Temporary end-on colostomy as a treatment for anastomotic dehiscence after a transanal rectal pull-through procedure in a dog.

OBJECTIVE: To describe a temporary end-on colostomy to treat the dehiscence of a transanal rectal pull-through in a dog. STUDY DESIGN: Case report ANIMAL: A 7-year-old intact female Australian shepherd dog that was treated for a rectal adenocarcinoma with a transanal rectal pull-through. METHODS: Partial dehiscence of the previous end-to-end colorectal anastomosis and formation of a perianal sinus tract were diagnosed 4 days after surgery. A pararectal approach was used to revise the surgery with debridement of the sinus tract, rectal wall reconstruction with single interrupted sutures, and placement of a passive drain. Dehiscence occurred 2 days later. The colon was transected cranial to the pelvic brim, and each stump was oversewn prior to salvage temporary end-on colostomy. Postoperative care included analgesia, antibiotic therapy, and local care of the perineal/perianal area and colostomy site. After 90 days, the perineal/perianal sinus tract had healed, the colostomy was eliminated, and an end-to-end anastomosis of the colon was performed. RESULTS: Management of postoperative complications focused on dermatitis of the stoma and perineal/perianal area, stoma incontinence, and perineal/perianal medications of the sinus tract. One year after the final surgery, the dog had occasional episodes of fecal incontinence and a good quality of life without other complications. CONCLUSION: Use of a temporary end-on colostomy prior to revision surgery led to a satisfactory outcome but required long and challenging postoperative management. CLINICAL SIGNIFICANCE: Temporary end-on colostomy may be an option to manage dehiscence and potential recurrent stenosis after transanal rectal pull-through in dogs.

Effect of different concentrations of dietary P and Ca on plasma inorganic P and urinary P excretion using noncolostomized and colostomized broilers.

Two 5-d bioassays were conducted to explore the P physiological threshold in broilers based on plasma inorganic P (iP), urinary P and Ca, and excreta P and Ca measurements in non-colostomized and colostomized broilers fed with different concentrations of non-phytate P (NPP) and Ca. In Experiment 1, 80 40-day-old Cobb 500 non-colostomized male broilers were assorted into 8 groups consisting of 10 broilers each and placed in individual metabolic cages. Similarly, 8 colostomized broilers of same age were allotted to 8 individual metabolic cages. The experimental diets consisted of a corn soybean meal basal containing 0.17% phytate P (PP) with 8 concentrations (0.08, 0.13, 0.18, 0.23, 0.28, 0.33, 0.38, and 0.45%) of NPP. The dietary Ca concentration was maintained at 0.5% by adjusting a 185-micron particle size limestone with each concentration of added P from added calcium phosphate, dibasic, monohydrate. After Experiment 1, broilers were fed a standard grower diet for 5 d and Experiment 2 was conducted the same as Experiment 1; however, Ca was maintained at 0.9% for all test diets. Plasma iP, urinary P and Ca, and total P (TP) and Ca retention along with phytate P hydrolysis were measured. At 0.5% Ca dietary level, the inflection points for dietary NPP obtained from segmented line regression analysis for plasma iP, urinary P, and urinary Ca were 0.26% (±0.04 SE), 0.28% (±0.01 SE), and 0.30% (±0.04 SE), respectively. The similar values for 0.9% Ca diets were 0.27% (±0.03 SE), 0.21% (±0.03 SE), and 0.30% (±0.0 SE), respectively. In summary, the present findings suggest that an increased dietary NPP would increase plasma inorganic P concentration along with increased % retention of TP and NPP until the broilers reach a point of physiological steady state (7.51 mg iP/dL - 8.13 mg iP/dL as found in this study). Excess P beyond physiological threshold is eliminated in urine coupled with decreased % retention.

Endoscopic colostomy with percutaneous colopexy: an animal feasibility study

Background: Indications for colostomy in colorectal diseases are obstruction of the large bowel, such as in cancer, diverticular disease in the acute phase, post-radiotherapy enteritis, complex perirectal fistulas, anorectal trauma and severe anal incontinence. Some critically ill patients cannot tolerate an exploratory laparotomy, and laparoscopic assisted colostomy also requires general anesthesia. Objective: To evaluate the feasibility, safety and efficacy of performing colostomy assisted by colonoscopy and percutaneous colopexy. Materials and methods: Five pigs underwent endoscopic assisted colostomy with percutaneous colopexy. Animals were evaluated in post-operative days 1, 2, 5 and 7 for feeding acceptance and colostomy characteristics. On day 7 full colonoscopy was performed on animals followed by exploratory laparotomy. Results: Average procedure time was 27 minutes (21- 54 min). Postoperative mobility and feeding of animals were immediate after anesthesia recovery. Position of the colostomy, edges color, appearance of periostomal area, as well as its function was satisfactory in four animals. Retraction of colostomy was present in one pig. The colonoscopy and laparotomy control on the seventh day were considered as normal. A bladder perforation that was successfully repaired through the colostomy incision occurred in one pig. The main limitation of this study is its experimental nature. Conclusion: Endoscopic assisted colostomy with percutaneous colopexy proves to be a safe and effective method with low morbidity for performing colostomy in experimental animals, with possible clinical application in humans (AU)

