Ventral peritoneal rectal tear repair in a mare.

A 12-year-old mare experienced a rectal tear which was successfully treated through surgical repair, despite post-surgical complications. The mare later resumed full work and performance at local events.

Clinical Presentation

• A 12-year-old thoroughbred mare experienced difficulty getting pregnant. Following a per rectum examination, a ventral rectal tear was discovered, leading to an immediate referral to the Royal Veterinary College’s Equine Referral Hospital.
• Upon examination, the mare showed signs of abdominal pain and was generally distressed, but had normal blood and gas analysis results. The tear was confirmed to be a grade 4 rectal tear, indicating a complete perforation into the abdominal cavity.

Surgical Intervention

• Prior to the surgery, the mare was administered a combination of medication to reduce inflammation and prevent bacterial infection.
• The surgical repair was carried out under general anesthesia. Due to the awkward position of the tear, three surgical assistants were utilized to retract viscera and maneuver the rectum towards the midline incision.
• The rectal defect was closed using two layers of 2-0 polyglactin 910 in a simple interrupted and Cushings suturing pattern. The abdominal incision was then closed under routine procedures.

Post-Surgery Treatment

• Postoperative care included administration of a polyionic electrolyte solution and a course of antibiotics, followed by oral meds over a three-week period.
• Despite complications during recovery that included abdominal pains and digestive issues, the mare slowly returned to a normal diet over a six-month period, regained health, and resumed normal work.

Discussion

• Grade 4 rectal tears, which perforate all layers of the rectum and extend into the abdominal cavity are severe and present various treatment options.
• Despite the complication of the particular ventral position of the tear, the direct suturing method proved effective through facilitated access thanks to a tilting table. This method might not be as suitable for tears occurring on the dorsal aspects of the rectum.
• The prompt recognition of the rectal injury by the referring vet was key in preventing further, potentially fatal contamination and achieving a successful recovery.