Surgical Diseases of the Rectum and Anus Flashcards
Taught by Dr. Guy St. Jean
This is a Grade ___ rectal prolapse
Grade 4
- Image shows a Grade 4 rectal prolapse with a tear and omentum
- Requires a celiotomy and maybe amputation of the infarcted portion of the small colon and rectum
What surgery is being performed here?
rectal amputation
- Needles placed in the viable rectum for stabilization
- Place ligating sutures full thickness through the rectum
- Amputate distal to the suture
When is a colostomy recommended for rectal tears?
Tears >25% of rectal diameter or tears located >50cm inside rectum
-
Colostomy is fecal diversion to the left paralumbar fossa
- Colostomy will result in complete diversion of the feces and can be maintained as long as necessary for the rectal tear to heal
T/F: All four grades of rectal prolapse have exposed mucosa
True
A tear that penetrates into the peritoneal cavity describes a Grade ____ rectal tear
Grade IV
What can be done to create inflammation and adhesions around the rectum in ruminants?
Inject iodine perirectally
Using your finger (or Kanye’s finger) and a 1.5” needle. This technique can NOT be used in foals or mares! They are too sensitive and would probably cry.
What are some causes of rectal prolapse in large animals?
constipation, impaction, dystocia, intestinal parasitism, colitis, urethral obstruction, excessive coughing, diarrhea, short tail
What is your diagnosis?
rectal prolapse and vaginal prolapse
The rectum is devitalized and needs to be removed. The two options for thise are submucosal resection of the rectum or complete amputation (more commonly performed)
What is your diagnosis?
Grade IV rectal tear
What is your diagnosis?
Grade III rectal tear
This is a Grade ____ rectal prolapse in a sheep
Grade 2
What is your diagnosis?
rectal prolapse and vaginal prolapse
Treatment: surgical resection of devitalized tissue
A tear through the muscularis layer describes a Grade ____ rectal tear
Grade II
(Mucosa and serosa still intact)
How is a rectal liner removed?
Chromic gut is used to suture it in place. This breaks down in 2 weeks and the PVC pipe and plastic bag are passed in feces
A tear through the mucosa, submucosa, and muscularis describes a Grade ____ rectal tear
Grade III
Prognosis for rectal tears depends on the grade of the tear. Grades 1 and 2 are good (82%). Grades 3 and 4 are fair to poor.
- Survival rate with colostomy is ~_____
- Survival rate with rectal liner is ~_____
- Survival rate with colostomy is ~60%
- Survival rate with rectal liner is ~40%
What is the treatment for Grade I or II rectal tears?
- Antibiotics
- Analgesics
- Laxatives/Diet to cause soft feces
- NO RECTAL PALPATION!
What is the treatment for rectal prolapse?
- Epidural anesthesia
- Manual reduction (or surgery if tissue is devitalized or manual reduction is impossible)
- Topical agents to decrease edema
- +/- purse string suture
What surgical approach is needed to place a rectal liner?
Caudal ventral midline incision
Rectal liner is constructed by gluing a palpation sleeve with the hand removed to a 5cm diameter and 7cm long rectal prolapse ring. The rectal liner is positioned cranial to the tear
What is your diagnosis?
Grade I rectal tear
Why should the patient be kept standing until the rectal liner has been passed?
To prevent retraction of the liner into the rectum when the horse lies down
A tear through the mucosa and/or submucosa describes a Grade ____ rectal tear
Grade I
What is the main cause of rectal tears in equine patients?
Iatrogenic (rectal palpation)
Which grade(s) of rectal tear should be referred?
Grades 3 and 4
What is the difference between a Grade IIIa and IIIb rectal tear?
- 3a: serosa remains intact
- 3b: extension into the mesocolon
T/F: Type 1 and 2 rectal prolapse will rarely cause complete obstruction
True
Type 1 and 2 prolapse will rarely cause complete obstruction unless they are present for a long time
What is your diagnosis?
Grade II rectal tear
