Bovis ISSN 2398-2993

Rectal tear: surgery

Contributor(s): Ash Phipps , Roger Blowey

Introduction

  • Extensive rectal tears most commonly occur in association with parturition, sometimes due to  dystocia, sometimes excessively forceful assistance, and sometimes due to the dam being in an abnormal posture.
  • Rectal tears may occur due to misdirection of the penis under natural mating.
  • Minor rectal tears e.g. of the mucosa, can occasionally occur due to rough rectal palpation and/or poor animal restraint during rectal palpation.
  • The prognosis for animals affected by rectal tears is dependent upon site, severity of tear and promptness of medical and surgical treatment.
  • Rectal tears are graded I to IV. Grade I to III carry a fair prognosis. Grave IV tears carry a grave prognosis.
  • Type I (Common): tear of the mucosa and submucosa only
  • Type II (Uncommon): tear of the mucosa, submucosa and disruption of the muscular layers.
  • Type III (Uncommon): tear of the mucosa, submucosa and muscular layer with serosa remaining  intact.
  • Type IV (Rare): tear of the mucosa, submucosa, muscular layer and serosa.
    • Type IV tears of the rectum that communicate with the vestibule are known as a recto-vaginal fistula. This type of injury is associated with dystocia and the management of these injuries is discussed in the article on vaginal repair (see related content).

Management of rectal tears as per their classification

  • Type I:
    • Rest from rectal palpation for a minimum of 7 days.
    • Offer a diet that has a laxative effect (green grass or silage).
    • An epidural anesthetic may be required for the first 24 to 48 hours post tear if the animal is straining excessively.
    • NSAID’s may also be indicated.
  • Type II:
    • Rest from rectal palpation for a minimum of 1 month.
    • Offer a diet that has a laxative effect (green grass or silage).
    • An epidural anesthetic may be required for the first 1 to 4 days post tear (reduce tenesmus).
  • Type III:
    • As per type II.
  • Type IV :
    • Management of these tears will be dependent on the size of the deficit, location and the degree of fecal contamination of the abdomen.
    • Euthanasia:
      • Tears that have resulted in extensive fecal contamination of the abdomen will result in septic peritonitis. Prognosis is guarded, and immediate euthanasia or salvage slaughter is indicated.
    • Medical management:
      • Small tears that communicate with the retroperitoneal space in the pelvic region, have a poor prognosis, however, the following medical management may result in survival of the individual:
        • Broad spectrum antibiotics for 1 – 2 weeks, depending on the severity of the tear.
        • NSAID.
        • Rest from rectal palpation.
        • Offer a diet that has a laxative effect (green grass or silage).
        • Epidural anesthetic may be required for the first 1 to 4 days post tear, to reduce tenesmus.
    • Surgical management:
      • Should only be attempted in cases of small tears with no or minimal fecal contamination of the abdomen.
        • Four surgical techniques have been described in equine practice that maybe considered for bovine cases:
          • Suturing: described below.
          • Temporary rectal liner: described below.
          • Loop colostomy: this procedure diverts feces away from the tear during the healing process. However, this involves two surgical procedures and is unlikely to ever be financially viable in cattle practice.
          • End colostomy: this procedure diverts feces away from the tear during the healing process. However, this involves two surgical procedures and is unlikely to ever be financially viable in cattle practice.
Selection of technique dependent upon location, severity and age of injury and presence/absence of peritonitis.
Consider animal welfare. If prognosis is poor then early euthanasia may be in your patient's best interests.

Uses

  • Surgical correction of type IV rectal tears.

Advantages

  • Simple, inexpensive standing procedure.
  • Non-visual technique requires minimal equipment.
  • May help to prevent progression of a rectal tear → higher grade → fecal contamination of abdomen → peritonitis.
  • Partial closure can prevent distraction of wound edges.
  • The use of a temporary indwelling rectal liner could help to prevent fecal contamination during the healing process.

Disadvantages

  • Access is difficult - often sutures have to be placed 'blind' using feel per rectum.
  • Special long-handled instruments may be required.
  • Laparotomy may be required.
  • A diverting procedure, e.g. temporary indwelling rectal liner or colostomy may be required to reduce fecal passage over damaged tissues during healing. Such procedures are poorly documented in cattle and the economics involved in such procedures is likely to preclude their use in cattle. 

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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Prognosis

  • Depends upon site, severity of tear and promptness of medical and surgical treatment.
  • Fair: Grade I to III.
  • Guarded: Grade IV tears can be rapidly fatal.

Further Reading

Publications

Refereed Papers

  • Recent references from PubMed and VetMedResource.
  • Eastman T G et al (2000) Treatment of grade 3 rectal tears in horses by direct suturing per rectum. Equine Vet Educ 12, 32-34 VetMedResource.
  • Baird A N & Freeman D E (1997) Management of Rectal Tears. Veterinary Clinics of North America: Equine Practice 13 (2), 377-392 PubMed.

Other sources of information

  • Parkinson T J, Vermunt J J & Malmo J (2010) Diseases of cattle in Australasia: a comprehensive textbook. New Zealand Veterinary Association Foundation for Continuing Education, Wellington, NZ. pp 121.
  • Anderson D E & Rings M (2008) Current Veterinary Therapy: Food Animal Practice. Elsevier Health Sciences. pp 126.
  • Rebhun W C, Guard C & Richards C M (1995) Diseases of dairy cattle. Williams and Wilkins. pp 192.


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