Small colon intussusception in a broodmare

A 9-year-old pregnant Standardbred broodmare was evaluated for signs of mild abdominal pain, failure to defecate, and mild abdominal distention. Rectal examination revealed the leading edge of a small colon intussusception, and peritoneal fluid analysis indicated suppurative peritonitis. Surgical management, including reduction of the intussusception and small colon resection with end-to-end anastomosis, resulted in successful outcome (1-year follow-up evaluation). Postoperative complications including dehiscence of the ventral midline surgical incision and simple obstruction at the anastomosis site necessitated a second surgical procedure. Small colon intussusception is an uncommon cause of signs of abdominal pain and is similar to type-IV rectal prolapse.     

Anastomoses of intestinal tract as a sequela to rectal stricture in swine.

Rectal stricture with anastomoses of colon and/or small intestine to a spherical dilatation of the descending colon proximal to the stricture was observed in six swine. In three of these swine, feces bypassed most of the colon in passage from the small intestine to the dilated colon. Rectal stricture with an anastomosis of a loop of colon to the rectal stricture was observed in one pig where feces bypassed much of the stricture.     

Diagnosis and surgical treatment of functional obstruction of the right dorsal colon in a horse

Functional obstruction of the right dorsal colon was found at surgery in a 6-year-old American Saddlebred gelding with a history of anorexia, depression, weight loss, and intermittent colic. Side-to-side anastomosis of the right dorsal colon to the small colon was done to bypass the obstruction. Histopathologic findings of the right dorsal colon and regional colonic lymph nodes were unremarkable. Surgical treatment was successful.     

Resection and Anastomosis of the Descending Colon in 43 Horses

Objectives: To determine (1) the short‐ (to hospital discharge) and long‐ (>6 months) term survival, (2) factors associated with short‐term survival, and (3) the perioperative course for horses with resection and anastomosis of the descending colon. Study Design: Multicentered case series. Animals: Horses (n=43) that had descending colon resection and anastomosis. Methods: Medical records (January 1995–June 2009) of 7 equine referral hospitals were reviewed for horses that had descending colon resection and anastomosis and were recovered from anesthesia. Retrieved data included history, results of clinical and clinicopathologic examinations, surgical findings, postsurgical treatment and complications, and short‐term survival (hospital discharge). Long‐term survival was defined as survival ≥6 months after hospital discharge. Results: Of 43 horses, 36 (84%) were discharged from the hospital. Twenty‐eight of 30 horses with follow‐up information survived ≥6 months. No significant associations between perioperative factors and short‐term survival were identified. Lesions included strangulating lipoma (n=27), postfoaling trauma (4), infarction (4), intraluminal obstruction (2), and other (6). Common postoperative complications included fever and diarrhea. During hospitalization 7 horses were euthanatized or died because of septic peritonitis (3), endotoxemia (3), and colic and ileus (1). Conclusions: Descending colon resection and anastomosis has a favorable prognosis for hospital discharge and survival ≥6 months. The most common cause of small colon incarceration was strangulating lipoma. Clinical Relevance: Complications include postoperative fever and diarrhea but the prognosis is good after small colon resection and anastomosis.     

Inguinal Herniation of the Ascending Colon in a 6‐month‐old Standardbred Colt

Objective— To report inguinal herniation of the ascending colon in a Standardbred colt. Study Design— Case report. Animals— A 6‐month‐old Standardbred colt. Methods— The colt underwent surgical exploration of the hernia with large colon resection and anastomosis. Results— A successful large colon resection and anastomosis was completed, however, the colt was euthanatized at the end of surgery upon owner request. Conclusions and Clinical Relevance— Although uncommon, indirect inguinal herniation of the ascending colon can occur in young horses.     

Idiopathic eosinophilic colitis lesions of the equine small (descending) colon

Five horses with a primary surgical lesion of the small (descending) colon were diagnosed with eosinophilic colitis based on visual and histopathological examination. These were evident as visibly striking, hyperaemic, focal lesions of the small colon, with serosal petechiation, oedema and marked thickening of the intestinal wall at the site. Areas of focal necrosis were also evident. The gross appearance of the lesions were considered to be sufficiently severe in all cases to merit resection, due to concerns about intestinal necrosis and septic peritonitis. An inability to fully exteriorise the affected portion of intestine to perform a resection and anastomosis necessitated intraoperative euthanasia of one horse. A total of three horses survived to hospital discharge. Eosinophilic colitis lesions are a rare cause of severe small colon disease, but should be considered in cases with similar visual characteristics.     

