reptile - Articles
Gastrotomy / gastrectomy
Introduction
- The most common indications for gastrotomy in exotic species include foreign body ingestion (common in reptiles), trichobezoars, neoplasia and gastric biopsy.
- Foreign body ingestion is common in reptiles, affecting chelonia and lizards most commonly. This can range from ingestion of housing substrate (bark chips in bearded dragons and other lizards) as well as stones (tortoises).
- Acute and chronic anorexia often lead to a negative energy balance in many exotic species with a secondary hepatic lipidosis.
- Ulceration and necrosis of the stomach may occur, and gastrectomy may be indicated in some patients if a perforation is suspected on laparotomy.
- Care needs to be taken when handling the gastrointestinal tract in many exotic species as the organ wall is often very thin, particularly when stretched due to bloat (cecum, stomach).
- To avoid iatrogenic tissue trauma during gastrotomy it can be helpful to have an assistant holding the relevant tissues instead.
Uses
- Foreign body removal.
- Neoplasia
.
- Gastric biopsy Biopsy overview.
Advantages
- Gastrotomy and gastrectomy allow for direct visualization of the gastrointestinal tract and possible ulceration.
- Biopsies of the gastric lining can be collected and removal of foreign bodies as well as biopsies and resection of necrotic lining performed.
Disadvantages
- Invasive procedure requiring celiotomy Celiotomy.
Technical problems
- Gastric content leakage into the abdomen.
- Size of patient, eg small chelonia.
- Risk of anesthesia in an already compromised patient.
Alternative techniques
- Endoscopic retrieval of foreign bodies Endoscopy overview.
- Emesis induction in appropriate species.
- Gastroscopy for biopsies Biopsy overview.
- Passage of nasogastric or orogastric tube to relieve tympany.
Time required
Preparation
- Dependent on species; longer in chelonians due to shell preparation, which requires a longer scrubbing time.
- 5-10 minutes for small patients.
- 10-15 for chelonians and big snakes.
- For snakes, prepare as large of an area as possible. Incisions must often be extended and enterotomy sometimes require multiple ones.
Procedure
- 30-60 min for core procedure, but dependent on difficulty of procedure and the species operated on. For example, large snakes requiring gastrotomy foreign body removal will require a larger incision for access to stomach.
Decision taking
Criteria for choosing test
- Diagnostic imaging indicative of a foreign body causing partial or complete obstruction - either radiography Radiography overview or ultrasonography Ultrasonography overview.
- Suspected neoplasia of the gastric lining.
- Need for biopsy where endoscopy unavailable or restricted. Endoscopy is often prohibited by the size of the patient.
- Need for biopsy where endoscopy unavailable or species restricted. Endoscopy is often prohibited by the size of the patient, eg small tortoises.
- Patients unresponsive to medical management for conditions such as foreign bodies in reptiles, eg substrate ingestion in lizards.
Risk assessment
- Patients are often critical and at a high risk of general anesthesia due to negative energy balance because of dehydration, nutritional deficits and secondary conditions such as hepatic lipidosis.
- Chronicity of the presenting problem needs to be considered as hemorrhage and ulceration of the gastric lining often develop quickly. These may not be correctable through surgery and can lead to euthanasia Euthanasia of the patient.
Requirements
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Preparation
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Technique
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Aftercare
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Outcomes
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