Rectal Prolapse - Horse
Introduction
Rectal prolapse in the horse is associated with conditions causing tenesmus (straining). These may include dystocia, constipation, neoplasia, foreign body obstruction, urethral obstruction or diarrhoea. Occasionally there is no apparent underlying cause.
Rectal prolapse is classified according to the type of tissue involved.
Type I (or 'incomplete' prolapse) involves the rectal mucosa and submucosa only, appearing as a large 'doughnut' shaped soft tissue swelling at the rectum.
Type II ('complete' prolapse) involves the entire rectal wall.
Type III involves complete prolapse of the rectum in addition to intussusception of the peritoneal rectum.
Type IV involves complete intussuseption of the peritoneal rectum beyond the anus .
Signalment
Mares are more commonly affected than geldings or stallions.
Diagnosis
A cylindrical soft-tissue mass protruding from the rectum is usually diagnostic for rectal prolapse. In the dystocic mare, a full vaginal and rectal examination should be carried out in order to rule out the possibility of tears. Other diagnostic tests to investigate the underlying cause of the prolapse may include endoscopy of the bladder and lower urinary tract, rectal biopsy and rectal endoscopy.
Treatment
Treatment should be aimed at reducing the prolapse as well as identifying and correcting the underlying cause of tenesmus. Affected horses should be prevented from becoming recumbent before the prolapse has been replaced.
Treatment depends on the type of prolapse. A simple prolapse of the rectum or rectal mucosa may be easily replaced providing minimal soft tissue trauma, contamination or dessication has occurred. In order to reduce any oedema, glycerin or dextrose combined with petroleum jelly may be applied topically. The prolapse may be replaced under epidural anaesthesia and a purse string suture placed in the anus. If the prolapse cannot be manually reduced, surgical amputation or resection of exposed tissue may be required. In the case of Type III and Type IV rectal prolapse, reduction of the intussuscepted segment may be possible as long as no ischaemia has occurred. If disruption to the blood supply has occurred, amputation of the affected segment may be required with subsequent colorectal anastamosis or colostomy.
It is important to provide faecal softeners following reduction of a prolapse to prevent straining and reduce the possibility of recurrence. Other complications following reduction include wound breakdown, infection and uterine or bladder prolapse (in mares).
Prognosis
The prognosis varies depending on the underlying cause but is generally good for Type I and Type II prolapse, and guarded for Type III and Type IV.
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References
- Lavoie, J. P., Hinchcliff, J. W. (2009) Blackwell's Five Minute Veterinary Consult: Equine John Wiley and Sons
- Mair, T. S., Divers, T. J., Ducharme, N. G. (2002) Manual of Equine Gastroenterology Elsevier Health Sciences
- Orsini, J. A., Divers, T. (2007) Equine Emergencies: Treatment and Procedures Elsevier Health Sciences
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