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Gastric Dilation and Intestinal Obstruction – Rabbit (view source)
Revision as of 16:53, 20 July 2010
, 16:53, 20 July 2010→Case assessment
''Performing surgery only to find that the obstruction has moved is preferable to performing a post-mortem examination on a rabbit that required surgical intervention.'' Harcourt Brown T R (2007) Journal of Exotic Pet Medicine 16 (3) 168-174
===Procedure with a case of gastric dilation===
Radiograph under opiate analgesia - fentanyl/fluanisone ((Hypnorm; Janssen-Cilag) 0.2-0.3ml/kg SC once only or buprenorphine 0.01-0.05mg/kg SC/IM/IV q 6-12hrs (Vetergesic; Alstoe) plus meloxicam (Metacam; Boehringer Ingelheim) 0.1-0.3mg/kg SC/IM q24h or carprofen (Rimadyl; Pfizer) 2-4mg/kg SC/IM q24hr. Prepare orthogonal radiographs - lateral and dorso-ventral with legs extended or ventro-dorsal views. Observe the dilation of the stomach and the presence and distribution of fluid (liquid and gas) in the gastrointestinal tract to identify location of obstruction. Note the degree of contact of the dilated stomach with the ventral abdominal wall. Assess the amount of gas in the small intestine and look for gas in the large intestine. If no gas in hindgut and stomach severely dilated it may be best to go for euthanasia. Free gas in peritoneum indicates rupture of the gastrointestinal tract and justifies euthanasia. A search for other pathology may indicate other problems like bladder stones, spinal arthritis etc and may also indicate euthanasia.
Pit-falls of radiography: Caecum and large intestine generally do not have large amounts of gas in normal rabbits BUT caecum and large intestine generally do not have no gas in obstructed rabbits Caecum and large intestine with gas and dilated stomach seen in cases carrying a better prognosis.
Search for peritoneal gas in rabbits with severe depression If found, this is an indication of rupture of the intestine and indicates euthanasia. Remember euthanasia always an option
Surgical Procedure
Serial radiographs (every 30 – 90 minutes) looking for gas in hindgut. If gas in hind gut this indicates that the obstruction is moving - administer NSAIDs (carprofen or meloxicam) if not already administered (see above) - followed by prokinetics if still anorectic after 2-3 hours.
Fluid accumulation in stomach leads to deficit in intra- and extra-cellular compartments. Parenteral fluids required. Give 10-20 ml Hartmann’s/kg /hr IV
Exploratory surgery may be attempted. Decision of whether to embark on surgery or conservative treatment depends on the time of presentation:
*Day => conservative treatment
*Night=> surgery more likely
and on financial considerations
===Surgical Procedure===
*Insert stomach tube to decompress: if it blocks, remove, flush and replace
o Procedure of gastric decompression
o Procedure of gastric decompression
+/- sedation
+/- sedation
• Postoperatively give antibiotics, prokinetics, food (force fed with Oxbow Critical Care Formula and baby cereal)
• Postoperatively give antibiotics, prokinetics, food (force fed with Oxbow Critical Care Formula and baby cereal)
Practical approach to exploratory laparotomy in rabbits with intestinal obstruction
===Practical approach to exploratory laparotomy in rabbits with intestinal obstruction===
1. Opiate premedication, oxygenation, gastric and tracheal intubation and isoflurane maintenance.
1. Opiate premedication, oxygenation, gastric and tracheal intubation and isoflurane maintenance.
2. Incision midline, sternum to umbilicus
2. Incision midline, sternum to umbilicus
10. Gastrotomy/enterotomy/ectomy???
10. Gastrotomy/enterotomy/ectomy???
11. Closure with Vicryl (not catgut)
11. Closure with Vicryl (not catgut)
Complications of rabbit intestinal surgery
===Complications of rabbit intestinal surgery===
• Insufficient omentum for omentalisation
• Insufficient omentum for omentalisation
• Intestine small and thin-walled
• Intestine small and thin-walled
• Food cannot be withheld during post-operative period
• Food cannot be withheld during post-operative period
o danger of hepatic lipidosis
o danger of hepatic lipidosis
Postoperative care
===Postoperative care===
• Warmth, quiet
• Warmth, quiet
• Fluid therapy
• Fluid therapy