Rectal Tears and Prolapses

Question 1

T/F: Rectal tear is rarely a catastrophic event in horses

Answer 1

F, it easily can be

Question 2

Iatrogenic Rectal Tear:

1. Occur when? Result from?

Answer 2

1. during palpation per rectum, from straining against operator’s hand and arm

Question 3

Most iatrogenic rectal tears are (dorsal/ventral)?

Answer 3

dorsal.

Question 4

Best ways to prevent iatrogenic rectal tear?

Answer 4

Copious lubrication, adequate restraing (sedation/muscle relaxation if needed), avoid palpating beyond your reach

Question 5

Spontaneous Rectal Tears: Pathogenesis?

Answer 5

Post-Foaling, due to pressure necrosis at level of pelvic inlet.

Question 6

How could you diagnose rectal tear immediately after they happen?
1.
2.
3.

Answer 6

1. Sudden release of pressure
2. Sudden ability to palpate abdominal organs distinctly
3. blood on sleeve

Question 7

Ways to confirm rectal tears 
1.
2.
3.
4.

Answer 7

1. Speculum examination of rectum
2. Careful palpation with bare hand (consider drugs to stop rectal contractions)
3. CBC
4. Abdominocentesis

Question 8

Signs of Rectal Tear:

____ and ____ occur within a few hours in more serious cases

Answer 8

Peritonitis and toxic shock

Question 9

Signs of rectal tear:

Idiopathic tears may initially present as….

Answer 9

colic/hemorrhagic feces/aymptomatic

Question 10

Describe Grade I rectal tear:

Answer 10

through mucosa and submucosa. May be asymptomatic

Question 11

Describe Grade II rectal tear:

Answer 11

Muscular layer disrupted, mucosa/submucosa may prolapse into defect and provide site for fecal impaction

Question 12

Describe Grade IIIa rectal tear:

Answer 12

All layers except serosa affected

Question 13

Describe Grade IIIb rectal tear:

Answer 13

involves mesorectum and retroperitoneal tissue

Question 14

Describe Grade IV rectal tear:

Answer 14

All layers into abdomen, may be associated with prolapse of small colon or small intestine through the defect

Question 15

Rectal Tear: Location:

1. Most tears are (ventral/dorsal)?
2. Most tears are (longitudinal/transverse)?
3. Distance from anus?

Answer 15

dorsal

longitudinal

15-55cm

Question 16

T/F: Distance from anus is not a good indicator of tear location relative to retroperitoneal reflection and abdominal cavity?

Answer 16

T

Question 17

Initial Treatment of Rectal Tears:

Treat septic shock and peritonitis with :

1.
2.
3.

Answer 17

Antibiotics

Flunixin

IV fluids

Question 18

Initial Treatment of Rectal Tears:

Administer ____ to allow…..

Answer 18

epidural anesthesia to allow gentle removal of feces

Question 19

Initial Treatment of Rectal Tears:

Would you want to increase or decrease rectal motility?

Answer 19

decrease

Question 20

Initial Treatment of Rectal Tears:

Gently pack rectum: Why?
1.
2.
3.

Answer 20

1. protect tear
2. prevent contamination of abdomen
3. prevent conversion of Grade II to Grade IV

Question 21

Non-Surgical Treatment of Rectal Tears:

Grade I or II:
1.
2.

Answer 21

1. Antibiotics and Flunixin

2. Soften Feces with mineral oil/bran mashes/green grass/moistened pellets

Question 22

T/F Grade III rectal tears often respond to non-surgical treatment

Answer 22

T

Question 23

Non-Surgical Treatment of Rectal Tears:

Two things to consider performing in Grade III:
1
2.

Answer 23

1. Frequent manual removal of feces

2. Peritoneal lavage?

Question 24

Three methods of surgical repair of rectal tears:

1.
2.
3.

Answer 24

1. Direct suture repair
2. Temporary indwelling rectal liner
3. Loop colostomy

Question 25

Direct Suture Repair of rectal tears: Best for what kind of tears?

Answer 25

fresh clean lesions that are close to the anus

Question 26

Direct Suture Repair of rectal tears: Drugs?

Answer 26

Epidurals

Question 27

Direct Suture Repair of rectal tears: Suture technique?

Answer 27

Stay sutures in the anus.

Question 28

Direct Suture Repair of rectal tears: If prolapse tear?

Answer 28

Hold with multiple Allis tissue foreceps, staple with TA90, than oversew with simple continuous suture

Question 29

Direct Suture Repair of rectal tears: 1. Lesions usually (are/are not) accessible via midline celiotomy?

Answer 29

are not

Question 30

Temporary, indwelling rectal liner as tx for Rectal Tear: Function?

Answer 30

protects tear and allows it to heal spontaneously

Question 31

Temporary, indwelling rectal liner as tx for Rectal Tear: 1. May be used with our without ____

Answer 31

direct suture

Question 32

Temporary, indwelling rectal liner as tx for Rectal Tear: Create liner by....

Answer 32

gluing palpation sleeve or similar thing to rectal prolapse ring

Question 33

Temporary, indwelling rectal liner as tx for Rectal Tear: Best way to access?

Answer 33

caudal midline celiotomy on anesthetized horse in dorsal recumbancy.

