I lost my 15 yr old warmblood gelding to this wretched ticking time bomb of a disease. My vets and I decided surgery would be for me not him as he did not handle stall rest well from his previous soft tissue injury and he would probably have another pedunculated lipoma of the small intestine episode at some point in his life. Surgery would go well, but recovery would be a bitch. My SIL, who’s a MD, said people have a hard time recovering from a similar surgery and that I made the right call to euthanize my beloved horse. He was fine one moment and 15 minutes later he was in absolute agony. Vet on site in less then 30 minutes. The longest 30 minutes of my life. It still haunts me.
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Very interesting to hear about the quarterly mild colics. That’s how my guy presented for much of the last 5 years of his life. A couple months before his final colic he had a mild episode and it didn’t resolve with tubing and meds so we took him to the University and he recovered just fine there. The on call vet said a lipoma was possible at that time. The last one was much worse -thrashing covered in sweat etc, we drugged him up and took him to the University. They opened him up and he had some necrotic small colon from lipoma entrapment. I decided to let him go on the table. We had just gone through another colic surgery with our much younger horse and I knew how the recovery went for him. This was not going to be as easy and he was likely to colic again. I just couldn’t do it. I think I would have rather had him PTS before going to the University to save him some pain. I will never forget how he looked getting on the trailer and then not being there with him. Sorry for the sob story. Afterwards, I talked with quite a few people and found out how common and deadly it was in older horses.
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Just want to add some details of some of my colic experiences - the pony who had the strangulating lipoma - which was confirmed via successful surgery - presented very similar to another horse who had a very sudden, intense colic that also came “out of nowhere.” The horse was completely fine coming in from turn-out, and 10 minutes later he was covered in sweat and clearly in intense pain. The vet came out pretty quickly and when the pain was not managed with banamine, he went to New Bolton Center. Surgery confirmed a twist - not a lipoma. So it is also entirely possible for a gas colic to develop that quickly and result in a twist even without rolling, like we usually associate with a twist 
It is a blessing and a curse to live so close to a surgery center, because making the decision about surgery in an emergency situation is one of the worst things I have ever had to do.
Colic is the worst 
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