Colic is the most common equine emergency. Most colic cases will respond to medical management but, around 10% will have a life-threatening lesion. A key challenge is to decipher whether the horse requires surgery or can be managed medically. Accurate assessment and swift decision-making to differentiate between such cases is of vital importance. A thorough colic assessment will enable early recognition of clinical “red flags” in life-threatening cases and therefore, will facilitate prompt surgical treatment which will help maximise survival. Furthermore, an effective evaluation will help to identify lesions that require more specific medical therapy. In this session we will cover the fundamentals, practical tips and new developments in colic assessment and treatment.