Management and Outcome of a Non-iatrogenic,Nearly Circumferential,Full-thickness Retroperitoneal Rectal Tear in a Horse

An 8-year-old Quarter Horse stallion presented to the Veterinary Teaching Hospital for evaluation of acute colic and a suspected rectal tear. Clinical examination revealed a nearly circumferential retroperitoneal full-thickness rectal tear. Exploratory laparotomy was performed, and medical management of the tear continued for 6 weeks. Multiple attempts at direct suturing of the tear were unsuccessful. Despite intensive medical management, the horse was not able to defecate, and the tear did not heal adequately, so the horse was humanely euthanized. Necropsy revealed complete obliteration of the muscular layers of the rectum with only a small area of rectal mucosa intact dorsally. There is limited information available on the management of circumferential rectal tears. Based upon this experience and other historical reports, a poor prognosis may be expected for circumferential full-thickness retroperitoneal rectal tears involving the ventral aspect of the rectum.     

THE MANAGEMENT OF RECTAL TEARS IN HORSES

Rectal trauma in horses is usually iatrogenic and carries a high mortality. Partial thickness tears heal without surgical assistance. Full thickness tears require surgical repair through the anus or a ventral laparotomy or, if these are not possible because of difficulty in gaining access to the tear in its usual site at the pelvic inlet, a diverting colostomy to allow the rectum to heal is necessary. This paper describes the management of 15 cases of rectal injury, only 3 of which survived. Two of these were partial thickness tears not treated surgically and the third had a temporary diverting colostomy.     

Novel application of internal obturator and semitendinosus muscle flaps for rectal wall repair or reinforcement

Internal obturator and/or semitendinosus muscle flaps were used to reinforce primary appositional rectal wall repair in three dogs and one cat in this case series. All three dogs incurred rectal wall compromise during surgical excision of anal sac tumours. The cat sustained bite wounds to the perianal region resulting in abscessation and a rectal tear. Our results indicate that application of an internal obturator and/or semitendinosus muscle flap can reduce the risk of rectal wall dehiscence after primary repair, and consequently the risk of pararectal abscess or rectocutaneous fistula formation.     

Use of laparoscopic-assisted jejunostomy for fecal diversion in the management of a rectocutaneous fistula in a dog

A 2-year-old female Siberian Husky was referred for evaluation of a rectocutaneous fistula of unknown etiology. On evaluation, a rectal tear and an associated perivulvar abscess and draining tract were identified. Several attempts were made to repair the rectocutaneous fistula and associated rectal tear. Primary repair and fascia lata graft repair failed. Successful management was achieved via a laparoscopic-assisted end-on jejunostomy for fecal diversion, and the wound healed readily by second intention. During the period of hospitalization, the dog lost a considerable amount of weight. Particular care should be taken regarding fluid therapy, administration of antimicrobials, and adequate nutrition in patients with rectocutaneous fistulas. Overall, the use of laparoscopic-assisted end-on jejunostomy for fecal diversion in the management of rectocutaneous fistulas in dogs appears to be feasible; end-on or loop jejunostomy may also be an option for the treatment of other diseases of the distal portion of the gastrointestinal tract.     

Surgical stapling for repair of a rectal tear in a horse

A grade-4 rectal tear in a mare was successfully repaired per rectum, using a surgical stapling device. The mare had only minor postoperative complications. This technique has some advantages over previously described procedures, but should be reserved for use in selected cases.     

Repeated manual evacuation for treatment of rectal tears in four horses

Horses with tears that involve all layers of the rectum except the mesocolon (grade IIIb) have a poor prognosis for survival because of the difficulty in treating these wounds and the propensity for them to progress to full perforations (grade IV). Most treatments for grade-IIIb rectal tears involve surgery of some kind, but not all grade-IIIb rectal tears require surgical intervention. We report on 4 horses with grade-IIIb rectal tears that were evaluated via palpation per rectum and endoscopy. Two of 4 horses were admitted with signs consistent with shock and endotoxemia, and evaluation of all peritoneal fluid samples was indicative of nonseptic peritonitis. Horses were treated via administration of antibiotics and anti-inflammatory drugs and repeated manual evacuation of the terminal portion of the small colon and rectum. Treatment centered on preventing further enlargement of the rectal tear by eliminating the storage function of the terminal portion of the small colon and rectum. None of our horses had worsening of the original injury, and horses were discharged within 2 weeks of admission with full resolution of the rectal tear. Outcomes in the horses of our report indicate that repeated manual evacuation can be successful for treatment of horses with grade-IIIb rectal tears.     

