Surgical Diseases of the Rectum and Anus

Question 1

This is a Grade ___ rectal prolapse

Answer 1

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

Question 2

What surgery is being performed here?

Answer 2

rectal amputation

• Needles placed in the viable rectum for stabilization
• Place ligating sutures full thickness through the rectum
• Amputate distal to the suture

Question 3

When is a colostomy recommended for rectal tears?

Answer 3

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

Question 4

T/F: All four grades of rectal prolapse have exposed mucosa

Answer 4

True

Question 5

A tear that penetrates into the peritoneal cavity describes a Grade ____ rectal tear

Answer 5

Grade IV

Question 6

What can be done to create inflammation and adhesions around the rectum in ruminants?

Answer 6

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.

Question 7

What are some causes of rectal prolapse in large animals?

Answer 7

constipation, impaction, dystocia, intestinal parasitism, colitis, urethral obstruction, excessive coughing, diarrhea, short tail

Question 8

What is your diagnosis?

Answer 8

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)

Question 9

What is your diagnosis?

Answer 9

Grade IV rectal tear

Question 10

What is your diagnosis?

Answer 10

Grade III rectal tear

Question 11

This is a Grade ____ rectal prolapse in a sheep

Answer 11

Grade 2

Question 12

What is your diagnosis?

Answer 12

rectal prolapse and vaginal prolapse

Treatment: surgical resection of devitalized tissue

Question 13

A tear through the muscularis layer describes a Grade ____ rectal tear

Answer 13

Grade II

(Mucosa and serosa still intact)

Question 14

How is a rectal liner removed?

Answer 14

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

Question 15

A tear through the mucosa, submucosa, and muscularis describes a Grade ____ rectal tear

Answer 15

Grade III

Question 16

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 ~_____

Answer 16

• Survival rate with colostomy is ~60%
• Survival rate with rectal liner is ~40%

Question 17

What is the treatment for Grade I or II rectal tears?

Answer 17

• Antibiotics
• Analgesics
• Laxatives/Diet to cause soft feces
• NO RECTAL PALPATION!

Question 18

What is the treatment for rectal prolapse?

Answer 18

• Epidural anesthesia
• Manual reduction (or surgery if tissue is devitalized or manual reduction is impossible)
• Topical agents to decrease edema
• +/- purse string suture

Question 19

What surgical approach is needed to place a rectal liner?

Answer 19

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

Question 20

What is your diagnosis?

Answer 20

Grade I rectal tear

Question 21

Why should the patient be kept standing until the rectal liner has been passed?

Answer 21

To prevent retraction of the liner into the rectum when the horse lies down

Question 22

A tear through the mucosa and/or submucosa describes a Grade ____ rectal tear

Answer 22

Grade I

Question 23

What is the main cause of rectal tears in equine patients?

Answer 23

Iatrogenic (rectal palpation)

Question 24

Which grade(s) of rectal tear should be referred?

Answer 24

Grades ​3 and 4

Question 25

What is the difference between a Grade IIIa and IIIb rectal tear?

Answer 25

• 3a: serosa remains intact
• 3b: extension into the mesocolon

Question 26

T/F: Type 1 and 2 rectal prolapse will rarely cause complete obstruction

Answer 26

True

Type 1 and 2 prolapse will rarely cause complete obstruction unless they are present for a long time

Question 27

What is your diagnosis?

Answer 27

Grade II rectal tear