Use of liposomal bupivacaine in dogs and cats undergoing gastrointestinal surgery is not associated with a higher rate of surgical site infections or multidrug-resistant infections

OBJECTIVE

To report the rate of surgical site infections (SSIs) after clean-contaminated and dirty gastrointestinal surgery in dogs and cats that did and did not receive incisional infiltration of Nocita and report the bacteria isolated.

ANIMALS

Client-owned dogs (n = 211) and cats (78).

METHODS

Records of dogs and cats that underwent gastrointestinal surgery at the Matthew J. Ryan Veterinary Hospital of the University of Pennsylvania and the University of Florida Small Animal Hospital between July 1, 2020, and April 1, 2023, were reviewed for surgical procedures, presence of preoperative septic peritonitis, use of Nocita, perioperative antibiotics administered, postoperative antibiotic use, SSI development postoperatively, and aerobic bacteria isolated.

RESULTS

7 of 124 (5.6%) dogs that received Nocita and 9 of 87 (10.2%) that did not receive Nocita developed an SSI. No dogs presenting with septic peritonitis and given Nocita (n = 5) developed an SSI. Two of 55 (3.6%) cats that received Nocita and 1 of 23 (4%) that did not receive Nocita developed an SSI. Multidrug-resistant (MDR) Escherichia coli was the most common aerobic bacteria isolated from SSIs (n = 3), and MDR bacteria were isolated commonly from both groups (4).

CLINICAL RELEVANCE

Use of Nocita for gastrointestinal surgery in dogs and cats is not associated with higher rates of SSI than published rates of SSI after gastrointestinal surgery. Use of Nocita in dogs with preoperative septic peritonitis is not associated with the development of SSI. MDR bacteria are commonly isolated via culture from both dogs that received Nocita and those that did not.

Prognostic indicators for survival in surgically managed small intestinal obstruction in pet rabbits: 141 presentations (2011-2021)

OBJECTIVE

To determine prognostic relevance of various patient factors and intraoperative variables associated with surgical management of small intestinal obstruction in pet rabbits.

ANIMALS

114 pet rabbits with 141 presentations of small intestinal obstruction treated surgically between June 2011 and December 2021.

METHODS

In a retrospective observational study design, medical records were reviewed for rabbits with small intestinal obstruction that had undergone surgical intervention. Data were collected on variables of interest and outcome (survival to hospital discharge). Univariable and multivariable logistic regression analyses were performed to identify variables associated with survival.

RESULTS

Overall survival was 75.2% (106/141). Specifically, 95.7% (22/23) of presentations involving rabbits < 25 months survived. The odds of survival on univariable modeling were significantly lower in presentations of rabbits > 72 months compared with those < 25 months (OR, 0.05; 95% CI, 0.01 to 0.40; P = .005). Rectal temperature, clinicopathologic findings, etiology of obstruction, presence of full-thickness gastrointestinal wall injury, and previous small intestinal obstruction surgery did not show significant effects on survival. In a multivariable model that controlled for plasma potassium and calculated plasma osmolarity and tonicity, the odds of survival in presentations of rabbits > 72 months were 95% lower than those < 25 months (OR, 0.05; 95% CI, 0.01 to 0.50; P = .012).

CLINICAL RELEVANCE

Surgical intervention should be considered a suitable treatment option for small intestinal obstruction in rabbits < 72 months and carried a good prognosis. The most common etiology was consistent with a compressed hair pellet, and extraluminal digital manipulation into the cecum was a successful surgical technique in most presentations.

Anoplasty and rectovaginal fistula repair in a gilt with atresia ani: A case report

A 2-year-old female Vietnamese potbellied pig was referred to the Large Animal Teaching Hospital at the Ontario Veterinary College for anoplasty and rectovaginal fistula repair. The presence of atresia ani and rectovaginal fistula had been previously diagnosed. Contrast radiography was used to confirm the diagnosis and determine the position of the fistula and terminal rectum. Under general anesthesia, the urethra was catheterized. An incision was made at the anatomic location of the anus, the rectovaginal fistula was isolated through deep dissection, and a Penrose drain was placed around it for caudal retraction. Transvaginal catheter placement through the fistula and into the rectum assisted with anatomic location. Once the urogenital and gastrointestinal tracts were clearly identified, the fistula was transected as close to the vaginal cavity as possible. The vaginal defect was sutured, and the fistula tract was mobilized 90° and sutured to the skin, creating the anal canal. Postoperative complications included constipation and cystitis. The gilt passed feces 5 d after surgery and was discharged on Day 11 of hospitalization. Normal urination and defecation were observed at the time, and fecal incontinence was resolved. Six months after surgical intervention, the gilt remained continent and no complications were reported. Key clinical message: Anoplasty and rectovaginal fistula repair were completed successfully in a gilt. Preservation of the fistula and its use during anal reconstruction may provide an internal anal sphincter and may be associated with improved continence.

Clinical outcomes of the use of unidirectional barbed sutures in gastrointestinal surgery for dogs and cats: A retrospective study

OBJECTIVE

To report the clinical outcomes of gastrointestinal surgery using unidirectional barbed sutures in single-layer appositional closure in dogs and cats.

STUDY DESIGN

Retrospective and descriptive study.

SAMPLE POPULATION

Twenty-six client-owned dogs; three client-owned cats.

METHODS

Medical records of dogs and cats that received gastrointestinal surgery closed with unidirectional barbed sutures were reviewed to collect information on signalment, physical examinations, diagnostics, surgical procedures, and complications. Short- and long-term follow-up information was collected from the medical records, the owners, or the referring veterinarians.

RESULTS

Six gastrotomies, 21 enterotomies, and nine enterectomies were closed with a simple continuous pattern with unidirectional barbed glycomer 631 sutures. Nine dogs had multiple surgical sites closed with unidirectional barbed sutures. None of the cases in the study developed leakage, dehiscence, or septic peritonitis during the 14-day short-term follow up. Long-term follow up information was collected for 19 patients. The median long-term follow-up time was 1076 days (range: 20-2179 days). Two dogs had intestinal obstruction due to strictures at the surgical site 20 and 27 days after surgery. Both were resolved with an enterectomy of the original surgical site.

CONCLUSION

Unidirectional barbed suture was not associated with a risk of leakage or dehiscence after gastrointestinal surgery in dogs and cats. However, strictures may develop in the long term.

CLINICAL SIGNIFICANCE

Unidirectional barbed sutures can be used during gastrointestinal surgery in client-owned dogs and cats. Further investigation of the role of unidirectional barbed sutures leading to abscess, fibrosis, or stricture is necessary.

