Small intestinal surgery Flashcards
Doyen forceps use for intestinal surgery
Atraumatically occludes bowel - good for the solo surgeon
if animal has linear forgein body and client refuses Sx, euthanize or not?
no, ~47% chance to pass on its own
INTESTINAL SURGERY – LINEAR FOREIGN BODY steps
STEP 1: Remove gastric FB through gastrotomy
STEP 2: Unplicate / relax bowel
STEP 3: Then one or more enterotomies….but Carefully inspect for mesenteric perforations
LINEAR FOREIGN BODY – RED RUBBER CATHETER TECHNIQUE
- what is this?
- After releasing anchored portion of FB, red rubber catheter sutured to remaining linear FB through gastrotomy or single enterotomy
- Catheter manipulated through SI and into colon where a non-sterile assistant can grasp it
- Not always possible in thicker FBs
EVALUATE INTESTINAL VIABILITY -FOUR P’S
- Pink
- Peristalsis
- Pulse
- Palpation
> Wall thickness
SUTURES AND NEEDLES -ENTEROTOMY
- 4-0 Taper needle
- Suture choice
> PDS vs Monocryl vs others?
> Role of pH
if using a simple continuous pattern to close intestine, we need to do what
maintain tension in the suture line
- Tension on the incision by Doyens or Assistant
ENTEROTOMY -LEAK TEST
- how to perform
- Do not overdistend!
- Remove fingers/Doyens prior to removing needle
- 20 ml into 10 cm of bowel occluded with fingers will achieve 34 mm Hg
two populations susceptible to intussusception
- <1 yr old dogs/cats: enteropathy
- Older animals (cats) : neoplasia
INTUSSUSCEPTION clinical signs and feeling? where should we look?
- Clinical signs similar to GI obstruction
- May be palpable as a “sausage” in the abdomen
- Examine ENTIRE GI tract as multiple can occur
INTUSSUSCEPTION - DECISION MAKING
- what do we do, depending on the nature of the intussusception?
- Non-reducible - Resection and anastomosis
- Reducible + non-viable GI - Resection and anastomosis
- Reducible + viable GI - ?????
> Resection and anastomosis?
> Enteroplicate?
> Nothing?
-ENTEROPLICATION? what is it and should we do it? complications?
- for intussuscepition
- Questionable evidence in literature
- Jejunum loops placed adjacently
- 3-0 PDS between them
- Complications: perforation, strangulation, obstruction
SHORT - BOWEL SYNDROME
-HOW MUCH BOWEL CAN YOU RESECT? risk?
- Small intestine length
> 80 cm - 1.3 m - cats
> 1.8 - 4.8 m - dogs - Up to 85% resection reported ok
- > 50% jejunum should pose concern but likely ok
- Malabsorption/maldigestion —> explosive diarrhea
enterectomy steps
Step 1:
- Pass the swaged/blunt end of the needle through the mesentery to minimize risk of bleeding
- Can also use vessel sealer for jejunal vessels
- seal off vessels, clamp around relevant section of bowel
Step 2: anastomosis
- Start at the mesenteric border!!
> Carefully peel mesenteric fat
> 2-3 sutures on either side of “12 o’clock”
> THEN, work your way down: simple continuous to 6 o’clock, then flip and do other side
- Full-thickness, simple interrupted pattern, 2-3mm wide bites!
- MUST include submucosa
- 4-0 PDS, taper needle
- Appositional vs crushing
- place 3 stay sutures at mesenteric border to help ensure ideal suture placement in critical area
> Tension allows for easier suture placement
LUMINAL DISPARITY commonly occurs when? terminology?
- Common occurrence with foreign body
- ABORAD end - non-dilated/SMALLER diameter
- ORAD end - dilated/LARGER diameter
