Rectal Tears in Horses

Question 1

most rectal tears are ____ cm from anus

Answer 1

4-60 cm

<30 cm more common secondary to foaling

Question 2

bypass techniques for rectal tears

Answer 2

• temporary indwelling rectal liner via celiotomy (passes in feces in 9-12 days)
• colostomy performed standing: double incision loop technique is GS

Question 3

indications for bypass procedures for rectal tears (4)

Answer 3

• prevents fecal impaction
• prevents worsening
• allow grade 3 to heal without direct repair
• can protect sutures post direct repair

Question 4

signalment for rectal tears

Answer 4

• ARABIANS
• miniature horses
• males > females
• fractious horses
• horses with previous tears

Question 5

rectal tears are most commonly in ____ aspect of rectum (unless secondary to foaling)

Answer 5

dorsal aspect

Question 6

grade 2 rectal tears

Answer 6

ONLY muscularis (mucosa and submucosa intact and bulge out) -> diverticulum where feces can get trapped

Do NOT bleed -> often go unnoticed

Question 7

this type of rectal tear can ONLY be treated via conservative management

Answer 7

Grade 2

Question 8

do you need to mention the risk of rectal tear to clients?

Answer 8

NO

Question 9

treatment for grade 2 rectal tears

Answer 9

NOT surgery

ONLY conservative

Question 10

surgical treatment options for rectal tears

Answer 10

• direct suture repair

- bypass procedures (temporary indwelling rectal liner vs. colostomy

Question 11

_____ allows grade 3 to heal without direct repair

Answer 11

bypass procedures

Question 12

main cause of rectal tears in horses

Answer 12

transrectal palpation (usually as wall contracts)

can also occur during foaling

Question 13

survival rate for grade 4 rectal tears

Answer 13

6% survival; usually only those that happen secondary to foaling (therefore fixed immediately) survive

Question 14

abdominocentesis with WBCs >_____ = peritonitis

Answer 14

50,000

Question 15

ways to minimize risk for rectal tears in horses

Answer 15

• lots of lube
• clean feces out
• relax arm when horse strains
• busocpan (decreases rectal pressure by 70%)
• lidocaine enemas (does NOT decrease rectal pressure)

Question 16

which direction do you close rectal tears?

Answer 16

transversely

Question 17

conservative management is only used for which type of rectal tears

Answer 17

• usually used for grade 1
• ONLY treatment for grade 2
• can be used for grade 3 BUT surgery is GS

Question 18

in this type of rectal tear, rectal material is contained within the mesocolon

Answer 18

3b: occurs be 11’clock and 1’clock -> rectal material is contained within the mesocolon

involves all layers except serosa

Question 19

______ drug decreases rectal pressure by 70%

Answer 19

buscopan

Question 20

grade 1 rectal tears

Answer 20

ONLY mucosa and submucosa

bleeds

Question 21

only type of rectal tear that does NOT bleed

Answer 21

grade 2

Question 22

treatment for grade 4 rectal tears

Answer 22

ONLY surgery

6% survival; usually only those that happen secondary to foaling (therefore fixed immediately) survive

Question 23

true or false: do not commit to covering referral cost for rectal tears

Answer 23

true

Question 24

GS technique used for colostomy

Answer 24

double incision loop technique

Question 25

what size should your bites be for rectal tear repair

Answer 25

<1.5 cm

Question 26

first aid measures for rectal tears (8)

Answer 26

- NEVER wait and see = negligence - stop horse from straining: xylazine and lidocaine epidural C1-C2 - assess severity - antibiotics - NSAIDs - fluids - rectal tampon - REFER ALWAYS

Question 27

chronic fecal impactions are sometimes seen secondary to this type of rectal tear

Answer 27

grade 2

Question 28

this rectal tear ONLY involves the muscularis (mucosa and submucosa intact and bulge out) -> diverticulum where feces can get trapped Do NOT bleed -> often go unnoticed

Answer 28

grade 2

Question 29

conservative management for rectal tears entails....

Answer 29

- antibiotics, NSAIDs, fluids - laxatives (oral fluids + MgSO4/epsom salt) + low bulk diet (pellets, mash) - daily removal of feces from rectum q1-2 hours for 5 days then q6 hours until healed **mineral oil is NOT a laxative

Question 30

grade 4 rectal tear

Answer 30

full thickness can lead to herniation of viscera

Question 31

treatment for grade 1 rectal tears

Answer 31

-conservative: survival 90% can do surgery if want faster healing

Question 32

treatment for grade 3 rectal tears

Answer 32

surgery is G.S. conservative management can be used (40-70% survival; must prevent conversion to grade 4)

Question 33

grade 3 rectal tear

Answer 33

ALL layers EXCEPT serosa bleeds 3a: occurs anywhere EXCEPT from 11 'clock to 1 'clock 3b: occurs be 11'clock and 1'clock -> rectal material is contained within the mesocolon

Question 34

approaches used for direct suture repair of rectal tears

Answer 34

- speculum and long handled instruments - non-visual - prolapse through anus (common for tears secondary to foaling) - laparoscope with hand assistance in rectum - ventral midline celiotomy for Grade 4 with evisceration (so you can assess blood supply)