Partial volvulus, entrapment, and extraluminal obstruction of the jejunum in a cat

A 2-year-old, spayed female, domestic shorthair cat was presented in compensated hypovolemic shock after 24 h of anorexia, vomiting, and lethargy. An enterotomy had been performed at 9 mo of age to remove a foreign body. Due to inconclusive findings on abdominal imaging, an exploratory laparotomy was done. An adhesion at the root of the mesentery, likely associated with the previous surgery, had resulted in partial volvulus, entrapment, and extraluminal obstruction of the jejunum. Transection of the adhesion allowed repositioning of the bowel without the need for resection. The cat was discharged from the hospital 7 d postoperatively. Adhesions have not previously been reported to cause small bowel volvulus in cats. Key clinical message: Abdominal adhesions as a cause of clinical disease in cats have apparently not been reported. This case report demonstrates how malposition of the gastrointestinal tract, secondary to adhesions, should be included as a differential diagnosis for feline patients presenting with acute abdomens. Previous abdominal surgery is a risk factor for development of adhesions. This case emphasized the importance of Halsted's principles of surgery to reduce the risk of postoperative adhesions, even in species not predisposed to forming adhesions.

Intestinal dehiscence and mortality in cats undergoing gastrointestinal surgery

OBJECTIVES

The aim of this study was to determine the incidence of and risk factors for both gastrointestinal (GI) incisional dehiscence and mortality in a large cohort of cats undergoing GI surgery. We hypothesized that cats with preoperative septic peritonitis (PSP), systemic inflammatory response syndrome (SIRS) or sepsis would have higher GI dehiscence and mortality rates than unaffected cats.

METHODS

A medical records search identified cats with surgically created, full-thickness incisions into their stomach, small intestines or large intestines. Preoperative data, including signalment, clinical signs, comorbidities, surgical history, current medications, presenting physical examination findings, complete blood counts and serum biochemistry values, were collected. It was determined whether or not cats had PSP, SIRS or sepsis at admission. Intraoperative data, final diagnosis and postoperative variables such as vital parameters, bloodwork and (if applicable) the development of GI dehiscence or mortality were noted. Postoperative follow-up of at least 10 days was obtained in survivors.

RESULTS

In total, 126 cats were included. One cat developed GI dehiscence following complete resection of a jejunal adenocarcinoma. Twenty-three cats (18.2%) died within 10 days of surgery. Cats with PSP (P = 0.0462) or that developed hypothermia 25-72 h postoperatively (P = 0.0055) had higher odds of mortality in multivariate analysis. Cats with PSP had 6.7-times higher odds of mortality than cats not diagnosed with PSP.

CONCLUSIONS AND RELEVANCE

In cats receiving GI surgery, the incidence of GI incisional dehiscence was <1%. Cats with PSP had a higher likelihood of mortality. SIRS was a common finding in cats with septic peritonitis, but was not associated with mortality. Postoperative mortality during the home recovery period might be significant in cats. Future studies evaluating postoperative mortality in cats should consider extending the research period beyond the date of discharge.

Laparoscopic colopexy for recurrent rectal prolapse in a Maltese dog

A 2.5-kg castrated male Maltese dog, suspected to be older than 10 y, was presented with a prolapsed mass at the anus. This had occurred on 2 previous occasions within the last 4 mo and had been managed with manual reduction and purse-string sutures. The rectal prolapse had viable tissue and was reducible but resulted in straining and fecal accumulation. Colopexy (with intracorporeal sutures) was performed laparoscopically using 3 ports; the distal colon was retracted cranially and attached to the abdominal wall with 3 simple interrupted sutures in a single row. The dog recovered uneventfully, had good appetite and normal activity, did not strain, and defecated without issues. There were no wound-healing complications and at 12-month post-operative examination, the patient was in good condition without clinical signs. Based on this case report, laparoscopic colopexy is clinically practical for management of rectal prolapse in small-breed dogs.

Evaluation of the sublingual microcirculation with sidestream dark field video microscopy in horses anesthetized for an elective procedure or intestinal surgery

OBJECTIVE

To compare the sublingual microcirculation between healthy horses anesthetized for elective procedures and horses with colic anesthetized for abdominal surgery and to determine the effect of mean arterial blood pressure (MAP) on the microcirculation.

ANIMALS

9 horses in the elective group and 8 horses in the colic group.

PROCEDURES

Sublingual microcirculation was assessed with sidestream dark field video microscopy. Videos were captured at 3 time points during anesthesia. Recorded microvasculature parameters were De Backer score (DBS), total density of perfused vessels (PVD) and small vessels (PVD-S), total proportion of perfused vessels (PPV) and small vessels (PPV-S), vascular flow index (MFI), and heterogeneity index (HI). Blood pressure during hypotensive (MAP < 60 mm Hg) and normotensive (MAP ≥ 60 mm Hg) episodes was also recorded.

RESULTS

During normotensive episodes, the elective group had significantly better PPV and PPV-S versus the colic group (median PPV, 76% vs 50%; median PPV-S, 73% vs 51%). In both groups, PPV decreased during anesthesia (elective group, -29%; colic group, -16%) but significantly improved in the elective group 15 minutes before the end of anesthesia (59%). During hypotensive episodes, PVD-S was better preserved in the colic group (11.1 vs 3.8 mm/mm²). No differences were identified for the microcirculatory parameters between normo- and hypotensive episodes in the colic group.

CONCLUSIONS AND CLINICAL RELEVANCE

Sublingual microcirculation was better preserved in healthy horses anesthetized for elective procedures than in horses with colic anesthetized for abdominal surgery despite resuscitation maneuvers. Results indicated that the macrocirculation and microcirculation in critically ill horses may be independent.

Comparison of patient outcomes following enterotomy versus intestinal resection and anastomosis for treatment of intestinal foreign bodies in dogs

OBJECTIVE

To quantify the relative risk of intestinal dehiscence in dogs undergoing intestinal resection and anastomosis (IRA), compared with enterotomy, for surgical management of small intestinal foreign bodies, and to evaluate the association between nasogastric tube placement for early enteral nutrition (EEN) and hospitalization time.

ANIMALS

211 dogs undergoing 227 surgeries for intestinal foreign body removal.

PROCEDURES

Medical records were reviewed for dogs undergoing a single-site sutured enterotomy or IRA for foreign body intestinal obstruction between May 2008 and April 2018. Multivariable logistic regression was used to quantify the association between surgical procedure and dehiscence. Multiple linear regression was used to quantify the association of nasogastric tube placement with total hospitalization time.

