Rectal tears Flashcards
Why are rectal tears important?
Almost always iatrogenic (during rectal examination)
Can be life threatening
Could lead to legal action
How to rectal tears usually present?
Blood on glove post rectal exam
Occasionally a popping sensation if a severe tear
How do rectal tears usually occur?
Due to normal contraction of the small colon wall over the examiners hand or forearm
Avoid forcing the hand or forearm against a horse that is straining or against a normal peristaltic wave.
Where do most rectal tears occur?
Dorsolaterally, longitudinal, often 30cm from the anus
Which horses are at higher risk of iatrogenic tears?
Arabian horses
Ponies
Small breeds
Fractious horses
Horses unaccustomed to rectal palpation
Previously had a rectal tear
Horses with colic
What special precautions can be used in horses at high risk of rectal tears?
Sedation
Muscle relaxants
First aid for a rectal tear
Prevent further straining and rectal contractions
- Sedation
Muscle relaxant/spasmolytic e.g. buscopan
- lidocaine enema
Gently remove faeces from rectum
Assess tear with ungloved hand
Layers of the rectum that could be torn
Mucosa
Submucosa
Muscularis
Serosa
Mesocolon (dorsally)
Possible grades of rectal tear
I, II, IIIa, IIIb, IV
Grade I rectal tear
Mucosa and submucosa disrupted
Muscularis and serosa still in tact
93% of cases survive
Grade II rectal tear
Muscularis disrupted
Mucosa, submucosa, and serosa in tact
100% of cases survived
Grade IIIa rectal tear
Mucosa, submucosa, and muscularis disrupted
Serosa in tact
68% of horses survived
Grade IIIb rectal tear
Mucosa, submucosa, muscularis, and serosa disrupted
Only mesocolon in tact
69.2% survive
Grade IV rectal tear
Mucosa, submucosa, muscularis, and serosa disrupted
Nothin in tact - direct communication into peritoneal cavity
6% survive
What to do when grade of rectal tear determined
Can offer referral whatever the grade
Call VDS - essential with higher grade tears
Broad spectrum antibiotics
What antibiotic to use for rectal tears
TMPS: grade I
Doxycycline: Grade I/II/III
Penicillin and gentamycin combination: Grade III/IV
Conservative management of rectal tears
Can only be used for grade I/II
Analgesia (NSAID)
Faecal softeners (mineral oil or paraffin oil)
Diet alterations - avoid dry hay and feed wet feeds
Faeces should be regularly and carefully evacuated from rectum
Treatment of higher grade rectal tears
Essential to call VDS
Referral strongly encouraged
- may want rectal packing prior to sending horse (lots of lube and place 10cm cranial to tear to prevent faecal contamination)
- may need an epidural to place
Grade III tears can occasionally be successfully managed conservatively
Surgical options for grade III and IV tears - direct suturing, surgical stapling, and faecal diversion procedures
Grade IV rectal tears are often euthanised at presentation
How to minimise the risk of rectal tears
Faeces should be evacuated from the rectum
Adequate lubrication
Insert hand beyond point of interest before moving caudally again to examine
- reduces tension on mesorectum and allows more latitude of movement of the rectum
Do not force hand through a peristaltic wave - pause and do not move hand again until the wave has passed
Ensure horse is appropriately restrained - handler, stocks, use of a twitch, if in doubt sedate the horse
If the horse continues to strain when sedated buscopan can be administered
