there won't be a hole to squirt into!  Keep us informed as things progress!

The vet performed surgery again Thurs afternoon, this time putting him out on the ground.  He went a lot deeper this time removing bad tissue, put a roll of betadine soaked gauze inside and did put in some stitches to keep the gauze in, but left a large opening, also flushed with fluids (DMSO and not sure what else).  He's on Tucoprin (antibiotic) for at least 10 days - until the large jar runs out.  Luckily Rico loves his grain and eats it all up. 

    I've been flushing it about 4-5 times a day with diluted betadine, hot compresses (which he doesn't care for) and massaging the area.  While I'm at work, a friend from the barn who is a vet tech will also flush it and she's bringing me some fluids the vet office saves for her.  I'll keep this baby open and will have the vet back out to check in about 10 days.  If this doesn't work he'll have to go to Palm Beach Equine for surgery and I want to avoid that. 

The bumpy areas are scar tissue that has developed and I don't think they will all go away.....

I sincerely thank you for your suggestions and will post updates.  I took him camping with me Fri - Sun as I could spend more time with him (didn't ride) as I board.  I took him walking, hand grazing, etc he handles it all quite well.  He's turned out at night in the grassy pasture and in the stall during the day (fan & screens) as it's getting hot already.  It was 91 degrees yesterday!  yck

thanks to everyone.  We'll get this darn thing licked

update - we worked really hard to get this abcess healing from the inside out, and thought we had it healed, but it reoccurred again last Thurs.  I took him to Palm Beach Equine a world class veterinary clinic for a consult and they are a bit baffled as well. 

I am taking him back tonight and he will have surgery Tues am and hopefully they will figure out what has been causing this problem and fix it once and for all.  I just want my horse back healthy and out of pain....