RESULTS

Dehiscence rates were 3.8% (7/183) and 18.2% (8/44) for enterotomy and IRA, respectively. Overall dehiscence rate for all surgeries was 6.6% (15/227). The odds of intestinal dehiscence for IRA were 6.09 times (95% CI, 1.89 to 19.58) the odds for enterotomy. An American Society of Anesthesiologists score > 3 (OR, 4.49; 95% CI, 1.43 to 14.11) and an older age (OR, 1.02 [95% CI, 1.01 to 1.02] for each 1-month increase in age) were significantly associated with greater odds of intestinal dehiscence, regardless of surgical procedure. Placement of a nasogastric tube was not associated with intestinal dehiscence or decreased total hospitalization time when controlling for the year of surgery.

CONCLUSIONS AND CLINICAL RELEVANCE

Patients undergoing IRA were at a significantly higher risk of intestinal dehiscence, compared with patients undergoing enterotomy. Although this finding should not be used to recommend enterotomy over IRA, this information may be useful in guiding owner expectations and postoperative monitoring.

Evaluation of intraoperative leak testing of small intestinal anastomoses performed by hand-sewn and stapled techniques in dogs: 131 cases (2008-2019)

OBJECTIVE

To compare the rate of postoperative dehiscence on the basis of intraoperative anastomotic leak test results (ie, positive or negative for leakage or testing not performed) between dogs that underwent hand-sewn anastomosis (HSA) or functional end-to-end stapled anastomosis (FEESA) of the small intestine.

ANIMALS

131 client-owned dogs that underwent 144 small intestinal anastomoses (94 FEESA and 50 HSA).

PROCEDURES

Medical records were searched to identify dogs that had undergone a small intestinal anastomosis (HSA or FEESA) from January 2008 through October 2019. Data were collected regarding signalment, indication for surgery, location of the anastomosis, surgical technique, the presence of preoperative septic peritonitis, performance of intraoperative leak testing, development of postoperative dehiscence, and duration of follow-up.

RESULTS

Intraoperative leak testing was performed during 62 of 144 (43.1%) small intestinal anastomoses, which included 26 of 94 (27.7%) FEESAs and 36 of 50 (72.0%) HSAs. Thirteen of 144 (9.0%) anastomoses underwent dehiscence after surgery (median, 4 days; range, 2 to 17 days), with subsequent septic peritonitis, including 10 of 94 (10.6%) FEESAs and 3 of 50 (6.0%) HSAs. The incidence of postoperative dehiscence was not significantly different between FEESAs and HSAs; between anastomoses that underwent intraoperative leak testing and those that did not, regardless of anastomotic technique; or between anastomoses with positive and negative leak test results. Hand-sewn anastomoses were significantly more likely to undergo leak testing than FEESAs. Preoperative septic peritonitis, use of omental or serosal reinforcement, preoperative serum albumin concentration, and surgical indication were not significantly different between anastomotic techniques.

CONCLUSIONS AND CLINICAL RELEVANCE

Performance of intraoperative anastomotic leak testing, regardless of the anastomotic technique, was not associated with a reduction in the incidence of postoperative anastomotic dehiscence.

Comparison of intestinal leak pressure between cadaveric canine and commercial synthetic intestinal tissue that did and did not undergo enterotomy

OBJECTIVE

To compare initial leak pressure (ILP) between cadaveric canine and synthetic small intestinal segments that did and did not undergo enterotomy.

SAMPLE

Eight 8-cm grossly normal jejunal segments from 1 canine cadaver and eight 8-cm synthetic small intestinal segments.

PROCEDURES

Intestinal segments were randomly assigned to undergo enterotomy (6 cadaveric and 6 synthetic segments) or serve as untreated controls (2 cadaveric and 2 synthetic segments). For segments designated for enterotomy, a 2-cm full-thickness incision was created along the antimesenteric border. The incision was closed in a single layer with 4-0 suture in a simple continuous pattern. Leak testing was performed with intestinal segments occluded at both ends and infused with dilute dye solution (999 mL/h) until the solution was observed leaking from the suture line or serosal tearing occurred. Intraluminal pressure was continuously monitored. The ILP at construct failure was compared between cadaveric and synthetic control segments and between cadaveric and synthetic enterotomy segments.

RESULTS

Mean ± SD ILP did not differ significantly between cadaveric (345.11 ± 2.15 mm Hg) and synthetic (329.04 ± 24.69 mm Hg) control segments but was significantly greater for cadaveric enterotomy segments (60.77 ± 15.81 mm Hg), compared with synthetic enterotomy segments (15.03 ± 6.41 mm Hg).

CONCLUSIONS AND CLINICAL RELEVANCE

Leak testing should not be used to assess the accuracy or security of enterotomy suture lines in synthetic intestinal tissue. Synthetic intestinal tissue is best used for students to gain confidence and proficiency in performing enterotomies before performing the procedure on live animals.

Intestinal incisional dehiscence rate following enterotomy for foreign body removal in 247 dogs

OBJECTIVE

To report the intestinal incisional dehiscence rate following enterotomy for foreign body removal in dogs.

ANIMALS

247 client-owned dogs with intestinal foreign bodies treated with enterotomy between November 2001 and September 2017.

PROCEDURES

Medical records were reviewed, and data were collected regarding signalment, history, surgery, clinicopathologic findings, hospitalization, intestinal incisional dehiscence, and survival to hospital discharge. Dogs were grouped according to whether intestinal incisional dehiscence occurred (dehiscence group) or did not occur (nondehiscence group) following enterotomy, and the rate of dehiscence for the total number of enterotomies during the study period was calculated. Univariable analysis was performed to identify variables associated with intestinal incisional dehiscence.

RESULTS

8 of the 247 (3.2%) dogs had preoperative septic peritonitis, and all 8 dogs survived to hospital discharge. Incisional dehiscence occurred following 5 of the 247 (2.0%) enterotomies, and only 2 dogs in the dehiscence group did not survive to hospital discharge. Duration of hospitalization was longer for dogs in the dehiscence group than for dogs in the nondehiscence group.

CONCLUSIONS AND CLINICAL RELEVANCE

Results indicated that enterotomy for intestinal foreign body removal had a lower rate of dehiscence in dogs during the study period, compared with rates previously reported; however, the low rate should not be used as a reason to perform an enterotomy rather than an enterectomy when needed. Surgeons should thoroughly evaluate the bowel and perform an enterotomy only when indicated.

Evaluation of short-term outcomes and potential risk factors for death and intestinal dehiscence following full-thickness large intestinal incisions in dogs

OBJECTIVE

To determine complication rates for dogs in which full-thickness large intestinal incisions were performed, assess potential risk factors for death during hospitalization and for intestinal dehiscence following these surgeries, and report short-term mortality rates for these patients.