Question 34

Temporary, indwelling rectal liner as tx for Rectal Tear: Describe the procedure to implant one:

Answer 34

Assistant passes lubricated ring guided by surgeon to cranial of where tear is. Secure ring with tight circumferential suture. Incorporate circumferential suture into individual sutures through all layers of colon and Dacron loops in ring. Bury circumferential suture with lember tpattern. Can cross tie to prevent cranial movement of sleeve when horse lies down.

Question 35

Loop Colostomy: 1. Is/ Is not preferable to end-colostomy

Answer 35

Is

Question 36

Loop Colostomy: Indications: 1 2 3.

Answer 36

1. Grade IV, +/- Grade III 2. Tear > 25% of rectal diameter 3. Tear > 50 cm from anus

Question 37

Loop Colostomy: Sites: 1 2 3.

Answer 37

1. High left flank 2. Low left flank 3. ventral midline

Question 38

Loop Colostomy: post care?

Answer 38

cradle = prevent self-mutilation

Question 39

Loop Colostomy: Complications 1 2

Answer 39

Dehiscence | Infection

Question 40

Survival % for Rectal Tears: Grade I? II? III? IV?

Answer 40

93% 80% 70% 6%

Question 41

T/F: Rectal prolapses are most common in horses

Answer 41

F, more rarely in horses

Question 42

Predisposing factors of Rectal Prolapse: Most common in what kind of cattle?

Answer 42

younger feedlot cattle

Question 43

Predisposing factors of Rectal Prolapse: 1 2. 3 4. sheep?

Answer 43

1. Altered pressure gradient (abdominal/pelvic cavity vs anus) 2. Decreased sphincter tone 3. Urogenital/Repro concerns (Constipation/diarrhea/colitis/cysyitis/dystocia) 4. Excessively short tail cropping

Question 44

Classification of Rectal Prolapse: only mucosa projects through anus = Type ___

Answer 44

I

Question 45

Classification of Rectal Prolapse: Small colon intussucepts into rectum = Type ___

Answer 45

III

Question 46

Classification of Rectal Prolapse: Prolapse of all layers of rectum = Type ___

Answer 46

II

Question 47

Classification of Rectal Prolapse: Rectum/colon intussusception through anus

Answer 47

IV

Question 48

Most common classifications of rectal prolapse?

Answer 48

Type I and Type II

Question 49

What can palpation reveal about rectal prolapse classification?

Answer 49

Type I - III will be continous with anus, | Type IV will have a palpable depression (TRENCH) inside rectum

Question 50

Management techinques to reduce rectal prolapse: ``` 1. 2. 3. 4. 5. ```

Answer 50

1. Eliminate predisposing factors 2. Eliminate straining 3. sooth mucosa 4. resolve prolapse 5. Caudal epidural anesthesia

Question 51

Purposes of Caudal Epidural Anesthesia with Rectal Prolapse Cases: 1. 2. 3. 4.

Answer 51

1. Temporarily resolves straining 2. Allows evaluation 3. May facilitate re-positioning/replacement 4. May allow surgery

Question 52

Rectal Prolapse: Treatment Options 1. 2. 3. For Type IV specifically: 4. ____/____/____

Answer 52

1. Replacement and purse string suture 2. Submucosal resection 3. Stair Step Amptuation / Amputation after through - and through- sutures 4. celiotomy/resection/anastomosis

Question 53

Replacement and Purse String Suture as Tx for Rectal Prolapse: Drugs to admin?

Answer 53

Caudal epirdual, lidocaine jelly

Question 54

Replacement and Purse String Suture as Tx for Rectal Prolapse: Before placing sutures:

Answer 54

Clean prolapse with hypertonic solution/glycerol, apply lidocaine jelly, and reduce prolapse

Question 55

Replacement and Purse String Suture as Tx for Rectal Prolapse: How tight? Remove after how long?

Answer 55

Tight enough to allow 2-3 fingers Remove after 1 week

Question 56

Submucosal resection as treatment for Rectal Prolapse Use when?

Answer 56

When you have necrotic ulcerated or traumatized mucosa with healthy underlying tissue

Question 57

Submucosal resection as treatment for Rectal Prolapse Technique Steps:

Answer 57

1. Epidural and hypertonic solution 2. Insert flexible tubing, fix with needles (cross pin) 3. Make two circumferential incisions, just through mucosa, at ends of tissue to be removed 4. Connect with longitudinal incision to same depth 5. Remove collar of damaged tissue by blunt dissection (ligating individual vessels) 6. Anchor tissue with 4 simple interrupted sutures (absorbable monofilament) 7. Complete apposition with continuous suture for each quadrant

Question 58

Stair Step Amputation for Rectal Prolapse: Has reduced risk of...

Answer 58

Stricture formation

Question 59

Stair Step Amputation for Rectal Prolapse: 1. Type of incision? 2. Preserve..... 3. Create....

Answer 59

1. Circumferential 2. inner mucosa and submucosa 3. create plane toward caudal aspect of prolapse

Question 60

Stair Step Amputation for Rectal Prolapse: Make incision through...

Answer 60

inner layer of mucosa

Question 61

Stair Step Amputation for Rectal Prolapse: Finish by...

Answer 61

creating flap of inner mucosa over outer mucosa, and suture