Enteroliths are calculi composed of struvite that form in the ampulla coli of the right dorsal colon and subsequently cause partial or complete obstruction of the right dorsal, transverse, or descending colon. Parts of California have an unusually high incidence, and Arabians, Morgans, American Miniatures, and American Saddlebreds are at increased risk for entheroliths. The most devastating aspect of this condition is the potential for pressure necrosis and rupture of the intestinal tract. An association between exposure to potential nidi and the development of enteroliths has been suggested, although the nidus most often consists of a mere speck of foreign material such as a pebble or grain of sand. The current recommendations for horses at risk for enterolithiasis include elimination of rich, California-grown alfalfa from the diet, daily feeding of concentrates to promote colonic acidification, daily exercise with access to pasture grass, evaluation of mineral components of the water supply, and possibly supplementation with apple cider vinegar to acidify colon contents. Definitive diagnosis can be determined with abdominal radiography, exploratory celiotomy, necropsy, or via palpation per rectum. Abdominal ultrasound is of limited value, except to rule out other conditions. Surgical management of enterolithiasis is most commonly performed through a ventral midline celiotomy, and techniques for removal will be influenced by accessibility to the site of impaction. It is important to complete a thorough abdominal exploration to avoid missing additional enteroliths.