ANIMALS

90 dogs.

PROCEDURES

Medical records of 4 veterinary referral hospitals were reviewed to identify dogs that underwent large intestinal surgery requiring full-thickness incisions. Signalment, history, clinicopathologic data, medical treatments, surgical procedures, complications, and outcomes were recorded. Descriptive statistics were calculated; data were analyzed for association with survival to discharge (with logistic regression analysis) and postoperative intestinal dehiscence (with Fisher exact or Wilcoxon rank sum tests).

RESULTS

Overall 7-day postoperative intestinal dehiscence and mortality rates were 9 of 90 (10%) and 15 of 90 (17%). Dogs with preoperative anorexia, hypoglycemia, or neutrophils with toxic changes and those that received preoperative antimicrobial treatment had greater odds of death than did dogs without these findings. Preexisting colon trauma or dehiscence, preexisting peritonitis, administration of blood products, administration of > 2 classes of antimicrobials, positive microbial culture results for a surgical sample, and open abdominal management of peritonitis after surgery were associated with development of intestinal dehiscence. Five of 9 dogs with intestinal dehiscence died or were euthanized.

CONCLUSIONS AND CLINICAL RELEVANCE

Factors associated with failure to survive to discharge were considered suggestive of sepsis. Results suggested the dehiscence rate for full-thickness large intestinal incisions may not be as high as previously reported, but several factors may influence this outcome and larger, longer-term studies are needed to confirm these findings.

Factors associated with dehiscence and mortality rates following gastrointestinal surgery in dogs

OBJECTIVE

To identify factors associated with dehiscence and mortality rates following gastrointestinal surgery in dogs.

ANIMALS

170 client-owned dogs that underwent gastrointestinal surgery from 2010 to 2016.

PROCEDURES

Medical records of all included dogs were reviewed to collect information on preoperative (breed, sex, age, body weight, American Society of Anesthesiologists [ASA] physical status classification, emergency status, and plasma lactate concentration), intraoperative (indication for surgery, type of surgery, and whether bacterial peritonitis was identified), and postoperative (development of dehiscence and survival status at 2 weeks after surgery) factors. Preoperative and intraoperative factors were evaluated for associations among each other and with postoperative factors.

RESULTS

Univariate analyses revealed that preoperative plasma lactate concentration increased with increasing ASA status, and lactate concentrations were significantly higher for nonsurvivors (mean ± SD, 4.6 ± 3.7 mmol/L) than for survivors (2.4 ± 1.7 mmol/L). Multivariate analysis controlling for age, body weight, and plasma lactate concentration revealed that dogs with an ASA status ≥ 3 were more likely to develop dehiscence after gastrointestinal surgery than were dogs with a lower ASA status (OR, 17.77; 95% confidence interval, 2.17 to 144.06). Multivariate analysis also revealed that dogs with an ASA status ≥ 3 or high lactate concentration were less likely to survive than were other dogs.

CONCLUSIONS AND CLINICAL RELEVANCE

These findings regarding ASA status and preoperative plasma lactate concentration and their associations with outcome may help clinicians to determine and provide optimal perioperative care to dogs requiring gastrointestinal surgery as well as to inform owners about prognosis.

Intra-abdominal complications following intestinal anastomoses by suture and staple techniques in dogs

OBJECTIVE To compare the incidence of intra-abdominal complications in dogs following resection and functional end-to-end stapled anastomosis (FEESA) versus anastomosis with an end-to-end sutured technique for treatment of enteric lesions. DESIGN Multicenter, retrospective descriptive cohort study. ANIMALS 180 dogs. PROCEDURES Medical records of dogs undergoing intestinal resection and anastomosis at 3 nonaffiliated private practice specialty centers were retrospectively reviewed. Preoperative clinical variables, indication for surgery, surgical technique (sutured end-to-end anastomosis vs FEESA), and evidence of postoperative anastomosis site leakage (dehiscence) were recorded. Variables of interest were analyzed for associations with dehiscence. RESULTS Dehiscence rates of sutured and stapled anastomoses were 12 of 93 (13%) and 4 of 87 (5%), respectively; odds of postoperative dehiscence were significantly lower for dogs with FEESAs than for dogs with sutured anastomoses (OR, 0.28; 95% confidence interval, 0.09 to 0.94). Among dogs that underwent surgery for treatment of intestinal dehiscence after surgery at another facility, subsequent dehiscence developed in 3 of 5 with sutured anastomoses and 0 of 11 with stapled anastomoses. Dehiscence rates varied significantly among clinics. No other variable was associated with risk of dehiscence. Eleven of 16 dogs with dehiscence were euthanized without additional surgery. Impaction at the anastomosis site was identified months or years after surgery in 3 dogs (4 anastomosis sites) that had FEESAs. CONCLUSIONS AND CLINICAL RELEVANCE Odds for dehiscence were significantly greater for sutured end-to-end anastomoses than FEESAs, and dogs undergoing surgery for previous dehiscence were significantly more likely to experience a subsequent dehiscence with a sutured anastomosis. However, variability of procedure types and dehiscence rates among clinics suggested further research is needed to confirm these findings. Obstruction at the anastomosis site was identified as a potential long-term complication of FEESA.

Effects of a surgical checklist on decreasing incisional infections following foreign body removal from the gastrointestinal tract in dogs

Two similar populations of dogs were evaluated in either a retrospective or prospective manner for 2 weeks after gastrointestinal foreign body surgery to determine the impact of a surgical checklist on the surgical site infection (SSI) rate. The medical records of 201 gastrointestinal foreign body surgeries were reviewed to determine the SSI rate without the use of a surgical checklist (SC-) and 101 consecutive gastrointestinal foreign body surgeries were performed using a surgical checklist (SC+). The SSI rate had a significant decrease from 19.9% to 11.9% with the use of the surgical checklist. When combining the cohorts, statistically significant predictors for development of an SSI following gastrointestinal foreign body removal included: a combined gastrotomy and enterotomy, an enterotomy, and known self-trauma.

