Intestinal Surgery - TrueCare for Pets Pawcast скачать в хорошем качестве

Intestinal Surgery - TrueCare for Pets Pawcast

Small intestinal biopsy -- Options include a 6 mm biopsy punch instrument, a #15 scalpel blade wedged around a stay suture, or an elliptical incision. The surgical defect is closed transversely with a one-layer closure in an appositional simple interrupted pattern. Disadvantage of this closure is the propensity to bend the bowel. Septic peritonitis due to dehiscence carries a 12% incidence rate. Endoscopic small intestinal biopsy can also be performed. Large capacity endoscopic forceps carry a greater biopsy quality when compared to oval and pediatric forceps, with no change in sampling depth. Enterotomy -- A longitudinal antimesenteric enterotomy is performed aboral to the obstruction location and closed longitudinally after foreign body removal in a simple interrupted or simple continuous suture pattern. Septic peritonitis due to dehiscence carries a 7 to 15% incidence rate. A single enterotomy catheter technique involves a 1 cm antimesenteric incision made in the proximal duodenum and tying the foreign body to a rubber or silicone catheter or tube. This is placed in the intestine and the enterotomy is closed. The objects are milked to the colon. The main complication is iatrogenic small intestinal tract perforation. Enteroplication -- Complete plication of the jejunum and ileum is performed to decrease intussusception recurrence as recurrence is typically seen at an area away from the initial lesion or proximal to the enteroplication site. The duodenum is spared because duodenal intussusception is rare. Absorbable or nonabsorbable suture may be used in a simple interrupted pattern that incorporates the submucosa of the antimesenteric and mesenteric borders of the small intestinal tract. An adhesive (n-Butyl cyanoacrylate) may also be used in cats with the disadvantage of not being significantly more rapid to perform and an increased risk of failed adhesion formation. Benefits of enteroplication include a low morbidity, minimal abdominal discomfort, and decreased vomiting, diarrhea, anorexia, and constipation. Complication rate seen at a minimum of one month post-operatively is 15% (when compared to a 5% rate without performing enteroplication) and includes abscessation, generalized septic peritonitis, jejunal volvulus (seen 2 months post-operatively), obstruction, perforation, and strangulation. Enterostomy -- Indications for enterostomy include rectal obstruction (neoplasia), rectal perforation (alone or along with a rectocutaneous fistula), and protection after a rectal resection and anastomosis. Maintenance of a temporary enterosotomy can extend between 9 to 32 days (if the rectocutaneous fistula remains) and up to 7 months in cases of cancer-related obstruction. Endoscopic linear cutting stapler -- Endoscopic linear cutting stapler devices can be used for patients of small size to form a functional end to end anastomosis when the large size of the GIA is prohibitive. The less surgical experience of the surgeon, the more time required to perform the hand sewn resection and anastomosis. Mesenteric volvulus -- A twist or rotation on the mesenteric axis around the root of the mesentery results in venous obstruction, lymphatic obstruction, and hypoxic, ischemic necrosis (via cranial mesenteric artery obstruction). Venous and lymphatic obstruction result in edema and vascular engorgement. Ischemic necrosis is seen of the distal duodenum, jejunum, ileum, cecum, and colon (ascending and proximal descending). Bacterial translocation, toxin absorption, and reperfusion injury result. Intestinal vasoconstriction results in a decrease in intestinal microcirculation with irreversible intestinal necrosis. As a result, endothelial cells, leukocytes, and platelets are activated, releasing cytokines. Systemic inflammatory response syndrome and disseminated intravascular coagulopathy result. Acute mesenteric ischemia is rare. Causes of the condition include blunt trauma, exocrine pancreatic insufficiency, gastrointestinal foreign body, history of gastrointestinal surgery, gastric dilatation and volvulus, ileocolic carcinoma, and lymphoplasmacytic enteritis. The common common cause is idiopathic. Young, male, large breed dogs are most commonly affected. Reported breeds include the German Shepherd and English Pointer. Toy breed dogs and one cat have been reported. Clinical signs and physical examination findings include abdominal discomfort and distention, anorexia, lethargy, restlessness, tenesmus, and vomiting. Affected dog may have a history of gastric dilatation and volvulus. Treatment includes an abdominal exploratory for duodenoileal anastomosis, derotation of the mesenteric root, and resection and anastomosis for focal or segmental disease. The German Shepherd breed carries a worse prognosis. All dogs with mesenteric root derotation recovered. Focal disease that is resected carries a good prognosis.