Intestine: rupture

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Introduction

  • Intestinal rupture is a life-threatening condition requiring emergency stabilization and treatment (surgery).
  • Cause :
    • Sequel to obstruction by foreign body, ruptured neoplasm, eg lymphoma, adrenocarcinoma, leiomyoma, torsion or intussusception.
    • As a result of penetrating trauma, eg gunshot.
    • Complication after bowel surgery, especially after anastomotic procedures.
    • Rarely secondary to hyperacidity caused by mast cell tumor/gastrinoma.
  • Acid-base, electrolyte and hydration status are usually abnormal.
  • Septic complications and peritonitis are likely to have begun prior to treatment.
  • Signs : depression/collapse, abdominal pain, dehydration, vomiting, tachypnea.
  • Diagnosis : history, radiography, abdominocentesis, hematology, biochemistry, ultrasonography.
  • Treatment : surgical resection and anastomosis, abdominal lavage.
  • Prognosis : guarded.

Diagnosis

Clinical signs

  • Pale or injected mucous membranes.
  • Dehydration.
  • Tachycardia.
  • Tachypnea.
  • Pain/splinting on abdominal palpation.
  • Pyrexia or hypothermia (depending on state of shock).

Differential diagnosis

  • Other causes of peritonitis :
    • Rupture of other abdominal organs, eg biliary tree, stomach, urinary tract, pancreas.
    • Retained swabs or other irritant materials after surgery.
  • The presenting symptoms and clinical appearance of the above may be very similar to intestinal rupture.

Outcomes

Prognosis

  • Guarded prognosis for any animal presenting with intestinal rupture.
  • Major complications post-operatively are usually seen within the first 48 hours, however this may be a difficult assessment in animals that were seriously ill prior to undergoing surgical treatment for intestinal rupture. Careful attention to basic clinical signs will usually allow an assessment of the direction in which the patient is moving.

Expected response to treatment

  • Improved basic clinical parameters and demeanor.
  • Consumption of oral fluids without vomiting.
  • Normal wound healing.

Reasons for treatment failure

  • Failures are generally noticed within 1-3 days of commencing treatment:
    • Irreversible or progressive pathophysiological complications of generalized peritonitis.
    • Breakdown of intestinal anastomosis in already debilitated patients.
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