Evaluation of the reasons for and outcomes of gastrointestinal tract surgery in pet pigs: 11 cases (2004-2015)

OBJECTIVE To evaluate the reasons for and outcomes of gastrointestinal tract surgery in pet pigs. DESIGN Retrospective case series. ANIMALS 11 pigs. PROCEDURES The medical record database of a teaching hospital was searched to identify pet pigs that underwent at least 1 celiotomy because of a possible gastrointestinal tract obstruction between 2004 and 2015. For each pig, information extracted from the medical record included history; signalment; clinical signs; physical examination, diagnostic imaging, and diagnostic test results; perioperative management; surgical diagnosis, duration, and procedures performed; postoperative complications; and outcome. Descriptive data were generated. RESULTS 11 pet pigs underwent 12 celiotomies during the study period. Five pigs with intestinal obstructions caused by foreign bodies survived to hospital discharge. Four pigs were euthanized during surgery: 2 because of extensive adhesions that prevented correction of an intestinal obstruction, 1 because of a perforated spiral colon, and 1 because of neoplasia. One pig with a fecal impaction in the spiral colon died during anesthetic recovery. A diagnosis was not achieved for 1 pig, which was euthanized after surgery because of a deteriorating clinical condition. For the pig that underwent 2 celiotomies, the first procedure was an enterotomy for removal of a foreign body, and the second was an intestinal bypass of a stricture caused by adhesions at the previous enterotomy site. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated prognosis was good for pet pigs following surgical removal of gastrointestinal foreign bodies; however, the presence or development of intra-abdominal adhesions appeared to adversely affect prognosis.

Removal of sialoliths using the intraoral approach in 15 horses

This study describes the use of an intraoral approach for sialolith removal in horses. All horses resumed their previous activity after surgery. Sialoliths were composed mainly of calcium carbonate, containing a nidus of plant material. The removal of sialoliths via an intraoral approach results in a high success rate with minimal complications.

Laparoscopic pyloromyotomy and pyloroplasty in dogs

This article describes clinical experiments involving laparoscopic pyloromyotomy and pyloroplasty in six dogs diagnosed with hypertrophy of the pyloric sphincter. Laparoscopic pyloromyotomy was performed in three dogs, and pyloroplasty was carried out in the remaining three animals. The patients were operated on based on the authors' previous experiences with experimental pyloromyotomy and pyloroplasty in pigs. Pyloromyotomy and pyloroplasty resulted in full recovery and complete subsidence of symptoms in all patients.

Effects of repeated gas sterilization on closure rates of ameroid ring constrictors in vitro

OBJECTIVE

To determine the effect of repeated gas sterilization on rate of closure of ameroid ring constrictors in vitro.

SAMPLE

Twenty-four 3.5-mm ameroid ring constrictors.

PROCEDURES

Ameroid ring constrictors were allocated to 1 of 4 treatment groups (6/group) to undergo gas sterilization 0, 1, 5, or 10 times. After sterilization, constrictors were incubated in canine plasma at a protein concentration of 3 g/dL for 27 days. A digital camera was used to obtain images of the constrictors prior to and at various points during incubation, and lumen diameter was measured.

RESULTS

Mean ± SD percentage of lumen closure for all groups of ameroid ring constrictors combined was 85.2 ± 1.6% at day 0 (prior to plasma incubation) and 95.4 ± 0.8% at day 27. Mean lumen area was 3.64 ± 0.43 mm(2) (95% confidence interval, 2.67 to 4.77 mm(2)) at day 0 and 1.32 ± 0.25 mm(2) (95% confidence interval, 0.76 to 2.04 mm(2)) at day 27. None of the ameroid ring constrictors had closed completely by day 27.

CONCLUSIONS AND CLINICAL RELEVANCE

Overall closure rates for ameroid ring constrictors appeared to be unaffected by repeated gas sterilization up to 10 times. Findings suggested that veterinary surgeons can resterilize ameroid ring constrictors up to 10 times with confidence that ring properties would remain suitable for clinical use.

An investigation of the effects of ketoprofen following rumen fistulation surgery in lactating dairy cows

Post-operative pain management following rumen surgery is not common practice. We examined the effect of providing the pain medication ketoprofen to dairy cattle following the first stage of a rumen cannulation surgery, which involves an incision in the body wall and exteriorizing and clamping the rumen. The results of this study provide clear evidence that the first stage of the surgery was painful and ketoprofen at the time of and 24 h following surgery, alleviated some, but not all, of the post-surgical pain. Pain mitigation should be included when performing flank surgery in cattle.

Human amniotic membrane and vitamin E/selenium for control of postoperative adhesion in dogs

This study was undertaken to compare between the human amniotic membrane (HAM) and intraperitoneal vitamin E (Vit E) and selenium in prevention of postoperative adhesions in dogs. A total of 18 apparently healthy adult Mongrel dogs were divided into three equal groups and the group (I) was treated with a sterile solution of 0.9% sodium chloride intraperitoneally as a control. Group II was treated with the HAM at jejunal enterotomy while group III was treated with Vit E and selenium administered intraperitonally. Dogs were euthanized 30 days postoperatively for histopathological examination. The results showed that both HAM and Vit E and selenium were effective in reduction of the postoperative adhesion in comparison with the group I. In terms of extent of adhesions, there was no significant difference between the HAM group and the Vit E and selenium group.

Postoperative ileus: pathogenesis and treatment

Surgical manipulation of the intestines activates intestinal macrophages that release cytokines and nitric oxide, which results in inhibition of intestinal motility. Subsequent infiltration of circulating leukocytes into the intestinal wall contributes to cytokine and nitric oxide release and exacerbates ileus. Other factors contributing to ileus are endotoxemia; edema of the intestine wall subsequent to excessive fluid therapy; hypocalcemia; and long abdominal incisions. Because treatment of ileus with prokinetic drugs has not proven to be very effective, efforts should be directed at reducing its severity. Strategies which reduce the severity of ileus include pretreatment with a nonsteroidal anti-inflammatory drug, minimizing the length of the abdominal incision, reducing intestinal manipulation, intraoperative lidocaine infusion, correction of hypocalcemia, limiting the volume of intravenous fluids to prevent intestinal edema, and administration of alpha(2) antagonists.

Surgical views: techniques for laparoscopic and laparoscopic assisted biopsy of abdominal organs

Multiorgan pathology is a common finding during the diagnostic work-up of complex medical diseases in small animals. Collection of cytologic or biopsy samples from several abdominal organs can give the clinician crucial information in guiding therapy. Although many modalities are available for sample collection, laparoscopic and laparoscopic-assisted techniques offer a minimally invasive approach for collection of high-quality biopsy samples from multiple organs during one anesthetic episode. This article discusses the laparoscopic approaches and techniques for multiorgan biopsy in cats and dogs..

Rumen cannulation: procedure and use of a cannulated bovine

Rumen cannulation can be done on a healthy animal currently in the herd with minimal expense. The surgery is no more difficult than most other routine surgical procedures performed by bovine practitioners. A cannulated animal provides a long-term, readily available source of rumen content that can be used to transfaunate herd mates that have suffered various digestive upsets.