Methodological studies on the formation of CO2 and volatile fatty acids in porcine ileo-chyme and faeces

As part of digestibility and energy metabolism studies in intact and ileorectostomized growing pigs model experiments were carried out on sampling techniques and the influence of storage conditions on CO2 and volatile fatty acid production in chyme. Results on the formation of CO2 and VFA in chyme and faeces are given. They indicate that chyme from the small intestine can be subjected to bacterial and enzymatic changes outside the animals and therefore must be stored in a cool place. In the chyme of IRA animals with closed colon descendens (end-to-end anastomosis) significantly reduced VFA contents were found in comparison to animals with open colon descendens (end-to-side anastomosis).     

Large colon resection

With large colon resection and anastomosis, up to 95 per cent of the length of the large colon has been successfully removed. A hand-sewn end-to-end anastomosis is effective for lesions in the left dorsal colon and pelvic flexure. Transection and a side-to-side anastomosis with stapling equipment is most effective for extensive resections (greater than 50 per cent). Horses with extensive colon resection (95 per cent) have permanent deficiencies of water absorption and digestion of cellulose and protein. Fermentative capacity is reduced, owing to decreased particulate matter retention time in the smaller capacity colon. These deficits are minimized with alfalfa hay as the source of forage (fed at 2 per cent of the body weight), and normal blood variables and body weight can be maintained. Voluntary intake increases to help maintain a positive nutrient balance. Grass hay, owing to the higher cell wall content, is inadequate as the sole source of energy and protein, and weight loss will occur. Ad libitum intake of water is recommended at all times, owing to the increased fecal water loss.     

Rectovaginal fistula following colectomy with an end-to-end anastomosis stapler for a colorectal adenocarcinoma

An 11-year-old, female neutered Labrador retriever was presented with a micro-invasive differentiated papillar adenocarcinoma at the colorectal junction. A colorectal end-to-end anastomosis stapler device was used to perform resection and anastomosis using a transanal technique. A rectovaginal fistula was diagnosed two days later. An exploratory laparotomy was conducted and the fistula was identified and closed. Early dehiscence of the colon was also suspected and another colorectal anastomosis was performed using a manual technique. Comparison to a conventional manual technique of intestinal surgery showed that the use of an automatic staple device was quicker and easier. To the authors' knowledge, this is the first report of a rectovaginal fistula occurring after end-to-end anastomosis stapler colorectal resection-anastomosis in the dog. To minimise the risk of this potential complication associated with the limited surgical visibility, adequate tissue retraction and inspection of the anastomosis site are essential.     

Cecocolic Anastomosis for the Surgical Management of Cecal Impaction in Horses

Fourteen horses with cecal impaction were treated by cecocolic anastomosis. In nine horses, the anastomosis followed enterotomy and evacuation of the cecal contents, and in two horses it followed saline infusion and massage of the cecum. In three horses, the anastomosis was the only surgical procedure performed. Cecocolic anastomosis was performed between the lateral and dorsal cecal teniae, and the lateral and medial free teniae of the right ventral colon. The anastomosis was hand sutured in five horses. In all other horses, the GIA surgical stapling instrument was used in combination with hand sutured seromuscular layer closures and became the preferred surgical technique. The anastomosis allowed an alternative route for the transit of ingesta from the cecum to the right ventral colon.
Twelve of the 14 horses survived 2 months or longer after surgery (short-term survival rate, 86%) and 10 horses survived 12 months or longer after surgery (long-term survival rate, 71%). Early postoperative complications included mild abdominal pain (6 horses), wound infections (3 horses), fatal peritonitis (2 horses), and large colon distention necessitating reoperation (2 horses).     

Comparison of a Biofragmentable Intestinal Anastomosis Ring With Appositional Suturing for Subtotal Colectomy in Normal Cats

