Equine Rectal Tears

Question 1

Rectum anatomy

Answer 1

Small colon to anus

• 25-30 cm
• cranial (peritoneal) segment
• caudal (retroperitoneal) segment

Question 2

Incidence

Answer 2

7% of legal claims against equine practitioners

• at least once in a career
• inherent risk of rectal palpation
• inappropriate care after the face (negligence)

Question 3

Causes

Answer 3

• peristaltic wave
• palpation of objects out of reach
• breeds predisposed (arabians and ponies)
• ages –> young fractious animals, older mares w/ deep pendulous tracts, age related degenerations
• colic

Question 4

Grade 1

Answer 4

Disruption of the only mucosa and submucosa

Question 5

Grade 2

Answer 5

Mucosa and submucosa intact only the muscular layer disrupted
- rare

Question 6

Grade 3

Answer 6

3A and 3B

• mucosa, submucosa, and muscular layers are disrupted only the serosal lay is intact
• can progress to grade 4

Question 7

Grade 4

Answer 7

All layers are disrupted

- communicates with the peritoneal cavity

Question 8

Step 1 is ____

Answer 8

Prevention!

• educate novice clients
• adequate restraint
• adequate lubrication!!
• relax with peristaltic waves
• insert hand past the structure being palpated

Question 9

Step 2

Answer 9

Evaluate the injury

• bloody sleeve
• sedate and minimize straining
• evaluate rectum via bare arm (grade 1 may be difficult to feel)

Question 10

Step 3

Answer 10

Client communication

• if the standard of care was met, the veterinarian was not negligent
• do not admit liability
• do not offer to pay
• discuss severity of tear and referral
• document all communications!

Question 11

Step 4

Answer 11

First aid and treatment

• immediate first aid
• K pen and gentamicin
• flunixin meglumine
• tetanus
• evacuate the rectum
• mineral oil or magnalax
• call referral –> rectal packing

Question 12

Treatment - grade 1

Answer 12

Essentially the same as first aid

• broad spec antibiotics
• NSAIDs
• stool softeners
• manual evacuation
• fast 24 hrs
• pelleted mash diet

Question 13

Treatment - grade 3 and 4

Answer 13

• rectal liner
• loop colostomy
• blind suture via rectum

Question 14

Treatment - grade 3

Answer 14

Medical management

• same as for grade 1
• manual evacuation every 2-3 hrs
• pack defect with betadine soaked gauze
• may need peritoneal lavage
• 75% success