Rectal atresia in a newborn donkey

A case of a type I rectal atresia (also known as membranous rectal atresia) in a newborn donkey is reported. Clinical examination, survey radiographs and barium enema radiographs suggested rectal atresia. An exploratory laparotomy was performed; however, surgical correction of the defect was not possible due to the narrow pelvic cavity. Euthanasia was performed. At necropsy, it was possible to observe a fibrous cord connecting the small colon to a residual rectal ampulla, which opened to a normal anus. The radiographic and anatomical characteristics enabled the classification of the defect as type I rectal atresia, which is a rare congenital anomaly that is difficult to correct through surgery. This report contributes to the study of rectal atresia in newborn equids, alerts for the occurrence in donkeys and is, to our knowledge, the first to be reported in this species in Brazil.     

Surgical technique to repair grade IV rectal tears in post-parturient mares

Objective— To describe a surgical technique for repair of grade IV rectal tears after parturition in mares and to report outcome.
Study Design— Clinical report.
Animals— Horses (n=6) with grade IV rectal tears.
Methods— Mares were sedated and restrained in standing stocks. After caudal anesthesia and evacuation of feces from the rectum, the perineal region was aseptically prepared. Four stay sutures were placed through the external anal sphincter before vertical transection (12 o'clock). Caudal retraction of the tear was performed using Allis tissue forceps (5 mares) or stay sutures before accurate apposition of the tear margins with steel staples below the tissue forceps. The mucosal edges were then sharply dissected leaving ∼5 mm edges which were apposed in a single layer (2-0 poliglecaprone 25) before stapler release. In 1 mare, the rectal tear was identified and apposed using a 2-layer hand-sutured closure. Systemic antibiotics and anti-inflammatory agents were administered postoperatively (5 mares) and standing abdominal lavage performed (3 mares).
Results— Four mares survived long term and subsequently became pregnant. Immediately after surgical repair, 1 mare was anesthetized for exploratory celiotomy and abdominal lavage but fractured her pelvis during recovery from anesthesia and was euthanatized. A 2nd mare was euthanatized after 72 h because of severe diffuse peritonitis; however, the repair was still intact.
Conclusion— In standing mares, rectal tears can be exteriorized by prolapse through the anal sphincter after sphincterotomy and repaired in 2 layers with staples oversewn with a continuous suture pattern.
Clinical Relevance— Rectal tears occurring as a result of parturition can potentially be repaired efficiently using an oversewn stapled primary closure technique.     

Rectal tears in the horse: malpractice or an unfortunate accident?

Rectal tears are a relatively rare complication of rectal palpation, mating or dystocia, and idiopathic spontaneous occurrence of rectal perforation has also been described. Rectal tears have been classified in a three or a four-grade system. Immediate recognition of the fact that a tear has been made and prompt action will improve the horses chance of survival, and is the best defence of the veterinarian against legislation. There is no clear explanation why rectal tears sometimes occur. A questionnaire of the Netherlands Equine Veterinary Association revealed that rectal tears occurred both to inexperienced veterinarians and to very experienced colleagues, working with or without a probe for ultrasonography. In the opinion of the authors, the approach in the legislation of rectal tears should be that a rectal tear is only considered 'malpractice' if the veterinarian obviously acted carelessly. However, this would create the ridiculous situation that it seems better for the veterinarian-client relationship when the veterinarian confesses to 'careless' rectal palpation. This point needs further clarification, and perhaps an 'insurance of the horse for rectal palpation' will be the solution. Further, retrospectively over the last ten years, the problem is often not 'making a rectal tear', but 'lacking recognition of making a tear'. Whenever a rectal tear is suspected, the veterinarian must assess its severity, discuss the problem openly with the owner and apply appropriate treatment including referral.     

大熊猫直肠脱出手术治疗1例

通过对1只发生直肠脱的幼龄大熊猫清洗、减压、手指还纳、荷包缝合等手术疗法以及输液治疗,特殊护理等措施,在短时间内使该大熊猫恢复了健康,手术取得了满意的效果.     