Intra-abdominal adhesions in horses: A retrospective evaluation of repeat laparotomy in 99 horses with acute gastrointestinal disease

The objectives of this study were (1) to determine the prevalence of pathological abdominal adhesion formation following exploratory laparotomy; (2) to establish the site of adhesion formation and its relationship to the initial lesion; (3) to ascertain whether the development of intra-abdominal adhesions decreases long-term survival and (4) to identify risk factors for adhesion formation. Of 1014 horses treated surgically for acute gastrointestinal disease, 113 (10.1%) were subjected to repeat laparotomy, with surgical records available for 99 of these cases. Pathological adhesions were the most common diagnosis at repeat laparotomy (28%), followed by complications associated with the anastomosis (16%). Adhesions were not associated with the site of the primary lesion, resection, or endotoxaemia, consistent with the hypothesis that surgical trauma is the most important stimulus in adhesion formation. Together these findings strongly support the need for pan-abdominal, rather than site-specific adhesion prevention measures in all horses undergoing exploratory laparotomy.

Efficacy of moxibustion after rolling correction in dairy cows with abomasal displacement

This study was performed to assess the efficacy of moxibustion after rolling correction in dairy cows with abomasal displacement (AD). The experimental group comprised 86 Holstein cows with left displacement of the abomasum (LDA) and right displacement of the abomasum (RDA), with a mean age of 3.8 with AD during a 2-year period. The cows were rolled for correction of AD. After the rolling procedure, moxibustion was conducted on six acupoints once a day during the course of treatment. After repositioning the abomasums, the bilateral points of BL-20, BL-21 and BL-26 were then stimulated. During the follow-up of 1 week, 67 (93.1%) of 72 LDA and 12 (85.7%) of 14 RDA cows were released as cured after moxibustion. In conclusion, moxibustion effectively treats AD following rolling correction in dairy cows.

[Surgical resection of a gastrointestinal stromal cell tumor by double enterectomy and partial pancreatectomy on a 13-year-old mixed breed dog]

Surgical resection of a gastrointestinal stromal cell tumor by double enterectomy and partial pancreatectomy on a 13-year-old mixed breed dog. A 13 year-old, male, mixed breed dog, has been presented for an abdominal mass. The exam showed the presence of an ileo-caeco-colic mass adhered to the distal portion of the pancreas and the mid duodenum. A double enterectomy and a partial pancreatectomy were carried out and a diagnosis of gastrointestinal stromal cell tumor has been established.

Effect of protein concentration on rate of closure of ameroid constrictors in vitro

OBJECTIVE

To evaluate the effect of protein concentration on rate of closure of ameroid constrictors in vitro.

SAMPLE POPULATION

Twenty-four 3.5-mm ameroid constrictors.

PROCEDURE

Ameroid constrictors were equally allocated into 4 treatment groups; constrictors were placed in saline (0.9% NaCl) solution (control) or plasma diluted with saline solution to obtain protein concentrations of 1.5, 3, or 6 g/dL. Ameroid constrictors were incubated for 27 days. A digital camera was used to image ameroid constrictors in culture at 1, 6, 11, 16, 21, and 27 days, and the lumen diameter of each constrictor was measured.

RESULTS

None of the rings were completely closed at 27 days. Mean final lumen diameter was 0.205 +/- 0.22 mm. Mean final lumen diameter of constrictors in the control group was significantly larger than that of constrictors in the 1.5, 3, and 6 g/dL groups. Constrictors in the 1.5 g/dL group closed to a larger diameter than that of constrictors in the 6 g/dL group. Constrictors in the control group had the smallest overall change in lumen diameter, compared with constrictors in the 3 and 6 g/dL groups. Constrictors in the 1.5 g/dL group had a significant decrease in overall lumen diameter, compared with constrictors in the 3 and 6 g/dL groups. The diameter of the ameroid lumen was a function of time and protein concentration.

CONCLUSIONS AND CLINICAL RELEVANCE

High plasma protein concentrations resulted in rapid closure of the ameroid constrictor lumen. Complete closure of ameroid constrictors may not be attributable to imbibition of casein.

Technical Note: Improved technique for fitting pigs with steered ileocecal valve cannulas1,2

Collection of ileal digesta to evaluate AA digestibilities has become increasingly important in swine nutrition research. Steered ileocecal valve cannulation of pigs permits total collection of ileal digesta, while still allowing normal digesta flow during noncollection periods. This technique was modified and used with 64 crossbred barrows in five trials. Our procedural changes included preoperative i.v. administration of a broad-spectrum antibiotic and nonsteroidal antiinflammatory drug, sharp incision through the muscle layers of the laparotomy wound, use of a heparinized saline lavage solution, replacement of the guide ring with a stylette, and fixing the outer cannula barrel in place with a hose clamp. The current technique involves a right flank laparotomy, parallel and distal to the last rib, with the pig under general anesthesia. A stainless-steel ring (inner ring = 2.0 mm thick, 35.0 mm i.d.) is introduced into the ileal lumen through an enterotomy proximal to the origin of the ileocecal fold. A nylon string attached to this ring is threaded through the ileum and ileocecal valve into the cecum using a silastic stylette, which encases the string. A second stainless-steel ring (outer ring = 2.0 mm thick, 34 mm o.d.) is fixed in place around the ileum, distal to the inner ring and just proximal to the ileocecal valve. A polyurethane cannula barrel (barrel = 100 mm long, 26 mm i.d., 32 mm o.d.; flange = 70 mm o.d.) is introduced into the cecal lumen via an enterotomy through the lateral cecal band and secured in place with two purse-string sutures. The cannula is exteriorized through an incision caudal and proximal to the intial laparotomy site, where it is plugged using a cylindrical stopper (26 mm o.d., 55 mm long) and held in place by a second cannula barrel (barrel = 43 mm length, 33 mm i.d., 41 mm o.d.; flange = 80 mm o.d.). Procedural changes decreased postsurgical complications, as evidenced by decreased seepage around the cannula and fewer and less severe adhesions noted at necropsy. Based on five trials, this technique is a reliable means of collecting ileal digesta for nutrient analyses.

Digital blood flow and plasma endothelin concentration in clinically endotoxemic horses

OBJECTIVE

To measure plasma endothelin-1 (ET-1) concentrations and digital blood flow in clinically endotoxemic horses.

ANIMALS

36 adult horses that underwent emergency celiotomy for primary gastrointestinal tract disease.

PROCEDURE

On days 2 and 5 following surgery, Doppler ultrasonographic digital arterial blood flow measurements were obtained. Hematologic and biochemical analyses were performed, and plasma concentrations of ET-1 and endotoxin (lipopolysaccharide) were determined. A scoring system based on 9 clinical variables was used to assign horses to group B (quartile with greatest cumulative score) or group A (remaining 3 quartiles). Follow-up at 2.5 years was obtained by telephone questionnaire.

