Rectal Tears in Horses Flashcards
most rectal tears are ____ cm from anus
4-60 cm
<30 cm more common secondary to foaling
bypass techniques for rectal tears
- temporary indwelling rectal liner via celiotomy (passes in feces in 9-12 days)
- colostomy performed standing: double incision loop technique is GS
indications for bypass procedures for rectal tears (4)
- prevents fecal impaction
- prevents worsening
- allow grade 3 to heal without direct repair
- can protect sutures post direct repair
signalment for rectal tears
- ARABIANS
- miniature horses
- males > females
- fractious horses
- horses with previous tears
rectal tears are most commonly in ____ aspect of rectum (unless secondary to foaling)
dorsal aspect
grade 2 rectal tears
ONLY muscularis (mucosa and submucosa intact and bulge out) -> diverticulum where feces can get trapped
Do NOT bleed -> often go unnoticed
this type of rectal tear can ONLY be treated via conservative management
Grade 2
do you need to mention the risk of rectal tear to clients?
NO
treatment for grade 2 rectal tears
NOT surgery
ONLY conservative
surgical treatment options for rectal tears
- direct suture repair
- bypass procedures (temporary indwelling rectal liner vs. colostomy
_____ allows grade 3 to heal without direct repair
bypass procedures
main cause of rectal tears in horses
transrectal palpation (usually as wall contracts)
can also occur during foaling
survival rate for grade 4 rectal tears
6% survival; usually only those that happen secondary to foaling (therefore fixed immediately) survive
abdominocentesis with WBCs >_____ = peritonitis
50,000
ways to minimize risk for rectal tears in horses
- lots of lube
- clean feces out
- relax arm when horse strains
- busocpan (decreases rectal pressure by 70%)
- lidocaine enemas (does NOT decrease rectal pressure)
which direction do you close rectal tears?
transversely
conservative management is only used for which type of rectal tears
- usually used for grade 1
- ONLY treatment for grade 2
- can be used for grade 3 BUT surgery is GS
in this type of rectal tear, rectal material is contained within the mesocolon
3b: occurs be 11’clock and 1’clock -> rectal material is contained within the mesocolon
involves all layers except serosa
______ drug decreases rectal pressure by 70%
buscopan
grade 1 rectal tears
ONLY mucosa and submucosa
bleeds
only type of rectal tear that does NOT bleed
grade 2
treatment for grade 4 rectal tears
ONLY surgery
6% survival; usually only those that happen secondary to foaling (therefore fixed immediately) survive
true or false: do not commit to covering referral cost for rectal tears
true
GS technique used for colostomy
double incision loop technique
what size should your bites be for rectal tear repair
<1.5 cm
first aid measures for rectal tears (8)
- NEVER wait and see = negligence
- stop horse from straining: xylazine and lidocaine epidural C1-C2
- assess severity
- antibiotics
- NSAIDs
- fluids
- rectal tampon
- REFER ALWAYS
chronic fecal impactions are sometimes seen secondary to this type of rectal tear
grade 2
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
grade 2
conservative management for rectal tears entails….
- 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
grade 4 rectal tear
full thickness
can lead to herniation of viscera
treatment for grade 1 rectal tears
-conservative: survival 90%
can do surgery if want faster healing
treatment for grade 3 rectal tears
surgery is G.S.
conservative management can be used (40-70% survival; must prevent conversion to grade 4)
grade 3 rectal tear
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
approaches used for direct suture repair of rectal tears
- 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)
