Colon: resection

Buy now to access the full article, existing subscribers login

Sections available in full article Introduction, Uses, Alternative techniques, Time required, Decision taking, Requirements, Materials required, Preparation, Procedure, Aftercare, Immediate Aftercare, Long term Aftercare, Sequelae, Complications, Prognosis, Reasons for treatment failure, Sources, Publications, Vetstream contributor(s),
Contributors Dr Cheryl Hedlund DVM MS
Mr Andrew Gardiner BVM&S, Cert SAS, MSc, MRCVS

Introduction

  • Resection of 90-95% of the colon followed by anastomosis comprises subtotal colectomy.

Uses

  • In the treatment of constipation/obstipation caused by megacolon  Megacolon  .
  • Causes of megacolon in cats include:
    • Congenital lesions.
    • Neurological dysfunction or injury.
    • Prolonged distension.
    • Idiopathic.
    • Outlet obstruction (eg pelvic canal narrowing due to fracture malunion; stricture; neoplasia).
    • Behavioral.
  • Most cases in cats are either idiopathic or arise due to pelvic fracture or sacroiliac luxation that has caused pelvic canal narrowing.

Advantages

  • Provides a surgical solution to an often intractable and recurring problem that may prompt owners to request euthanasia.

Disadvantages

  • Once more than 70% of the colon is resected loose feces/diarrhea result, though these symptoms commonly abate after a period of 1-2 months. Fecal consistency usually becomes acceptable, although the cat may defecate more often than normal.

Requirements

Materials required

Minimum equipment

  • Standard surgical pack.
  • Padiatric Balfour retractor  Surgical instruments: self-retaining retractors - Balfour abdominal  .
  • Doyen atraumatic clamps.

Ideal equipment

  • Suction.

Minimum consumables

  • Polydioxanone or polyglyconate suture material is recommended (3/0 and 4/0).
  • Laparotomy sponges/towels.

Preparation

  • 15 minutes.
    Preoperative enemas are unnecessary - it is difficult to remove all material and the fecal slurry produced may make intraoperative contamination more (not less) likely.
  • Cats with severe and chronic obstipation may be dehydrated, toxic and have electrolyte disturbances from vomiting. They should be assessed and stabilized preoperatively.
  • Preoperative antibiotics  Therapeutics: antimicrobial drug  should also be administered; drugs should be effective against the aerobic and anaerobic species encountered in the colon.

Sequelae

Complications

  • Stricture: if excessive inversion or eversion suture techniques are used. Uncommon with appositional closure.
  • Incontinence: rare.
  • Diarrhea: sometimes due to small intestinal bacterial overgrowth.
    Note that loose feces are expected for several weeks postoperatively, until the small intestinal absorptive capacity increases to cope with the shortened colon. Ensure owners are made aware of the fact that loose and frequent feces can persist for up to 6 weeks postoperatively. Most cats then regain a much more normal fecal consistency, although frequency of defecation may remain elevated.
  • Constipation  Constipation  may occasionally recur.
  • If problems arise specific diets are available which will assist in modifying fecal consistency.

Prognosis

  • Generally good to excellent.

Reasons for treatment failure

  • Insufficient removal of colon may result in persistent constipation.

Sources

Publications

  • De Haan J J et al (1992) Surgical correction of megacolon in cats. Feline Practice 20, 6.

Sample content only, to unlock the full article login or buy now

Loading...