RESULTS

For all horses on day 2, median (interquartile values) plasma ET-1 concentrations were 1.4 (0.8, 1.7) pg/mL, whereas on day 5, plasma ET-1 concentrations were 1.0 (0.5, 1.6) pg/mL. On day 2, digital blood flow was 0.057 (0.02, 0.07) mL/min in group A horses and 0.035 (0.02, 0.03) mL/min in group B horses. On day 5, plasma ET-1 concentration was significantly (73%) higher in group B horses, compared with group A horses. Thirty of 36 horses were alive at 2.5 years; group A horses were more likely to have survived (odds ratio, 25; 95% confidence interval, 2.4 to 262). Significant associations were found between an increase in digital pulses, hoof wall temperatures, or both and increased digital blood flow (0.14 vs 0.04 mL/min) on day 2 and increased digital arterial diameter (0.32 vs 0.23 cm) on day 5.

CONCLUSIONS AND CLINICAL RELEVANCE

Horses with more severe endotoxemia had decreased digital blood flow, increased plasma ET-1 concentrations, and decreased long-term survival.

Surgical abdomen of the calf

Although underrepresented compared with infectious diseases, calves' surgical abdomen diseases and abdominal surgery are a part of daily veterinary practice. Clinical presentations may differ from adult cattle and change rapidly. The decision whether to perform abdominal surgery or refer the animal has to take into consideration the condition and its prognosis for the calf. This article discusses clinical presentation of calves and focuses on specific situations with a detailed description of the surgical techniques, atresia coli, and umbilical remnants infection.

The effect of exogenous melatonin on experimental colonic anastomosis

In this study we investigated the role of exogenous melatonin administration on the healing of colonic anastomoses.

MATERIALS AND METHODS

Rats were divided into four groups: control, vehicle, 1 mg/kg and 10 mg/kg melatonin, which was administered postoperatively on days 0, 1, and 2. Following colon resection and anastomosis, the rats were sacrificed on the 3rd and 7th days to measure bursting pressure and hydroxyproline content of the anastomoses.

RESULTS

Bursting pressure significantly increased on the 7th day compared with the 3rd day in all groups. Hydroxyproline levels did not show any significant change on the 3rd day compared with the 7th day in any of the groups. Hydroxyproline levels were significantly higher in control groups than in melatonin groups.

CONCLUSION

Results suggest that exogenous melatonin has no beneficial effect on the healing of colonic anastomosis.

Comparison of the effect of laparoscopic and conventional pyloric surgery on gastric emptying in dogs

The effect of a laparoscopic approach and pyloric surgery on canine gastrointestinal activity, particularly gastric emptying time, is not well understood. The purpose of this study was to compare the effect of laparoscopic and conventional pyloric surgery, in Ramstedt pyloromyotomy and Heineke-Mikulicz pyloroplasty, on complete gastric emptying time in 20 clinically normal dogs. Dogs were divided into four groups of five animals: dogs with laparoscopic Ramstedt pyloromyotomy, conventional Ramstedt pyloromyotomy, or laparoscopic Heineke-Mikulicz pyloroplasty, and the conventional Heineke-Mikulicz pyloroplasty group. Gastric emptying time using barium sulfate mixed with dry kibble dog food was measured fluoroscopically before and 1 month after surgery. Gastric emptying of solids was significantly enhanced in the pyloroplasty groups in the postoperative period compared with preoperative emptying. Just as after conventional pyloromyotomy, gastric emptying time after laparoscopic pyloromyotomy was not statistically different as compared with preoperative values. This study indicates that the fluoroscopic test meal is a valuable tool for defining complete gastric emptying time in normal dogs. We conclude that pyloromyotomy was less effective in decreasing complete gastric emptying time than Heineke-Mikulicz pyloroplasty in normal dogs. The possibility of decreasing complete gastric emptying time by laparoscopic surgery suggests a potential clinical application for this technique in small animals.

Esophageal and gastric feeding tubes in ICU patients

Providing nutrition to critically ill patients is important to the healing process. This article will focus on selection and placement of nasoesophageal, nasogastic, esophagostomy, and gastrostomy tubes. Advantages and disadvantages of these tubes will be discussed, as well detailed instructions on the placement of the aforementioned tubes.

Liposome-encapsulated oxymorphone hydrochloride provides prolonged relief of postsurgical visceral pain in rats

Adequate pain control is necessary for optimal postsurgical recovery and humane treatment of laboratory and companion animals. Opioid drugs are currently the most potent analgesic agents available in human and veterinary medicine. Long-acting formulations of opioid drugs confer several important advantages over standard pharmaceutical preparations, especially for use in animals. A long-acting formulation of oxymorphone hydrochloride was produced by encapsulation into liposomes. Liposome-encapsulated (LE) oxymorphone was tested in a rat model of visceral postoperative pain. Rats were given one subcutaneous injection of LE oxymorphone (1.2 or 1.6 mg/kg of body weight) or standard oxymorphone (0.3 mg/kg) at the time of intestinal transection or resection. A single administration of LE oxymorphone hydrochloride was as effective for relief of postoperative pain in rats (P = 0.18), as were multiple (q4 h or q8 h) injections of 0.3 mg/kg of the standard pharmaceutical preparation. The rats given LE oxymorphone prior to intestinal resection also had significantly higher body weight at three and seven days after surgery than did rats that were given standard oxymorphone. In conclusion, LE oxymorphone was effective in treating visceral pain associated with intestinal surgery in rats. On the basis of body weight gain, rats treated with LE oxymorphone had improved recovery outcome, compared with rats treated with repeated injections of standard oxymorphone.

Barrier pressure at the gastroesophageal junction in anesthetized dogs

OBJECTIVE

To evaluate the effect of body position on barrier pressure at the gastroesophageal junction in anesthetized Greyhounds and to assess alterations in barrier pressure following gastropexy.

ANIMALS

8 adult Greyhounds.

PROCEDURE

Barrier pressure at the gastroesophageal junction was measured by fast (1 cm/s) and slow (1 cm/10 s) withdrawal of a subminiature strain gauge transducer through the gastroesophageal junction in 8 anesthetized dogs. The effect of body position was measured. Each dog then was placed in right-lateral recumbency, and gastropexy was performed in the left flank. Additional measurements were obtained 1, 5, 10, 20, and 30 minutes after gastropexy.

