Surgery of the Small Intestine Flashcards
Importance of small intestinal surgery
It accounts for around 25-64% of all colic disorders- strangulating mostly (60-85% are strang)
Assesment of intestinal viability
Flueorescin dye: for ischaemic stang disorder
Surface oximetry: PsO2 has specificity of 100%
Doppler US: haem strang
Histopath
Clinical assesment:
- colour of serosa and mucosa
- Peristalsis or changes in peristalsis
- pulsation of mesnterial artery
What is unique about the small intestine?
The villi have a special bs therefore is less tolerant than the Large colon
Strang lesions account for 60-85%
Prestenotic dilation is a concern
Ischaemic wall could be prone to reperfusion injury
What are the strang obstructions of the SI
Volvulus
Epiploic foramen
Penunculated lipoma
Tears of the mesentery
Intussusception
Inguinal hernia
Lig gastrolienalis tear- int hernia
Umbilical hernia- Richter’s or Littre’s
Diaphragmatic hernia
Volvulus
Usually at 2-4 months of age
Mesnterium turns >180degrees
Volvulus nodosus: when the mesentery forms a know: seen btw 2-7 months of age
Foramen epipoicum Winslowi
Left to R
Ileum involvement
Crib biters and wind suckers
Usually requires reoperation
Mostly mild clinical signs, 50% have reflux
Itussusception
Jejunojejunal- all ages, long
Ileocaecal <3yrs, small
Abdomical hernias
Umbilical
Traumatic
Postop
Prepubic tendon rupture
Inguinal hernias
When abd organs found in the ing canal (usually SI loop)
Acquired: Direct vs indirect(real)
Congenital: scrotal (hernial content in the vaginal tunic)
Congenital indirect inguinal hernia
Foals
No colic symptoms
Can palpate intestines in the scrotum
Fluctuent swelling
Not painful
Treatment: can outgrow in 3-5 months! Immediate surgery if colic signs do develop
If direct: need to perform surgery!!
Acquired indirect inguinal hernias in adults
Clinical symptoms:
Early: rectal palpation of stuctures is v painful!
Indolent: no pain upon palpation- suspect necrotic intestine in this case
Acquired indirect intestinal hernias: Diagnosis and Differentials
Diagnosis: History and clinical signs
Palpation
Visual exam
Palpation upon rectal exam
Differentials
- Twisted testicle
- Thrombosis of testicular artery
- Seroma or hematoma
- Pyocele- pus in vaginal tunic
- Orchitis
- Teratomas of testicle or scrotum
Acquired indirect intestinal hernias: treatment
Peracute: Pull out rectally, or massage back in whilst under GA and then continue to castrate the animal
Surgical: GA Dors recumbency
- herniotomy- resection of gut if it is necessary
- decompression the prestenotic part of the intestine
- Castration- close ext ing ring
- Should probably castrate other side too
- Laparoscopic closing of vaginal process
Acquired direct inguinal hernias: clinical signs, treatment and prognosis
Mild to moderate colic!
Adhesions and inflamm of intestines
Treatment: must act quickly to close the hernial ring
Guarded to good prognosis
Non-strangulating obstructions of the small intestine
Impaction of the ileum
Hypertrophy of muscle of ileum
Ascarids- impactions
Duodenitis, prox jejunitis
Neoplasia
Gastroduodenal obstruction
Ileal impaction
Up to 90cm
Seasonal: winter-early spring
Anoplocephala perfoliata
Mares and arabians
Enterotomy is contra!!
Jejunocecostomy not usually recommened
Reimpactions are rare
Parascaris causing impaction
usually around 5 months of age
Over half after antihelminthic treatment
High mortality in serious cases
- Toxins
- Necrotising enteritis
- Peritonitis, adhesions
- Mechanical obturation etc
Duodenitis, prox jejunitis (is this also known as prox entritis?)
Cause unknown- Clostr toxins, parasites?
Fever, incr WBCs, reflux!- can produce 48L in 24hrs!- has reddish discolouration
Colic signs
Decompression offers improvement (decr HR)
Peritoneal fluid normal
Rectal exam: distension
Treatment: decompression, electrolytes
AB’s and PREVENT LAMINITIS
Enteritis and Fibrosis
Eosinophilic gastroenteritis: local or generalised
Anastomosis of the SI
End to end using continuous Lembert
Side to side: seen with jejunocaecostomy?
Disorders of the caecum
- Impaction
- Caecocaecal invagination
- Caecocolonal invagination
- Volvulus, torsion
- Infarction
Caecum impactions
Type 1: hard: mechanical?
Type 2: semi-solid/fluid: paralytic?
What can cause caecocolic or ileocaecal intussusception?
Anoplocephala perfoliata
Diseases of the ascending colon (the L and R ventral and dorsal colon)
Large colon tympany- most common cause of colic!
Impaction- try to trat conservatively
Sand colic
Enterolithiasis
Large colon displacement: because the suspension is loose
Torion or volvulus
*displacement occurs more frequently than torsion
Tympany
Together with displacement
Decompress:
- through the caecum- with marek trocar or 12G IV catheter
- or through rectum
Pelvic flexure enterotomy
Requires a colon tank
Suture in 2-3 layers
*I think indicated for RDD?
LEft dorsal displacement
Also known as Nephrosplenic entrapment
Conservative treatment 90% successful
Phenylephrine for splenic contration
In recurrent cases: Laparoscopic closure of the NSS
Prophylaxis:
- ablation of the space laparoscopically
- coloplexy
- large colon resection
Volvulus
Also known as torsion
Strang vs non-strang (90-360degrees)
Usually seens in prev colic cases (esp broodmares)
Post foaling
Sever pain
Characterised by direction and point of twist: bad if >90degress clockwise
Treatment of Volvulus
Resection: must assess the viability of the colon
- clinically: mucosa, pulse
- Intraluminal P (by Doppler)
- Histopath!!
- Pre-op lactate in the plasma
- Post-op colon wall thickness- measure on US
Colopexy
Desc colon
Colon tenue
Has broad antimesenteric taenia
Long, fatty mesocolon
Diseases of the descending colon
Miniature breeds esp!!
Impaction/obstipation
Tooth problems
Lesions of vessels
Lipoma pedulans
Enteroliths
Diseases of the descending colon: complications of conseervative treatment
Thrombophlebitis
Diseases of the descending colon: complications of surgery
Paralytic ileus
Wound infection
Colic!! because of adhesions
Thrombophlebitis
Rectal tears and prolapse
Tear: I, II, IIIa and IIIb, IV
Prolapse: I-IV
Non intestinal colic diseases
- CV: thrombus in iliac artery, pericarditis
- Thorax: pleuritis and pleuropneumonia
- Abdomen: neoplasia, abscess, peritonitis, haematoma
- Liver: cholelithiasis, cholangiohepatitis
- Spleen: abscess, splenomegaly
- Urinary tract: nephrolith, pyelonephritis, cystits, bladder rupture
- Mare genital tract:ovulation, theca or gran cell tumour, uterine torsion
- Stallion genital: testicle torsion, orchitis
- Muscle-bone: laminitis, rhabdomyolysis
- NS: tetanus, botulismus, EMND
Muscle hypertrophy of the ileum
Lecture notes on inguinal hernias
Congenital vs acquired
Indirect:
- Intact peritoneum covering the hernial sac
- Recurrence is frequent
- Adult stallions: acute, aggressive colic
- V. hard vaginal tunic
- Won’t see SI loops in this case?
Dircect
- Rupture of vaginal tunic - SI can come out through and this is visible under the skin OR tear just next to the inguinal canal
