Surgical affections of small intestine
Surgical affections of small intestine are Intestinal obstruction or ileus, Intussusception, Volvulus, Intestinal torsion, Foreign body in intestine, Colic etc.
Principles of intestinal surgery
Fluid Therapy
Correcting the fluid and electrolyte imbalance is of great priority before venturing for intestinal surgery Fluids like RL and MES are highly helpful and the dehydration score chart is used to correct the deficit. In case of severe blood loss blood transfusion and colloids administration is indicated.
Antibiotic Prophylaxis
The small intestine has both gram positive and gram negative organisms. The surgical procedure can be classified as clean, clean contaminated and contaminated depending upon the condition for which it is operated. In general a broad spectrum antibiotic is indicated as prophylaxis.
Usually second or third generation cephalosporin is employed. In case of gangrene to counter anaerobic organisms metronidazole is indicated.
Assessment of Intestinal Viability
This is important for prognosis of the patient. It can be done by visual comparison, Fluorescein dye test and surface oximetry. Surface oximetry is more useful method
Choice of suture material for closure
Monofilament synthetic absorbable (PDS) or synthetic non-absorbable (prolene) are excellent choices.
Multi-filaments are also employed for closure but produces more tissue drag when compared to monofilaments
Choice of Suture Pattern
Simple interrupted pattern is ideal for small intestinal surgery.
Suture Reinforcement
Application of Omental and serosal patch aids in faster healing clean instruments should be set aside for closure.
Clean procedures such as liver biopsy should be performed before intestinal biopsy. Intestine samples can be obtained with a scalpel blade or skin biopsy punch suture can be placed in the intestine to be sampled.
The stay suture allows manipulation of the sample without damage. The sample and attached stay suture can be placed directly in formalin; the suture will not interfere with processing.
The intestinal wall should be incised near the stay suture to limit the size of the resulting surgical wound.
Surgical affections of small intestine
Surgical affections of small intestine in animals are-
- Intestinal obstruction or ileus
- Intussusception
- Volvulus
- Intestinal torsion
- Foreign body in intestine
- Colic
Intestinal obstruction or ileus
Intestinal obstruction or ileus is the hindrance to onward passage of intestinal contents. Intestinal obstruction or ileus is various types. It may be Mechanical, Paralytic or Congenital (Meckel’s diverticulum).
Etiology
- Foreign body obstruction
- Stenosis due to inflammation
- Paralitic Ileus
- Congenital stenosis or agenesis
- Faecal stasis
- Intussusception
- Torsion or volvulus
Clinical Signs
- Small animals suffering from intestinal obstruction may vomit.
- Extreme weakness and animals may die in the course of 8-10 days.
- Smooth foreign bodies pass through and may cause stoppage at the ileocecal valve
- Distension of bowel loops and distended abdomen
- Passing no stool/ blood tinged mucous discharge
- per rectal examination reveals empty rectum and distended bowel loops.
Diagnosis
- Based on clinical signs
- By palpation
- By X-rays- Plain or Contrast (Barium sulphate meal)
- Ultrasound
- Laparoscopy or endoscopy
Treatment
Treatment is only surgical correction here, that is known as Enterotomy (It is an incision into the intestine).
Enterotomy procedure
- Exteriorize and isolate the diseased or obstructed intestine from the abdomen by packing with towels
- Gently remove the intestinal contents from the isolated segment
- With non crushing intestinal forceps, occlude the intestinal lumen
- Make a full thickness stab incision into the intestinal lumen with a No 11 scalpel blade
- Remove the foreign bodies by incising the healthy-appearing tissue distal to the foreign body
- Remove the foreign body
- Close the incision with apposition or inversion simple interrupted sutures and omentalization.
Intussusception
Intussusception is the telescoping or invagination of a proximal intestinal segment (intussusceptum) into the lumen of the distal segment (intussuscipiens).
Abdominal palpation reveals a sausage shaped mass.
Treatment of Intussusception is by enteropexy.
Enteroanastomosis is done if the intestinal segment is devitalised.
Symptoms
- Pain
- Vomiting
- Scanty-pasty and blood stained faeces
- Empty rectum
- Dehydration
- Depression and jaundice
Diagnosis
- X-ray radiographs
- exploratory laparotomy (In calves its difficult to diagnose)
Treatment
Perform laparotomy and correct intussusception by gentle traction and simultaneous squeezing the outer wall of the invaginated portion to push out the invaginated part. Recurrence can be prevented by ventro-fixation of the bowel to mesentery where invagination has started. In case of adhesion and devitalisation – enterectomy & enteroanastomosis.
Volvulus
Volvulus is the twisting of the bowel in its mesenteric axis or a segment of intestine coiling around & strangulating another segment of intestine.
Volvulus is common in equines.
Intestinal torsion
Intestinal torsion is the twisting of bowel in its long axis.
Symptoms
severe colic occurs suddenly-animal kicks towards the abdomen Lies down & get up, walk in circle- within an hour bilateral distension of the abdomen, edema, venous stasis, hypovolemic shock, toxemia-death within 6-24 hrs. Initially temperature raise later falls. Weak & accelerated Pulse, sweating, marked depression, anxious expression, maniacal movements and various degree of acetonemia also may be present.
Diagnosis
- Based on clinical symptoms
- Per rectal examination (In large animals rectal examination reveal twisted mass of intestine)
- Exploratory laparotomy
Treatment
Laparotomy is the only surgical treatment.
Foreign body in intestine
Pebbles, hair bands, fish hooks are some commonly seen foreign body in intestine of animals.
Linear foreign body typically anchors itself around the base of the tongue or at the pylorus causing intestinal loops to gather into accordion like pleats along the object.
Colic
Colic in animals may be true or false colic-
- True colic: Overloaded stomach, Spasm of ileum, Impaction of colon, caecum, volvulus of jejunum and colon, Incarcerated inguinal hernia
- False colic: Liver toxicosis, Renal abscessation
Symptoms
Anxiety, restlessness, Stamping the hindlimb, kicking of abdomen, Rolling, biting objects, profuse sweating, defecation, grinding of teeth, Accelerated respiration & pulse with normal rectal temperature, Petechiae of mucus membrane, depression and dullness.
Treatment
Relief of pain by analgesic, xylazine, Pentazocine. Body massage, Provide bedding, Relieve gas and fluid from stomach by Naso-gastric tube intubation, Compensate fluid loss and shock, Exploratory laparotomy and corrective surgery.