A standing pararectal approach to treat small colon obstruction by a pedunculated lipoma

Abstract

Summary In an 18‐year‐old Paso Fino mare presented with mild colic of 36 h duration, a luminal obstruction was found on rectal palpation in the most oral part of the rectum, and this appeared to be caused by a tight band on the left side. A standing procedure was used that involved pararectal dissection with long‐handled instruments to the level of the constricting band, guided by a hand in the rectum. A hooked bistoury designed for treating entrapped epiglottis was used to transect the band, which immediately released the obstruction and allowed manual evacuation of the aboral end of the small colon. The band was most likely the pedicle of a pedunculated lipoma that had encircled the oral end of the rectum. The mare made a complete recovery.

Surgical approaches to the equine abdomen

“…Although the approach, as described in the article, was inadequate to allow exploration of the abdomen, it enabled the pedicle of a mass, suspected to be a pedunculated lipoma, obstructing the rectum to be transected (Durket et al . ).…”

“…The ability to explore even the caudalmost aspect of the abdomen of a horse through a pararectal approach was not determined by the authors of the accompanying article, because they were able to relieve the rectal constriction by inserting only the tip of a bistoury into the abdomen of the horse (Durket et al . ). Previously, the use of pararectal incision has been limited to accessing the retroperitoneal portion of the bladder in standing, sedated horses to remove cystic calculi (Van Dongen and Plenderleith ; Abuja et al .…”

“…Thus, if the lesion is located in the left side of the abdominal cavity, as was the case in the study reported here (Durket et al . ), a right‐handed surgeon may experience difficulty operating unwieldy, long‐handled instruments necessary to complete dissection on the left side of the rectum.…”

“…In the study reported here (Durket et al . ), financial limitations posed by the client appear to be the primary factor driving the selection of the pararectal approach to resolve a lesion constricting the peritoneal portion of the rectum. An approach through colpotomy was also considered, but apparent inability of the surgeon to insert his/her hand into the mare's vagina eliminated this option.…”

“…The vaginal celiotomy is often referred to as a colpotomy. The pararectal approach described in the accompanying article (Durket et al 2019) is a modification of the G€ okel's approach to the retroperitoneal portion of the bladder, described for removing a cystic calculus. The abdomen can also be explored using laparoscopic techniques, with the laparoscope and instruments inserted at the flank or ventral aspect of the abdomen.…”