A subtotal colectomy was performed on 12 normal adult cats using an interrupted apposing suture pattern of monofilament polyglyconate (n = 6) or a biofragmentable intestinal anastomosis ring (Valtrac, Davis and Geek Company, Danbury, CT) (n = 6) composed of polyglycolic acid and barium sulfate. Abdominal radiographs were made daily, beginning 10 days after surgery, to determine fragmentation rates of the anastomosis ring. The cats were euthanatized 30 days after surgery, and a gross and histopathological evaluation of anastomotic healing and stricture formation was performed. The technique for implantation of the anastomosis ring was easy to learn and required only two purse string sutures to complete. Intraoperative complications associated with the anastomosis ring were minor, and included problems with purse string suture placement, small serosal tears, and spasms of the colon that reduced the lumenal diameter. There were no intraoperative complications in the cats with sutured anastomoses. Postoperative recovery was uneventful in all cats. The anastomosis rings fragmented 12.2 ± 1.1 days (mean ± standard deviation [SD]) after implantation and passed in the stool 3.8 ± 1.9 days later without clinical signs in five of six cats. There were no statistically significant differences between the time required to perform the anastomosis ( P = .348), postmortem gross anastomosis grades ( P = .088), or percent of lumenal stricture ( P = .178) between the two groups. Histologically, the only significant differences were an increased muscular inversion in the anastomoses performed using the fragmentable ring ( P = .039) and an increased muscular eversion in the sutured anastomoses ( P < .001) compared with normal colonic architecture.     

T-shaped malformation of the ventral colon in a Thoroughbred filly with colic

A 4-month-old Thoroughbred filly presented for abdominal pain was diagnosed with a T-shaped malformation of the ventral colon at exploratory laparotomy. Following resection and anastomosis of the large colon, no further episodes of abdominal pain occurred during a 12-month follow-up. Acute dehiscence of the linea alba occurred as a complication of the initial laparotomy, but was successfully managed following additional surgical repair. T-shaped malformation of the ventral colon has not previously been reported and is considered a congenital malformation of mesocolon formation.     

A Modified Technique for Extensive Large Colon Resection and Anastomosis in Horses

Objective —To describe an alternative technique for large colon resection and anastomosis in horses.
Study Design —Retrospective study of clinical patients.
Animal Population —37 horses that had ventral midline celiotomies between July 1, 1990, and July 1, 1994.
Methods —Large colon resection and anastomosis was performed using a modification of previously described techniques. Modifications include mesocolon ligation with a stapling device and an end-to-end apposition of the right ventral and right dorsal colon.
Results —Twenty-one of the 37 horses were discharged from the hospital without complications. Two horses were euthanatized immediately after recovery from anesthesia because of hindlimb fracture. Fourteen horses were euthanatized in the initial postoperative period because of persistent endotoxemia and abdominal pain.
Conclusions —The described technique is a safe, reliable method for large colon resection and anastomosis in horses.
Clinical Relevance —The described technique is fairly simple to perform and requires less surgical time compared with other techniques.     

Evaluation of three techniques for end-to end anastomosis of the small colon in horses

In an attempt to determine the best method for surgical removal of devitalized small colon lesions, 12 horses underwent a double small colon resection and end-to-end anastomosis. In 4 horses (study 1), an appositional single-layer (APP-1) suture pattern was compared with an inverting 2-layer (INV-2) suture pattern. In 8 horses (study 2), an appositional 2-layer (APP-2) suture pattern was compared with the INV-2 suture technique. Polydioxanone suture (size 1-0), was used. Horses were evaluated at necropsy 3, 10, 14, 28, or 56 days after surgery. Postoperative complications (peritonitis, impaction, or excessive adhesions) were encountered in 100, 42, and 13% of the APP-1, INV-2, and APP-2 anastomoses, respectively. Postmortem evaluation of the small colon revealed dehiscence of the anastomotic site, diffuse peritonitis, and adhesion formation in 3 of the 4 horses in which the resection line was closed with the APP-1 pattern. With the INV-2 and APP-2 techniques, more intestinal inversion was present in the nontaenial than in the taenial portion of the small colon. More postoperative impactions were found with the INV-2 (n = 5) anastomoses than with the APP-2 (n = 1) technique; this appeared to be the result of excessive tissue inversion. There was no difference in lumen diameter between the INV-2 and the APP-2 techniques (P greater than or equal to 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)     

Necessity for end colostomy with transection of the descending colon in guinea pigs

Surgical procedures for resection and transection of the descending colon in the guinea pig were studied. Wedge resection with removal of less than 1 cm diameter of tissue resulted in an 80% (8 of 10 guinea pigs) survival rate. Colonic transection with restorative anastomosis, either end-to-end or side-to-side, resulted in a 94% (35 of 37 guinea pigs) death rate due to colonic impaction proximal to the site of anastomosis. A modified procedure for ventral end colostomy resulted in a 79% (19 of 24 guinea pigs) survival rate. These results indicated that caution should be taken in surgical manipulations intended to treat or study diseases of the colon in the guinea pig.     

