In cases of equine acute abdominal disease, where pancreatic damage is suspected, pancreatic damage can be assessed by measuring increased trypsin activity in the plasma of horses suffering intestinal obstruction and severe shock. The pancreas is particularly vulnerable to splanchnic hypoperfusion because it is a highly active tissue. In this study, 10 horses undergoing abdominal surgery for intestinal obstruction were assayed for trypsin activity on admission and, because of extensive intestinal lesions that were not amenable to surgery, euthanasia was selected; the pancreas was removed before euthanasia. Trypsin activity in the plasma of these horses was significantly higher than in healthy horses (196 ng/ml +/- 128.2 versus 28.5 ng/ml +/- 19.2; P = 0.0026). Light and transmission electron microscopy revealed slight to severe lesions of vacuolar degeneration, a few zymogen granules, dilation of the endoplasmic reticulum, and swelling of mitochondria in the exocrine pancreas. The activation of an inflammatory cascade occurring during strangulating intestinal obstruction could increase pancreatic anoxic lesions caused by severe shock and hypoperfusion in the horse. Further studies will show the significance of pancreatic lesions and the ensuing damage in equine acute intestinal obstruction and shock.