• Veterinary Gastrointestinal surgeryVeterinary Gastrointestinal surgery(Part-III)(Part-III)

• Presented byPresented by• Dr. Rekha PathakDr. Rekha Pathak• Senior scientist , IVRISenior scientist , IVRI

The photographs have been collected from different sources i.e. Internet,

text books etc

G. neoplasmG. neoplasm

• Avg. age 8 yAvg. age 8 y• Alimentary tract: oral Alimentary tract: oral

cavity – rarely in cavity – rarely in stomachstomach

• Persistent vomiting Persistent vomiting unrelated to eating unrelated to eating

•Within the antrum on the Within the antrum on the lesser curvature lesser curvature

•Metastasis: liver, lungs, spleenMetastasis: liver, lungs, spleen

•Leiomyoma/ Leiomyoma/ rhabdomyosarcoma/polyps rhabdomyosarcoma/polyps (solitary or multiple)(solitary or multiple)

• Polyps – due to Polyps – due to sharp fragment sharp fragment of bones- resting of bones- resting for long in for long in antrum - injure antrum - injure mucosa – mucosa – herniation of sub herniation of sub mucosamucosa

• Clinical signs; Clinical signs; anorexiaanorexia

•Loss of wt. Loss of wt. Obstructing Obstructing gastric out flow gastric out flow

•Normal Normal peristalsis is peristalsis is interfered interfered

•AnemiaAnemia•Abd. PainAbd. Pain

• Emesis unrelated to Emesis unrelated to ingestion of food ingestion of food /water/water

• MelenaMelena• palpationpalpation• Exploratory Exploratory

laparotomylaparotomy

• RG: contrast – RG: contrast – filling defectfilling defect

• Endoscope Endoscope • UltrasonographyUltrasonography• Adenocarcinoma: Adenocarcinoma:

most commonmost common• Sex predilection for Sex predilection for

malesmales• Treatment Treatment • Chemotherapy: Chemotherapy:

not successfulnot successful

• SurgicalSurgical

• Gastrectomy: Partial Gastrectomy: Partial gastrectomy is done gastrectomy is done

• Removal of any portion Removal of any portion of the stomach and up to of the stomach and up to (30-40%) in antrectomy(30-40%) in antrectomy

• Partial gastrectomy – 40-Partial gastrectomy – 40-70% 70%

• Subtotal gastrectomy : Subtotal gastrectomy : 70- 90%70- 90%

• Antrectomy: Antrectomy: reconstruction- reconstruction- gastroduodenostomygastroduodenostomy

(bilroth I ) or (bilroth I ) or gastrojejunostomy(II)gastrojejunostomy(II)

• Two variations of partial Two variations of partial gastrectomy gastrectomy

• A-CA-C : stay sutures are : stay sutures are placed to elevate the placed to elevate the stomach and to minimize stomach and to minimize leakageleakage

• Necrotic tissue is excised Necrotic tissue is excised with a rim of viable tissuewith a rim of viable tissue

• A two layer inverting A two layer inverting closure is usedclosure is used

• D-ID-I : atraumatic forceps : atraumatic forceps are placed across viable are placed across viable tissue and necrotic tissue tissue and necrotic tissue is excised is excised

• The stomach body is The stomach body is subsequently closed subsequently closed with a parker- Kerr line with a parker- Kerr line

• The first inverting The first inverting layer suture is placed layer suture is placed over the clampsover the clamps

• Remove clamps, pull Remove clamps, pull and invert the suture and invert the suture lineline

• Second inverting Second inverting suture rowsuture row

• End to end End to end anastomosis of anastomosis of stomach stomach

• Bilroth II – Bilroth II – performed if more performed if more radical radical gastrectomy is gastrectomy is required, if there required, if there is excessive is excessive duodenal duodenal involvement or involvement or bothboth

BloatBloat

• Bloat : Major problems- GIT – cattle Bloat : Major problems- GIT – cattle and buffaloesand buffaloes

• Higher in buffaloesHigher in buffaloes• Acute/chronicAcute/chronic• Gaseous bloat – free gas - dorsal part Gaseous bloat – free gas - dorsal part

of rumenof rumen• Frothy bloat – gas trapped with Frothy bloat – gas trapped with

ingesta- dispersed throughout the ingesta- dispersed throughout the rumen contentrumen content

• Acute: rapid feeding and sudden diet Acute: rapid feeding and sudden diet change – large ruminantschange – large ruminants

• s. ruminants – large quantities of s. ruminants – large quantities of grain ingestion/cerealsgrain ingestion/cereals

