Hand-assisted laparoscopic repair of a grade IV rectal tear in a postparturient mare.
Abstract: An 8-year-old multiparous Thoroughbred broodmare was admitted for evaluation of a rectal tear sustained during parturition. Results: On initial evaluation, the mare had mild signs of abdominal discomfort. A full-thickness rectal tear located 30 cm cranial to the anus and extending approximately 15 cm longitudinally along the surface of the small colon between the 4 and 6 o'clock positions, when viewed from behind, was diagnosed on examination per rectum. Results: Laparoscopic evaluation of the abdomen was performed to assess the tear and extent of peritoneal contamination. A hand-assisted repair via a flank incision was performed. The tear was closed in a single-layer, simple continuous pattern with size-0 polydioxanone with a handheld needle holder. Subsequently, a ventral midline celiotomy was performed, and intestinal contents were evacuated via a pelvic flexure enterotomy and a typhlotomy. Following surgery, the mare was managed with IV fluid therapy, partial parenteral nutrition, antimicrobials, and NSAIDs for 5 to 7 days before being gradually reintroduced to a complete pelleted feed and alfalfa hay. Prior to discharge, examination per rectum revealed no stricture formation associated with repair. The mare was discharged from the hospital and performed successfully as a broodmare, with the delivery of a live foal 1 year after surgery. Conclusions: Successful repair with an excellent outcome was achieved in this mare. Hand-assisted laparoscopic repair should be considered as a possible treatment option in horses with grade IV rectal tears.
Publication Date: 2014-09-18 PubMed ID: 25229534DOI: 10.2460/javma.245.7.816Google Scholar: Lookup
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Summary
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This research paper describes a successful surgical procedure for treating a serious rectal tear in a horse, wherein the tear was repaired using a minimally invasive hand-assisted laparoscopic technique.
Background
- An 8-year-old Thoroughbred broodmare experienced a full-thickness rectal tear during childbirth. The tear, located 30 cm from the anus and stretching approximately 15 cm along the small colon, was identified through a rectum examination.
- Such tears induce considerable discomfort and pose a risk of peritoneal contamination, which can lead to life-threatening conditions if left untreated.
Methodology
- The first step was to evaluate the extent of the tear and possible contamination through a laparoscopic examination of the abdomen.
- A hand-assisted procedure was then conducted to physically stitch the tear closed. This was achieved via a flank incision, employing a single-layer, simple continuous pattern with a size-0 polydioxanone thread.
- A ventral midline celiotomy was also performed to evacuate the intestinal contents, reducing the risk of infection and further damage.
Post-Surgical Care
- After the procedure, the mare received intravenous fluids, partial parenteral nutrition, antimicrobial drugs, and NSAIDs. This treatment was continued for a period of 5 to 7 days.
- The feeding was gradually reintroduced, starting with a complete pelleted feed and alfalfa hay.
- Before discharge, the veterinarians verified through a rectum examination that no stricture (unnatural narrowing of a bodily passage) had formed due to the surgical repair.
Outcome
- The surgical procedure and subsequent care were successful, with the mare showing no signs of complications from the operation. A year later, she even successfully delivered a live foal, indicating good recovery and resumption of reproductive function.
- The authors conclude by suggesting that hand-assisted laparoscopic repair can be a viable treatment option for horses with grade IV rectal tears, given the successful outcome in this case.
Cite This Article
APA
Stewart SG, Johnston JK, Parente EJ.
(2014).
Hand-assisted laparoscopic repair of a grade IV rectal tear in a postparturient mare.
J Am Vet Med Assoc, 245(7), 816-820.
https://doi.org/10.2460/javma.245.7.816 Publication
Researcher Affiliations
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA 19348.
MeSH Terms
- Animals
- Female
- Hand-Assisted Laparoscopy / veterinary
- Horse Diseases / surgery
- Horses
- Obstetric Labor Complications / surgery
- Obstetric Labor Complications / veterinary
- Pregnancy
- Rectum / injuries
- Wounds and Injuries / surgery
- Wounds and Injuries / veterinary
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