No disponible

Pilot Study: Colostomy and Urine Collection Protocol for Investigating Potential Inciting Causes of Hen Diuresis Syndrome.

Hen diuresis syndrome has emerged over the past 5 yr as a significant cause of mortality in the U.S. broiler breeder industry. The condition affects hens in production and is characterized by transient muscle weakness in the vent region, transient diuresis, and often urate deposits on the skin below the vent. Affected hens are often seen straining to lay an egg, which suggests oviduct contraction is also impaired. Related hen mortality, often reaching 1% or more a week, is believed to be primarily the result of male aggression of the vent region (Turner et al., "Investigating Causes of Excessive Urate Production in Broiler Breeder Hens Associated with Peritonitis and Cannibalism Mortality," Oral Presentation at The American Association of Avian Pathologists Annual Meeting, p. 139, 2010). The exact association between the cause of mortality and this syndrome is unknown, but it may be the consequence of transient partial to full oviduct prolapse, which predisposes or stimulates cannibalism and aggression. Based on unpublished work done prior to this study (Turner et al., ibid.), the evidence suggests the underlying problem is metabolic. We feel that urine collection and analysis is an essential component to understanding this condition. This study serves as a pilot study for future investigations that attempt to identify the nature and cause of the metabolic disturbance through paired urine and serum collection and analysis. For the purpose of this study, a small sample of 10 affected and 10 unaffected birds was used for sample collection. In order to collect pure urine, the birds were surgically colostomized. Colostomy did prove to be a useful means of collecting urine free of feces, and for the purposes of our study it yielded adequate urine samples for analysis. There were statistically relevant urine values observed. Affected birds had a higher presence of blood in the urine, a lower uric acid excretion rate (mg/hr), higher concentration (mEq/L) of urine Na+, and a lower concentration (mEq/L) of urine K+ than unaffected birds. This pilot study helps to address some of the pitfalls previously associated with colostomy and to determine when collection can begin postoperatively so that we can better understand when and how to begin our sampling in future trials to address the etiology of this condition.

Modified colostomy technique for colonic atresia in calves.

OBJECTIVE: To report a modified colostomy technique for permanent fecal diversion in calves with colonic atresia. STUDY DESIGN: Prospective study. ANIMALS: Calves (n=19) with colonic atresia. METHODS: Clinical findings, white blood cell counts, radiologic, ultrasonographic, and intraoperative findings were recorded. Calves were randomly divided into 2 groups: group 1 (n=9) had conventional colostomy and group 2 (n=10) had a modified colostomy. Technique efficacy was evaluated by postoperative observation, owner satisfaction, and calf survival. RESULTS: Fifteen (79%) calves were discharged from the hospital; 4 (21%) group 1 calves died within 24 hours after surgery. Two (40%) group 1 calves died 18 and 30 days after surgery and 5 (50%) group 2 calves died 2-60 days after surgery. Eight calves reached slaughter weight (120+/-10 kg); 5 group 2 calves grew normally but the 3 group 1 calves had lower weight gain. Owners of the calves with conventional colostomy reported that the evacuation of feces was continuous whereas owners of calves with the modified colostomy reported that feces were released through the stoma in intervals. CONCLUSION: Modification of conventional colostomy by forming an hourglass shaped stoma lessens fecal incontinence but there was no difference in survival rate. CLINICAL RELEVANCE: Modified colostomy was considered advantageous because of intermittent fecal discharge from the stoma compared with continuous fecal release in conventional colostomy. The modified technique seemingly has a beneficial effect on growth of the calf.

Surgical repair and management of congenital intestinal atresia in 68 calves.

