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Intussusception: surgical correction
Introduction
- To correct intussuscepted intestine, where one part of the intestine has “telescoped” into another. This results in a partial obstruction of the bowel lumen and partial occlusion of the blood supply to sections of bowel. Chronic cases may involve adhesions.
- Signs may be acute or chronic.
- The etiology of the intussusception is rarely identified but possible causes include enteritis, neoplasia, parasitism Parasitic gastroenteritis, dietary changes, mural granuloma, abscess, mural hematoma and altered intestinal motility (potentially a consequence of medication).
- Intussusception occurs most commonly in the distal portion of the jejunum
, but may affect the proximal jejunum, ileum, cecum and spiral colon.
Uses
Advantages
- Correction of intussuscepted bowel, which if not corrected will result in the death of the animal.
Disadvantages
- Major abdominal surgery with significant risk of complications.
- Economic cost of procedure.
- Challenges to control post-operative pain due to limited analgesia options in cattle.
Technical problems
- Adequate restraint, lighting, availability of assistant and limitations of field surgery set up.
Alternative techniques
- Euthanasia Euthanasia techniques.
Time required
Preparation
- Approximately 30 mins, to prepare “operating theatre” and patient.
Procedure
- Variable, depending upon surgical requirements and experience of the surgeon.
Decision taking
Criteria for choosing procedure
- Animal with acutely painful abdomen for up to 24 h (kicking at abdomen, restless, saw-horse stance
, getting up and down from lying) or more rarely, intermittent abdominal pain, an absence or reduction of feces (may contain blood and/or mucus). Adult cattle often present with clinical signs of low-grade abdominal pain which can delay presentation of the animal to a veterinary surgeon for examination. - Abdominal distension may be apparent after 24-48 h as fluid and gas accumulates in the intestinal lumen and forestomach.
- Sequestration of ingesta within the gastrointestinal tract results in continued dehydration and a deteriorating clinical picture.
- Blood work may reveal hemoconcentration, inflammatory leukogram, hypochloremic metabolic alkalosis, hyponatremia, hypokalemia, hypocalcemia, azotemia and hyperglycemia.
- A firm, sausage shaped intestine may be palpated on rectal examination (but not always as it depends on the location of the affected bowel), loops of gassy distended intestine may be palpated.
- An echodense structure may be visualized on ultrasonography (but not always), with the typical “target” shape of the intussusception.
Risk assessment
- Ensure your safety, the safety of other attendees and the patient’s safety by ensuring you have adequate restraint, sedation, pairs of hands, etc before commencing surgery.
Requirements
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Preparation
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Procedure
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Aftercare
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Outcomes
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