RESULTS

Barrier pressure for dogs positioned in sternal recumbency (mean +/- SEM, 1.1 +/- 0.53 mm Hg) was significantly less than for dogs positioned in right lateral or left lateral recumbency. Following gastropexy, there was a steady increase in barrier pressure. Thirty minutes after gastropexy, barrier pressure was significantly higher (13.36 +/- 3.46 mm Hg), compared with the value before surgery.

CONCLUSIONS AND CLINICAL RELEVANCE

Barrier pressure in anesthetized dogs is highly variable and influenced by body position. This is most likely the result of anatomic interrelationships between the diaphragm, stomach, and terminal portion of the esophagus. Gastropexy also increases barrier pressure in the immediate postoperative period, which may be clinically relevant in terms of understanding how resolution of gastroesophageal reflux disease associated with hiatal hernia may be affected by gastropexy combined with hernia reduction.

Short-and long-term evaluation of surgical treatment of strangulating obstructions of the small intestine in horses: a review of 224 cases

A retrospective study was carried out of 224 horses operated for strangulating small intestine obstructions. Fifty-four horses were euthanized and 5 horses died during surgery which means that 165 (73%) were allowed to recover. Of these, 53 horses were euthanized or died in the clinic and 112 (50%) were discharged from the hospital. Of 90 horses available for follow-up 1 year postoperatively, 76 (84%) were still alive. The most important causes of death or reasons for euthanasia in the direct post-operative period were post-operative paralytic ileus, (adhesive) peritonitis and intra-abdominal haemorrhage. After discharge from the hospital the reasons were (adhesive) peritonitis and (recurrent) colic. Of the horses which survived for at least 1 year, 16% sometimes suffered from colic, 12% experienced problems with incisional woundhealing and 4% suffered from jugular vein thrombosis. All were in good or reasonable condition and 88% performed at (approximately) the same level as before the operation. The type of surgical intervention (i.e. enterotomy, enterectomy) did not significantly influence the outcome of surgery, whereas the type of anastomosis did. End-to-end jejunojejunostomy had a better prognosis than side-to-side jejunocaecostomy. It was concluded that strangulating obstructions of the small intestine still carry a poor to guarded prognosis. Mortality was highest in the direct peri-operative period. Once discharged from hospital, prognosis can be considered to be fair to good. Attempts to improve outcome should be directed at a better handling of the ileal stump during surgery and at the prevention of post-operative ileus and the formation of adhesions.

A comparison of two opioid analgesics for relief of visceral pain induced by intestinal resection in rats

While developing a rat model for human short bowel syndrome, we noted that untreated rats as well as rats administered buprenorphine after intestinal resection exhibited behavior and appearance consistent with visceral pain and distress. To provide appropriate analgesics, we developed criteria to assess pain-related behavioral changes and conducted an experiment to evaluate the effectiveness of buprenorphine versus oxymorphone to alleviate the pain induced by intestinal resection. Rats underwent either small-bowel resection or transection surgery; in addition, animals received jugular catheterization for the delivery of total parenteral nutrition (TPN). Rats treated with buprenorphine received 0.5 mg/kg every 6 h subcutaneously, and rats treated with oxymorphone received 0.03 mg/kg hourly for 32 h via continuous intravenous (i.v.) infusion with TPN solution. Rats treated with buprenorphine exhibited behavior and appearance consistent with pain and distress for as long as 32 h postoperatively, whereas animals treated with oxymorphone exhibited behavior and appearance similar to their preoperative state. Thus, oxymorphone alleviated the pain-related behavioral changes after intestinal resection far better than did buprenorphine. Of interest, we observed that the buprenorphine was associated with a decrease in the volume of urine collected, whereas oxymorphone was associated with urine volumes similar to those of nonresected rats maintained with TPN. Because oxymorphone appeared to be a superior analgesic, we also evaluated three routes for administering this drug. Pain-related behavior changes were alleviated by the administration of oxymorphone by either Alzet mini-pump, bolus i.v. injection, or continuous i.v. infusion. We conclude that compared with buprenorphine, oxymorphone is a superior analgesic for the alleviation of visceral pain due to intestinal resection.

Ventral marsupialisation in the treatment of gastric dilatation-volvulus in two dogs

A ventral marsupialisation technique is described which was used successfully to manage gastric dilatation-volvulus (GDV) in two large breed dogs. The procedure allowed the stomach to be completely and rapidly emptied and lavaged without peritoneal contamination. Drainage was maintained in the postoperative period for both dogs and the technique was expected to result in a permanent ventral gastropexy.

Gastrointestinal emergencies

The animal with a surgical gastrointestinal emergency usually requires a rapid, thorough physical examination with concurrent resuscitation. As the diagnosis is being made, the animal must be made as stable as possible before undergoing general anesthesia. During surgery, there must be a critical evaluation of gastrointestinal viability and the use of precise technical skills to achieve the best outcome. Adept postoperative management, including careful monitoring and an index of suspicion for potential complications, is vital.

Enteroplication in cats, using suture of N-butyl cyanoacrylate adhesive

Enteroplication has been recommended to prevent recurrence of intussusception in dogs and cats. This study investigated the impact of enteroplication on subsequent function of the plicated small intestine as measured by transit time of barium impregnated polyethylene spheres (BIPS) and compared two methods of achieving enteroplication--sutures using polydioxanone and cyanoacrylate tissue adhesive. Twenty-two healthy young cats were used--four controls, nine sutured and nine glued. The mean +/-SD transit times before, one week after and four weeks after enteroplication were respectively 2.0+/-0.80 hours, 1.6+/-0.80 hours, 2.2+/-1.18 hours. There was no significant difference in transit time or in the time to create enteroplication in the two plicated groups. Maintenance of intestinal adhesion was greater for the sutured plications. There was no significant change in internal diameter with either technique. Adverse clinical signs after enteroplication were not severe, however, they were more prevalent in cats which had glued plication. The inflammation associated with the suture was of a greater depth initially but that associated with the adhesive was more widespread and persisted for the four weeks of the experiments. Enteroplication in cats was a relatively benign procedure which did not cause significant alterations in small intestinal function. However, cyanoacrylate tissue adhesive cannot be recommended for this clinical procedure.

Critical care nutrition: routes of feeding

Nutrition is an integral part of the management of the critically ill patient. Nutritional support can be provided by either parenteral or enteral routes. Whenever possible, enteral nutrition is the method of choice, as it reduces complication rates and improves outcome. Potential choices for enteral feeding include nasoesophageal, esophagostomy, gastrostomy, jejunostomy, and transpyloric feeding tubes. The modes of parenteral and enteral nutrition are reviewed individually, including indications and selection of appropriate routes of feeding, methods of tube placement, and benefits and risks associated with each feeding approach.