OBJECTIVE: To determine outcome and survival rate after surgical treatment of intestinal atresia, gender predilection, and effect of rectal palpation on the cause of atresia coli in calves. STUDY DESIGN; Prospective clinical study. ANIMALS: Newborn calves (n=68). METHODS: Data collected were husbandry system, anamneses, physical examination findings, surgical treatments, and postoperative results. Calves with atresia ani, and with atresia coli et recti had anal reconstruction and right flank colostomy, respectively. In midflank colostomized calves, the inner muscular layers were dissected to form a valve-like stoma. RESULTS: Of 68 calves with intestinal atresia, 37 were treated surgically. Anal reconstruction was performed in 21 calves with atresia ani with a long-term survival rate of at least 6 months with good condition. Colostomy was performed in 14 calves with atresia coli and 1 with atresia coli et recti; survival rate was 73%. The case morbidity rate for intestinal atresia was 13.8% and for atresia coli, 5.7% in the hospital population. No gender predilection for occurrence of atresia ani and atresia coli was identified. Palpation per rectum for early pregnancy diagnosis did not predispose to atresia coli. CONCLUSION: Surgical treatment of atresia ani through circular anal skin removal has a good prognosis for survival. Colostomy is not an acceptable treatment from the calf's perspective because of the resulting poor condition but the high survival rate is important to allow continued milk production of the dam. CLINICAL RELEVANCE: Early diagnosis, supportive treatment, and surgical correction are important in management of atresia coli.

Use of a temporary incontinent end-on colostomy in a cat for the management of rectocutaneous fistulas associated with atresia ani.

A 2 1/2-month-old cat was evaluated for the presence of multiple draining tracts ventral to the tail of 8 days duration. Clinical and radiographic examination revealed that the cat had rectocutaneous fistulas and type II atresia ani. The cat underwent a temporary end-on colostomy for faecal diversion. Sixty days after surgery and after the fistulas resolved the animal underwent a second surgery for colostomy closure and anal reconstruction. Two years after surgery the cat was reported to be in good health with no faecal incontinence.

Surgical technique to repair grade IV rectal tears in post-parturient mares.

OBJECTIVE: To describe a surgical technique for repair of grade IV rectal tears after parturition in mares and to report outcome. STUDY DESIGN: Clinical report. ANIMALS: Horses (n=6) with grade IV rectal tears. METHODS: Mares were sedated and restrained in standing stocks. After caudal anesthesia and evacuation of feces from the rectum, the perineal region was aseptically prepared. Four stay sutures were placed through the external anal sphincter before vertical transection (12 o'clock). Caudal retraction of the tear was performed using Allis tissue forceps (5 mares) or stay sutures before accurate apposition of the tear margins with steel staples below the tissue forceps. The mucosal edges were then sharply dissected leaving approximately 5 mm edges which were apposed in a single layer (2-0 poliglecaprone 25) before stapler release. In 1 mare, the rectal tear was identified and apposed using a 2-layer hand-sutured closure. Systemic antibiotics and anti-inflammatory agents were administered postoperatively (5 mares) and standing abdominal lavage performed (3 mares). RESULTS: Four mares survived long term and subsequently became pregnant. Immediately after surgical repair, 1 mare was anesthetized for exploratory celiotomy and abdominal lavage but fractured her pelvis during recovery from anesthesia and was euthanatized. A 2nd mare was euthanatized after 72 h because of severe diffuse peritonitis; however, the repair was still intact. CONCLUSION: In standing mares, rectal tears can be exteriorized by prolapse through the anal sphincter after sphincterotomy and repaired in 2 layers with staples oversewn with a continuous suture pattern. CLINICAL RELEVANCE: Rectal tears occurring as a result of parturition can potentially be repaired efficiently using an oversewn stapled primary closure technique.

Improved colostomy technique and excrement (urine) collection device for broilers and broiler breeder hens.

In conducting nutritional experiments using chickens, scientists are limited in determining the urinary excretion of nutrients because of the difficulty of separating urine from feces. Our main objective was to improve the colostomy procedure for urine collection in broilers and both urine and egg collection for broiler breeder hens. Ketamine HCl (10 to 30 mg/kg i.m.) in combination with Xylazine (2 to 6 mg/kg i.m.) was used to anesthetize broilers (4 wk old) and broiler breeder hens (25 wk old). The colostomy technique involved: 1) transecting the distal colon at approximately 1.5 to 2 cm from the proximal cloaca and ligating the distal colonic segment with 3-0 absorbable surgical suture, 2) ligating the seromuscular coat of the colon to the peritoneal tissue at 3 points in a triangular shape using 4-0 silk suture, 3) ligating the mesentery at the skin level to prevent continued bleeding of the colostomy stoma, and 4) placing 3 sutures using a triangulation technique that consisted of the seromuscular aspect of the transected proximal colonic segment and the skin, and finally, 5) suturing all exteriorized edges of the transected proximal colonic segment after mucosal eversion to the skin with simple interrupted sutures using absorbable suture. For the purpose of urine or egg collection or both, the appropriate size of drainable pouch with a curved tail closure was used. Feces were collected on a tray. The colostomized broilers could be kept for several days and the colostomized broiler breeder hens for several months to collect urine, eggs (for breeder hens), and feces separately without the problem of cross-contamination.