Rectal tears in the horse: an analysis of 35 cases

The records of 35 horses with Grade 3 or 4 rectal tears, presented to the Veterinary Medical Center at Texas A & M University over a five year period, were reviewed. Grade 3 tears were sub-classified according to whether the remaining tissue was serosa (Grade 3a) or mesorectum (Grade 3b). Five horses were destroyed on presentation and 30 were treated by primary suture closure (8 horses), faecal diversion alone (9 horses) or in combination with suture closure (11 horses) and packing of the tear with medicated gauze sponges (two horses). Faecal diversion was achieved with a temporary indwelling rectal liner (TIRL) in 19 horses and colostomy in one. Survival was related to classification of the tear, efficacy of first aid measures administered at time of injury and method of treatment. Seventy-four per cent of horses with Grade 3a tears and 44 per cent of those with Grade 3b tears survived. Grade 4 tears had a grave prognosis. Horses given adequate first aid before admission had a better survival rate. With proper patient selection, primary closure of the tear with sutures yielded excellent results. In horses which were not candidates for suture closure alone, a combination of faecal diversion and suturing gave better results than faecal diversion only. In addition, selected horses were treated successfully by packing the rectal tear with gauze sponges. The results demonstrate the value of a TIRL to divert faeces and appropriate first aid measures in treating rectal tears.     

Standing rectal and tail surgery.

A variety of rectal, perirectal, and coccygeal surgeries can be performed in the standing equine patient if appropriate chemical and physical restraints are available and adequate regional anesthesia can be achieved. Some rectal tears and most rectal prolapses, mass lesions, perirectal abscesses, rectal biopsies, and selected injuries of the tail can be managed without prohibitive difficulty. Severe injuries that compromise the small colon cranial to the peritoneal reflection may require flank laparotomy, midline celiotomy, or humane euthanasia to manage the disease process effectively and appropriately. The foremost perioperative consideration beyond the use of effective restraint is the management of tenesmus in horses with rectal tears or prolapses. Medications to control bowel motility, epidural anesthesia, antiinflammatory analgesics, and topical compounds adequate to soothe and lubricate inflamed rectal tissues are an important adjunctive therapy in the aftercare of these surgical patients. Of nearly equal importance is the requirement that a loose fecal consistency be maintained with laxative diets, psyllium, and mineral oil. Failure to maintain a loose consistency of stool after treatment of these conditions may lead to rectal impaction or incisional dehiscence and surgical failure.     

Oil Red O-positive lipid in peritoneal fluid from a horse with a rectal tear

A 4-year-old Quarter Horse mare was presented to the Texas A&M University Veterinary Medical Teaching Hospital for evaluation of a rectal tear. On initial evaluation, rectal palpation and colonoscopy revealed a grade IIIb rectal tear. Analysis of peritoneal fluid revealed a modified transudate. Preliminary supportive care included fluid therapy and mineral oil administration via nasogastric tube. Approximately 48 hours after presentation, a second abdominocentesis was performed, and cytologic examination of the fluid revealed a marked suppurative exudate. Round clear nonrefractile material observed within neutrophils and macrophages and in the background stained bright pink to red with Oil Red O, confirming the material as lipid, likely from leakage of mineral oil through the rectal tear. The condition of the mare deteriorated and euthanasia was elected due to the poor prognosis. At necropsy, gross and histologic findings included peritoneal effusion and a full-thickness rectal tear with transmural necrotizing pyogranulomatous colitis and fibrinous peritonitis. To the authors' knowledge, this is the first reported case of Oil Red O-positive lipid vacuoles in the peritoneal fluid of a horse from presumed leakage of mineral oil through a transmural rectal perforation. The frequency of this occurrence in horses is unknown, but it is important for cytopathologists to be familiar with the appearance and significance of lipid-type droplets in phagocytic cells in cytologic fluid analysis specimens.     

北京地区泌乳牛夏季鼓膜温度昼夜节律及影响因素研究

【目的】 试验旨在揭示北京地区荷斯坦泌乳牛鼓膜温度的群体特征及其随昼夜和环境温湿度指数（temperature-humidity index,THI）的变化规律,探究中度热应激下泌乳牛鼓膜温度的影响因素及其与直肠温度的关系。【方法】 2021年8月对北京地区某规模化牧场638头荷斯坦泌乳牛的鼓膜温度、直肠温度及环境温湿度进行测定,并对其进行描述性统计;对161头荷斯坦泌乳牛6 h鼓膜温度和直肠温度进行相关性分析;利用混合线性模型分析THI、测定时间、胎次、泌乳阶段和繁殖状态等因素对鼓膜温度和直肠温度的影响。【结果】 北京地区荷斯坦泌乳牛夏季鼓膜平均温度为（39.01±0.40）℃;测定时间内THI为76.11~83.18,此时泌乳牛处于中度热应激。泌乳牛鼓膜温度昼夜变化较大,昼夜节律表现为上午低、下午和傍晚均较高且在早晨和下午出现不正常峰值,鼓膜温度的变化滞后于THI变化。鼓膜温度与直肠温度呈显著正相关关系（P<0.05,r＝0.35）,且两种体温均随着THI的升高而升高,回归系数分别为0.09（P<0.05,R²=0.09）和0.10（P<0.05,R²=0.08）。测定时间和胎次对泌乳牛鼓膜温度有显著影响（P<0.05）,胎次和泌乳阶段对泌乳牛直肠温度有显著影响（P<0.05）,且THI对两部位温度的回归均显著（P<0.05）。【结论】 本研究揭示了奶牛体温的节律变化和影响因素,鼓膜温度可有效反映奶牛实时体温,可为精细化管理牛群提供理论依据。     

