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.     

Rectal tears in the horse: two case reports

Rectal tears occur incidentally and often have a poor prognosis. Early recognition of the problem and adequate therapy determine the outcome. The history, clinical examination, therapy, and outcome of two horses with grade IIIb and grade IV rectal tears are discussed.     

A review of equine rectal tears and current methods of treatment

Rectal tears are a risk of rectal palpation during equine clinical examination and can be life‐threatening; prompt medical and surgical intervention is required to improve patient outcome. Depending on the degree of the tear, conservative treatment or surgical management may be warranted. Surgical management involves either direct suturing or faecal diversion techniques, such as colostomy or a temporary indwelling rectal liner. The prognosis for a horse with a rectal tear depends on size of the tear, grade and location of the tear, and time between occurrence and first aid measures.     

Laparoscopic assisted surgical removal of a congenital rectal hamartoma in a foal

In this report we describe a 3‐week‐old Paint horse filly that presented with rectal bleeding associated with a protruding mass. Rectal bleeding in neonates can be caused by infectious agents, trauma, congenital defects, rectal tears or tumours. Histopathology was performed on an avulsed piece of tissue. A second mass was identified endoscopically and was removed using a stapling instrument per rectum under endoscopic guidance and laparoscopic assistance. The mass was diagnosed as a rectal hamartoma. Recovery was uneventful.     

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.     

Rectal and Colonic Injury in the Llama Anatomic Considerations and Surgical Management in Four Llamas

Transrectal palpation in llamas can result in iatrogenic rectal and colonic injury. The purpose of this report is to define the caudal extent of the peritoneal cavity in llamas and to describe the surgical management of rectal or colonic injuries in four llamas. Measurements were made of six adult llamas during necropsy. The mean distance from the peritoneal reflection to the anus was 3.9 ± 0.1 cm (3.4 - 4.3 cm). Four llamas were examined for rectal or colonic perforations. One laceration was of partial thickness and three lacerations were of full thickness. Two of the defects were repaired by a transanal approach and two by celiotomy to facilitate removal of fecal debris and abdominal lavage. Successful repair of the rectal or colonic tears was achieved in all four llamas. Wound infection and incisional hernia occurred in both llamas that underwent celiotomy. Two llamas died 3 and 18 months later, and two llamas have survived 2 years. Rectal tears in llamas are accompanied by a high risk of peritoneal contamination, and primary closure is recommended. If fecal contamination of the abdomen has occurred, celiotomy is indicated to allow mechanical removal of fecal debris and peritoneal lavage.     

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.     

Non-surgical management of rectal tears in two mares

Two mares presented with life-threatening rectal tears were successfully treated with intensive medical management. Although surgery has been regarded as mandatory for grade 3 or 4 rectal tears in the past, recent reports have indicated the value of medical management alone. The case reports presented in this article detail the use of antibiotics, flunixin meglumine, laxative diets and faecal softeners in the medical management of two mares presented with grade 3 rectal tears.     

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.     

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.     

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.     

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.     

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.     

Resting rectal temperature of Vietnamese potbellied pigs.

OBJECTIVE: To determine resting rectal temperatures of Vietnamese potbellied pigs. DESIGN: Prospective clinical trial. ANIMALS: 85 potbellied pigs on a single farm and 27 potbellied pigs examined at a veterinary teaching hospital for routine veterinary care. PROCEDURE: Rectal temperatures of the potbellied pigs on a farm were measured during the morning, afternoon, and evening. Rectal temperatures at the time of initial examination were obtained from medical records for the potbellied pigs examined at the hospital. RESULTS: Mean rectal temperatures for both groups of potbellied pigs were the same. Overall unadjusted mean +/- SD rectal temperature was 37.6 +/- 0.8 C (99.7 +/- 1.5 F; range, 35.1 to 39.6 C [95.2 to 103.3 F]). However, diurnal variation in rectal temperature was found among the farm population of potbellied pigs. After adjustment for age and repeated sampling, rectal temperatures recorded during the morning were found to be significantly lower than temperatures recorded during the afternoon and evening (mean difference, 0.5 and 0.9 C [0.9 and 1.6 F], respectively), and rectal temperatures recorded during the afternoon were found to be significantly lower than temperatures recorded during the evening (mean difference, 0.4 C [0.7 F]). There was a significant inverse linear relationship between age and rectal temperature. CONCLUSIONS AND CLINICAL RELEVANCE: Rectal temperatures of Vietnamese potbellied pigs may be lower than the lower limit of the reference range reported for domestic pigs. Because of diurnal variation in rectal temperatures, it is important to compare temperatures obtained at the same time of day when assessing patients.     

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.     

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.     

Rectal prolapse.

Rectal prolapse is a common occurrence in cattle and small ruminants. This article discusses the causes, correction, and postoperative treatment of rectal prolapse in cattle and sheep.     

Management of rectal injuries

Diagnosis, evaluation, and management of the various grades of rectal tears is discussed. Surgical techniques, which include direct closure, diverting colostomies, and placement of temporary rectal liners, are detailed. Also, rectal prolapses and various methods of repair are outlined.     

Influence of F strain Mycoplasma gallisepticum infection on response of commercial layers to heat exposure

Commercial layers were inoculated with F strain Mycoplasma gallisepticum (MG) and housed in either conventional chicken houses or the lower-stress environment of biological isolation units. At the end of 2 weeks, all treatment groups were placed in environmental chambers and subjected to 4 hr of heat stress (40 C with a dew point of 21 C). Rectal temperature, an indicator of response to high heat, was monitored. Rectal temperatures of F strain MG-inoculated hens housed in the conventional chicken house environment were significantly higher than those of uninoculated controls, whereas rectal temperatures of hens held in isolation units were comparable to those of their uninoculated controls.