Torsion and volvulus of the transverse and descending colon in a German shepherd dog

A German shepherd dog was presented two months after surgery for correction of acute gastric dilatation volvulus. The dog had been diagnosed with exocrine pancreatic insufficiency. Radiographs revealed marked gaseous distension of one loop of intestine with a generalised increase in intestinal gas content. A 360 degrees anticlockwise rotation of the descending and transverse colon, around the longitudinal axis of the mesocolon, was diagnosed at exploratory coeliotomy. The transverse and descending colon appeared uniformly necrotic and an end-to-end colo-colic resection and anastomosis was performed. The dog initially made satisfactory postoperative progress but was euthanased on the third postoperative day after it developed an intestinal intussusception.     

Cecal volvulus in a dairy cow: partial resection of the proximal portion of the ascending colon

Cecal volvulus in a dairy cow with vascular compromise of the proximal portion of the ascending colon was corrected surgically with preservation of the ileocecocolic junction. Partial cecectomy was combined with resection of the proximal portion of the ascending colon and anastomosis of the remaining cecum to the distal portion of the ascending colon. The procedure was done with the use of mechanical suturing devices while the cow was standing. Previously, general anesthesia and relocation of the ileocecocolic junction had been suggested.     

Successful outcome after surgical correction of large colon atresia in a colt foal

This report describes successful surgical correction and long-term survival of a case of large colon atresia in a 24-h-old Warmblood colt, referred with signs of unrelenting abdominal pain and a suspicion of meconium impaction. Radiographic and ultrasonographic examination was indicative of large colon meconium impaction with secondary ileus. Due to deterioration of the foal, surgery was recommended. An atretic segment was found between the left ventral and dorsal large (ascending) colon. A band of fibrous tissue with no identifiable lumen connected the segments. Surgical correction was done by performing a stapled side-to-side anastomosis. Twelve days after surgery, the foal was discharged. Twenty-two months after discharge, the owner reported the foal developing as expected compared with its peers, but had a mild, self-limiting episode of colic at 20 months of age.     

Survival and Complications After Large Colon Resection and End‐to‐End Anastomosis for Strangulating Large Colon Volvulus in Seventy‐Three Horses

Objective— To report complications and survival after large colon resection and end‐to‐end anastomosis in horses with strangulating large colon volvulus. Study Design— Retrospective case series. Animals— Horses (n=73) with strangulating large colon volvulus. Methods— Records (January 1995 to December 2005) of horses that had large colon resection and anastomosis for strangulating large colon volvulus were reviewed for complications. Follow‐up data were obtained by telephone questionnaire at least 1 year postoperatively. Cox proportional hazards model was used for multivariate association with survival time. Variables included admission date, age, temperature, heart rate, packed cell volume, total plasma protein concentration, white blood cell count, breed, and sex. Significance was set at P<.05. Results— The most common postoperative complication was diarrhea. None of the 9 variables of interest were significant for survival. Short‐term survival rate (to discharge) was 74%. Overall survival rates at 1, 2, and 3 years postoperatively were 67.8%, 66.0%, and 63.5%, respectively. Four horses died of colic in the first year after surgery. All horses surviving long‐term (>1 year) returned to their intended use (37 brood mares, 2 racehorses, and 1 show horse) with no chronic problems related to the surgical procedure. Conclusion— None of the variables examined were associated with survival. Outcomes were similar to other large studies of surgical colic in the horse. Self‐limiting diarrhea is common after large colon resection and the prognosis for survival after hospital discharge is favorable. Clinical Relevance— Horses that survive the early postoperative period and are discharged after large colon resection and anastomosis have a good chance for long‐term survival with minimal negative impact on quality of life and use.     

Preservation versus excision of the ileocolic junction during colectomy for megacolon: A study of 22 cats

From 1984 to 1991, 22 cats with megacolon underwent colectomy by end-to-end anastomosis of the distal colon to either the proximal colon (preserving the ileocolic junction in 14 cats) or to the distal small intestine (excising the ileocolic junction in eight cats). During the postoperative adaptive period, the two groups showed similar stool consistency, and the presence of either anorexia, lethargy, weight loss or diarrhoea with faecal incontinence. During the long term post-operative adaptive period, no significant difference in recurrent constipation was found between the two groups. The overall constipation rate after colectomy was 45 per cent (10 cats), and because of constipation recurrence 18 per cent (four cats) were euthanased, and 18 per cent (four cats) required further surgery. Long term following colectomy, those cats which under-went excision of the ileocolic junction had significantly looser stools than those cats in which the ileocolic junction was preserved. The preservation of the ileocolic junction during colectomy is therefore recommended.