Conservative management of uroperitoneum in a gelding.

Uroperitoneum as a sequela to urethral calculus in an adult gelding was successfully managed by use of subischial urethrotomy and abdominal drainage. Necrosis of bladder mucosa was seen endoscopically, but a tear or rupture was never identified. Peritonitis developed but was controlled with antibacterial treatment. Although uroperitoneum is usually a sequela to bladder rupture and the ideal treatment is surgical repair, conservative management may be warranted in selected cases.     

Temporary indwelling rectal liner for use in horses with rectal tears

A temporary indwelling liner was surgically installed in 17 horses with grade III or grade IV rectal tears. The rectal tears of 9 of the horses healed. The remaining 8 horses developed peritonitis as a result of peritoneal contamination before surgery, a change in grade of the tear, or material failure.     

Evaluation of transanal endoscopic treatment of benign canine rectal neoplasia

OBJECTIVES: To evaluate transanal endoscopic treatment in the management of benign canine rectal neoplasia. METHODS: A retrospective study was carried out to evaluate the response to transanal endoscopic treatment in 13 dogs with extensive rectal neoplasia that was considered inoperable by conventional surgical techniques but was indicated as benign by previous biopsy. RESULTS: Tumours affected the lengths of rectal mucosa varying from 2 to 13 cm. Between 25 and 100 per cent of the rectal circumference was affected in each case. Transanal endoscopic treatment of canine rectal neoplasia was curative in five dogs, palliative in three and associated with a poor result in the remaining five. Complications of the technique included rectal perforation, leading to peritonitis and death. CLINICAL SIGNIFICANCE: Transanal endoscopic treatment can be recommended as an alternative to radical, full-thickness rectal excision for the management of extensive but benign canine rectal neoplasia. Owners should be informed that the treatment may be palliative rather than curative and that complications, if they occur, can be fatal. Dogs should be hospitalised for at least five days after treatment and observed for signs of potentially fatal complications such as rectal perforation.     

Decision for surgery

Based on the clinical impression and the current knowledge of the clinical variables (rectal examination, abdominal distention, abdominal fluid, intractable pain) most likely to differentiate between medical and surgical cases, three decision trees are provided as a guide to making the management decision in a horse with abdominal pain. Prior elimination of horses with limited life expectancy because of age or function or where financial constraints are present is understood. It must be emphasized that most of the information presently available originates from referral centers where the prevalence of surgical candidates is much higher than in general practice. This would influence the accuracy of the clinician in identifying horses with a surgical lesion or estimating survival (positive predictive value).     

Near circumferential retroperitoneal rectal tear in a pony

A 13-year-old, 370-kg, Appaloosa gelding with mild colic of 4 days' duration was found to have a near circumferential retroperitoneal rectal tear. Accumulation of feces at the site of the repair had created a large perirectal cavity. Removal of feces and cleansing of the perirectal cavity were performed daily. Sutures were placed to stabilize, but not reappose, the torn ends of the rectum. The perirectal cavity filled with granulation tissue, and the rectal tear healed.     

Type IV rectal prolapse secondary to a long‐standing urinary bladder lithiasis in a donkey

Rectal prolapse has been attributed to conditions generating tenesmus or increasing abdominal pressure in both horses and donkeys. This report presents the case of a 7‐year‐old gelded donkey that sustained a type IV rectal prolapse secondary to a long‐standing cystic calculus after several episodes of intermittent mucosal prolapse. Rectal prolapse was addressed first on an emergency basis by colorectostomy. After medical stabilisation, pain and straining management with repeated epidural drug administrations, a laparoscopic‐assisted cystotomy was performed one week later to remove the calculus. The donkey was discharged and resumed his normal life at pasture.