Use of an incontinent end-on colostomy in a dog with annular rectal adenocarcinoma.

An 11-year-old, mixed-breed dog with dyschezia, tenesmus and haematochezia was presented. A rectal stricture caused by an adenocarcinoma was diagnosed. Following the failure of a rectal 'pull-through' procedure, which dehisced seven days later, an incontinent end-on colostomy was performed, allowing amputation of the colorectum with the anus and perineal skin. A two-piece device consisting of a flange and a drainable pouch was used for postoperative faecal evacuation and collection. Mild peristomal dermatitis was the only complication. Patient management was easily carried out by the owner at home, and the dog survived for four months with a satisfactory quality of life. Incontinent end-on colostomy may prove to be a useful treatment for canine annular colorectal tumours.

Treatment of irreducible caecocolic intussusception in horses by jejuno(ileo)colostomy.

Six of eight horses with caecocolic intussusception were treated successfully by jejuno- or ileocolostomy. The other two horses were euthanased during surgery. Four of the six horses survived long term, but two died within two-and-a-half months, of problems related to the surgery. Compared with other techniques for treating caecocolic intussusception, jejuno- or ileocolostomy reduces surgical time and decreases the risk of abdominal contamination.

Effects of caecal ligation and colostomy on water intake and excretion in chickens.

1. The effect of caecal ligation and colostomy on water intake and excretion were examined in chickens fed a low-protein diet or a low-protein diet supplemented with urea. 2. When fed a low-protein diet, the water intake and the ratio of water intake to food intake were increased by colostomy (P < 0.05) but not changed further by caecal ligation of colostomised chickens. 3. When fed a low-protein diet supplemented with urea, the amount of water intake and the ratio of water intake to food intake were not changed by either treatment. 4. Total water excretion was much higher in the colostomised plus caeca-ligated chickens than in other 3 groups fed both types of diet (P < 0.05). 5. The amount of faecal water excretion was increased by cecal ligation in colostomised chickens fed either diet (P < 0.01). 6. No effect of any treatment on water balance was observed in chickens fed either diet. 7. It is concluded that the lower intestine plays a useful role in the water economy of chickens fed a low-protein diet or a low-protein diet supplemented with urea.

Design and clinical use of a modified colon tray for large colon evacuation in the horse.

A modified colon tray to perform large colon evacuations in horses was designed. A funnel-shaped accessory was constructed to create a mechanical separation between the sterile and nonsterile part of the tray. Sterile hooks were used to make a temporary and stabile colostomy. Thirty horses with surgical correction of nonstrangulating large colon obstruction underwent a large colon evacuation with this modified tray. The surgical procedure was uncomplicated and resulted in a positive outcome in 29 horses. This less labour-intensive way to evacuate the large colon results in minor contamination and makes extraluminal lavage becomes superfluous. This modified tray is a very efficacious and practical instrument for emptying the large colon in horses.

The use of colonic irrigation to control fecal incontinence in dogs with colostomies.

OBJECTIVE: To determine if once-daily colonic irrigation results in fecal continence for a 24-hour period in dogs with colostomies and if colonic volume increased in response to the irrigation. STUDY DESIGN: A prospective controlled experimental study. ANIMALS: Four intact male and one intact female mixed breed dogs. MATERIALS: All dogs received left end-on paralumbar colostomies. Four dogs received once-daily colonic irrigation for 8 weeks, whereas the control dog did not. Daily fecal weights were recorded for the length of the study in all dogs. Barium enema studies and volumetric studies were used to determine colonic volumes. RESULTS: Daily fecal weights were significantly decreased in treatment dogs compared with the control dog. Colonic volume increased in irrigated dogs in response to daily irrigation over the 8 week period of the study. CONCLUSIONS: Colonic irrigation resulted in significantly decreased fecal production over a 24-hour period. Therefore management of dogs with colostomies would be more practical and cost effective. It did not result in complete fecal continence in this study. Further clinical studies are indicated to determine if longer periods of irrigation would result in complete continence.

Identification of the major urinary and fecal metabolites of 3,5-dinitrobenzamide in chickens and rats.