• More pressure on diaphragm – More pressure on diaphragm – hypoventilation and red. Venous hypoventilation and red. Venous return to the heartreturn to the heart

• signs: bulge on Para lumbar fossasigns: bulge on Para lumbar fossa

• Abdominal distensionAbdominal distension

• Cyanotic mmCyanotic mm

• v. serious – lying down – asphyxiated v. serious – lying down – asphyxiated – open mouth- protruded tongue and – open mouth- protruded tongue and tachycardiatachycardia

• Treatment: puncture wall – left side with Treatment: puncture wall – left side with trocar and canulatrocar and canula

• if frothy – antifoaming agents – if frothy – antifoaming agents – turpentine oil (80ml) + mustard oil (500-turpentine oil (80ml) + mustard oil (500-1000 ml)1000 ml)

• antifroth prepn. – bloatosilantifroth prepn. – bloatosil• gives immediate relief to ailing animalgives immediate relief to ailing animal• avoid conc. – 2-3 days and leguminous avoid conc. – 2-3 days and leguminous

fodderfodder

• Resort to rumenotomy / rumenostomyResort to rumenotomy / rumenostomy

• S. animal: IV- RL or oral soda bicarbS. animal: IV- RL or oral soda bicarb

• Chronic bloat: TRP (FBS) – reticuloperitonitis/ Chronic bloat: TRP (FBS) – reticuloperitonitis/ fibrinous pneumonia – pleuritis involving the fibrinous pneumonia – pleuritis involving the vagus nervevagus nerve

• Liver abscess, splenic cyst and abscess, Liver abscess, splenic cyst and abscess, enlarged mediastinal lymph nodes, pyloric enlarged mediastinal lymph nodes, pyloric stenosisstenosis

• Rumen fistulation / rumenotomy can be doneRumen fistulation / rumenotomy can be done

• Rumen fistulation: Rumen fistulation: • Anesthesia and surgical Anesthesia and surgical

prepn.: standing prepn.: standing positionposition

• Sternal recumb. – Sternal recumb. – CamelCamel

• Left Para lumbar fossa Left Para lumbar fossa • Circular area – ventral to Circular area – ventral to

transverse process of transverse process of lumbar vertebrae- lumbar vertebrae- approx 10 cm dia.- approx 10 cm dia.- infiltrated infiltrated

•A circular piece of A circular piece of skin (4cm) – skin (4cm) – removed to removed to expose the expose the underlying underlying abdominal mus.abdominal mus.

•Bluntly dissect Bluntly dissect and expose and expose rumen – grasp – rumen – grasp – pulled in a cone pulled in a cone fashion to the fashion to the skin surfaceskin surface

•Anchor with 4 Anchor with 4 horizontal horizontal mattress mattress suture through suture through rumen and rumen and skinskin

• Remove central Remove central portion of rumenportion of rumen

• Incised edge of Incised edge of rumen is sutured to rumen is sutured to the skin with the skin with simple interrupted simple interrupted and non- and non- absorbable absorbable

• Alternately – all the Alternately – all the layers – apply layers – apply interrupted interrupted mattress sutures in mattress sutures in circular rimcircular rim

• Rumenotomy: Rumenotomy: • Indications: FB, Indications: FB,

ruminal ruminal impaction, bloat, impaction, bloat, atony of atony of omasum or omasum or abomasumabomasum

• Inverted L – Inverted L – blockblock

• Local infiltration Local infiltration along line of along line of incisionincision

• Para vertebral Para vertebral blockblock

• Surgical Surgical technique: 20 cm technique: 20 cm incision- middle of incision- middle of tuber coxae and tuber coxae and last riblast rib5 cm ventral to 5 cm ventral to lumbar processlumbar process

• Caudal to last rib Caudal to last rib (close to (close to reticulum)reticulum)

• Esp. in deep Esp. in deep bodied animals bodied animals

• Anchor rumen to Anchor rumen to the incision to the incision to avoid avoid contamination of contamination of abdominal m. abdominal m. and peritoneumand peritoneum

• Continuous Continuous inverting pattern – inverting pattern – non-absorbablenon-absorbable

• Alternatively use Alternatively use weingarts ring weingarts ring (quicker)(quicker)

• Incise rumen Incise rumen with scalpelwith scalpel

• Evacuate and Evacuate and explore for FB in explore for FB in reticulum and reticulum and removeremove

• Try to feel for Try to feel for abscess in abscess in reticular areareticular area

• Reticulum is Reticulum is swept with a swept with a magnet to magnet to retrieve the iron retrieve the iron FB FB

• Rumen cud + Rumen cud + soda bicarb= soda bicarb= mineral oil mineral oil