Surgical Removal of Feacalith in a Dog.
Intestinal obstruction refers to a situation when the intestinal contents cannot be forced further in aboral direction. Obstruction is classically categorized as either mechanical or functional. Mechanical obstruction in the gastrointestinal tract is most often due to entrapped foreign material within the gastrointestinal lumen, but can also be caused by intussusception, intestinal entrapment, torsion, mucosal or muscular hypertrophy or neoplasia. Functional obstruction of gastrointestinal tract, also referred to as ileus, most often results from inflammation or infection. Gastrointestinal foreign bodies are commonly encountered in small animals with a variety of clinical signs depending on location, degree and duration of obstruction (Aronson et al., 2000 and Papazoglou et al., 2003). Gastrointestinal obstruction results in disturbances of fluid balance, acid-base status and serum electrolyte concentrations due to hyper secretion and sequestration within the gastrointestinal tract which is exacerbated by vomiting and impaired oral intake of fluid and nutrients (Boag et al., 2005). The present case report records intestinal obstruction due to piece of cloth and leather lodged in colon (feacalith in colon) and its successful surgical removal by enterotomy.
History and Observations
An eight year old male Doberman dog weighing 24 kgs was presented with history of being a guard dog in a shoe factory, loss of appetite since last thirteen days and complete cessation of food intake, intermittent vomition, dullness and absence of defecation since last five days. The animal had already been treated for several days with antibiotics, stool softeners and soap water enema by a Veterinarian with no improvements.
The condition was deteriorating as time passed and on the day of presentation, the dog was debilitated and disinclined to move. Clinical examination revealed congested conjunctival mucous membranes, severe dehydration, sunken eye balls, sub-normal body temperature (36.4[degrees]C) along with increased heart rate (126 beats per minute) and increased respiratory rate (36 breaths per minute). Abdominal palpation revealed pain along with severe tenderness in abdomen. A right lateral and ventro-dorsal radiograph did not show any radio opaque mass in abdominal cavity but loops of intestine appeared fluid/gas filled. On basis of history, clinical findings and radiographic examination, intestinal obstruction was suspected to be a cause. Owing to the critical condition of the patient, it was decided to perform an immediate exploratory laparotomy for confirmatory diagnosis and its correction.
Prior to surgery, the animal's hemodynamic and electrolyte status was stabilized by administering intravenous fluid (Intalyte (a) 20 ml/kg/hr). Preoperatively, Dexamethasone 80 mg by slow IV and Ceftriaxone @ 25mg/kg IV were also administered. After the pre-anaesthteic preparation, the animal was pre-medicated with a combination of Glycopyrrolate @ 0.01mg/ kg b. wt., Xylazine hydrochloride @ 0.5 mg/kg b. wt. and Butorphanol 0.2 mg/kg b. wt., intramuscularly. After fifteen minutes of pre-medication, general anaesthesia was induced with intravenous administration of Propofol (1%) till effect and maintained with Halothane. Animal received intravenous fluid (Intalyte) intra-operatively throughout the procedure. A caudal ventral midline incision was made and intestine was exteriorized and observed for obstruction and its location by proceeding cranial to caudal direction. The colon was found impacted over 15 cm of its length with a material of almost solid consistency and this was unable to move caudally (Fig.1). The effected loop was identified and exteriorized of abdominal cavity and cavity was packed off with sterile gauze pieces to prevent accidental spillage of intestinal contents. The affected part was observed for its viability. The obstructing mass was palpated and longitudinal antimesenteric incision of about 5 cm length was made directly over healthy intestine cranial to the obstructing mass and removed slowly by holding with tissue forceps (Fig. 2). After removing the obstructing mass which was a feacalith, the incision was closed with 2-0 PGA in two layers. The exteriorized intestinal loop was thoroughly washed with Normal saline and Metronidazole solution. Abdominal cavity was also irrigated with Normal saline solution followed by Metronidazole plus Normal saline solution. The muscles and subcutaneous tissue were closed with No. 1 PGA in simple continuous pattern. Skin incision was closed with nylon in horizontal mattress pattern, finally antiseptic bandaging was done. Post-operatively, the animal was prescribed inj. Intacef (a) (Ceftriaxone @ 25 mg/kg IV, BD) for five days, inj. Melonex (a) (Meloxicam @ 0.5 mg /kg IM, OD) for three days, Syp. Cremaffin (b) @ 1 TSF PO BD for five days. The animal was maintained on intravenous fluids (Intalyte (a)) for three days and owner was advised to give only liquid diet for next three days. Daily antiseptic dressing of the wound was advised for ten post-operative days. Skin sutures were removed on eleventh post-operative day and dog recovered without any complication.
Ingestion of various foreign bodies like bones, choke belts, fruit pits, stones, plastics, toys, fish hooks, sewing needle and bottle caps were reported to cause gastrointestinal obstruction in dogs (Mahesh et al., 2008; Malik et al., 2014). Gastrointestinal foreign bodies may cause complete or partial obstruction. In general, complete obstruction is associated with more dramatic clinical signs and rapid deterioration whereas partial obstruction may be associated with more chronic signs of maldigestion and malabsorption (Papazoglou et al., 2003). Foreign bodies lodged in the gastrointestinal tract cause ulceration, haemorrhage, anorexia, dehydration, perforation, peritonitis and can result in death if not treated timely (Anoop et al., 2010). Alongside the challenges of diagnosis and anaesthesia, surgical treatment and wound healing are compromised by intestinal wall viability, intraluminal bacterial overgrowth, ileus and hypoproteinaemia (Ralphs et al., 2003).
Gastrointestinal obstruction is considered a surgical emergency. Prior to surgery, the animal's hemodynamic and electrolyte status should be stabilized, although surgery should not be delayed unnecessarily. A complete and thorough abdominal exploration is necessary to locate suspected obstructions. For intestinal foreign bodies, subjective criteria are most often used to determine the viability of tissue at the level of obstruction and to decide whether simple enterotomy or intestinal resection and anastomosis is indicated to address the problem. These parameters include: color, peristalsis, arterial pulsation, capillary (cut surface) bleeding and tissue thickness. In present case, the viability of the intestine was maintained as judged on the basis of above parameters and hence simple enterotomy and removal of obstructing mass was opted. Early recognition may prevent most major complications, however intestinal necrosis, perforation, dehiscence, peritonitis and sepsis are all possible complications for gastrointestinal obstruction.
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V. Malik (1), Sudhir Kumar (2) and A. Rajpoot (2)
Department of Surgery and Radiology
College of Veterinary Science and Animal Husbandry
UP. Pandit Deen Dayal Upadhyaya Pashu Chikitsa Vigyan Vishwavidyalaya
Evam Go-Anusandhan Sansthan (DUVASU)
Mathura - 281001 (Uttar Pradesh)
(1.) Assistant Professor and Corresponding author. E-mail: firstname.lastname@example.org
(2.) Post Graduate Scholar
(a) - Brand of Intas Animal Health, Ahmedabad
(b) - Brand of Abbott Health Ltd., Mumbai
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|Title Annotation:||Short Communication|
|Author:||Malik, V.; Kumar, Sudhir; Rajpoot, A.|
|Date:||Jan 1, 2018|
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