Colostomized chickens given oral doses of 3,5-dinitrobenzamide (nitromide) cleared nitromide predominantly through the urine (58% of dose) and feces (21% of dose). Rats cleared 52% of nitromide via urinary excretion and 44% via feces. Major urinary metabolites for both chickens and rats include: 3-amino-5-nitrobenzamide, 3-acetamido-5-nitrobenzamide, 3-acetamide-5-aminobenzamide, and 3,5-diacetamidobenzamide. The major fecal metabolite in chickens was 3-acetamido-5-nitrobenzamide (67% of fecal 14C) and 3-acetamido-5-aminobenzamide in rats (approximately 50%).

Cecocolic and cecocecal intussusception in horses: 30 cases (1976-1996).

OBJECTIVE: To determine the prognosis in horses with cecocolic or cecocecal intussusception. DESIGN: Retrospective study. ANIMALS: 30 horses with cecocolic intussusception or cecocecal intussusception. PROCEDURE: Information on history, physical examination findings, and laboratory values was summarized from the medical records. Laboratory data included results of hematologic examination, serum biochemical analysis, and peritoneal fluid color, total nucleated cell count, and total protein concentration. A one-year follow-up via the telephone was used to determine long-term survival. RESULTS: Horses ranged from 7 months to 30 years old, but 63% were < or = 3 years. Standardbred horses were significantly overrepresented. Twenty-six horses had acute-to-subacute disease, and 4 had a chronic wasting disease. Cecal intussusceptions were suspected on the basis of finding a mass on abdominal palpation per rectum (14 of 24 horses) and positive ultrasonographic findings (2 of 3 horses). Thirteen horses with colic for > 1 day had scant, soft feces. Six horses died or were euthanatized without undergoing surgery, and 24 were treated surgically. Six of the latter horses were euthanatized during surgery because of peritonitis, rupture of the cecum, and irreducible intussusception. All 4 horses with a chronic disease were euthanatized because of irreversible changes in the cecum. Of the 18 horses allowed to recover from surgery, 15 survived long-term. Surgical treatments were reduction, with or without partial typhlectomy (6 horses), partial typhlectomy through a colotomy and reduction (6), reduction through a colotomy and partial typhlectomy (3), partial typhlectomy for a cecocecal intussusception (1) and an ileocolostomy (2). CLINICAL IMPLICATIONS: Cecal intussusception has a good prognosis with surgical correction without delay. Reduction through colotomy has a high success rate. Bypass by ileocolostomy should be used as a last resort.

Management of rectal tears.

Rectal tears have important medicolegal implications, and severe tears have a poor prognosis. Prompt diagnosis, immediate application of first aid measures, early referral, use of appropriate definitive treatments, and aggressive aftercare will improve the prognosis. The grade of rectal injury will determine the definitive treatment, but there are few guidelines to determine which treatment is best in each case. Bypass procedures, such as colostomy and indwelling rectal liner, have their own advantages and disadvantages, but can facilitate healing and prevent life-threatening complications if they are used with minimum delay. Suture of the tear can be difficult, but should be attempted to hasten healing and to prevent progression of the tear to a more severe injury.

Use of colostomy to manage rectal disease in dogs.

OBJECTIVE: The purpose of this study was to develop a diverting colostomy technique for use in dogs. STUDY DESIGN: Clinical case series. ANIMALS: Five client-owned dogs presented for diseases requiring diverting colostomy during treatment. METHODS: Diverting colostomy was performed in five dogs. A ventral approach was used in the first dog and the colon was exteriorized adjacent to the linea alba. The technique used in the next four dogs involved creation of a left flank rod-supported loop colostomy in which the colon was exteriorized through a muscle-separating flank approach to the abdomen. RESULTS: Peritoneal leakage of fecal material resulted in the perioperative death of the first dog. The flank colostomies were maintained for times ranging form 3.5 weeks to 7 months. No major complications were observed, but skin excoriation occurred occasionally around the stoma sites in all dogs. CONCLUSION: Diverting colostomy is a technique that is suitable for use in treatment of dogs with obstruction or leakage involving the distal colon or rectum.

An improved colostomy technique in turkeys.

1. A modified method for colostomy of turkeys was developed which allowed normal and consistent gains for 4 to 8 weeks. 2. Female Nicholas turkeys, 5 to 7 weeks of age and weighing 1.2 to 2.2 kg body weight, were subjects. Major adjustments in the technique included: transfixing of the peritoneum with 4 stay sutures prior to opening, suturing the peritoneum to the seromuscular coat of the colon, eversion of the end of the colon and joining of adjacent skin to the rim of the colon. 3. Urine was collected in a plastic bag attached around the vent with a urine collection fitting. Faeces passing through the colostomy were collected on a tray below the cage.