Rectal tears in the horse: an analysis of 35 cases

Abstract

Summary The records of 35 horses with Grade 3 or 4 rectal tears, presented to the Veterinary Medical Center at Texas A&M University over a five year period, were reviewed. Grade 3 tears were sub‐classified according to whether the remaining tissue was serosa (Grade 3a) or mesorectum (Grade 3b). Five horses were destroyed on presentation and 30 were treated by primary suture closure (8 horses), faecal diversion alone (9 horses) or in combination with suture closure (11 horses) and packing of the tear with medicated gauze sponges (two horses). Faecal diversion was achieved with a temporary indwelling rectal liner (TIRL) in 19 horses and colostomy in one. Survival was related to classification of the tear, efficacy of first aid measures administered at time of injury and method of treatment. Seventy‐four per cent of horses with Grade 3a tears and 44 per cent of those with Grade 3b tears survived. Grade 4 tears had a grave prognosis. Horses given adequate first aid before admission had a better survival rate. With proper patient selection, primary closure of the tear with sutures yielded excellent results. In horses which were not candidates for suture closure alone, a combination of faecal diversion and suturing gave better results than faecal diversion only. In addition, selected horses were treated successfully by packing the rectal tear with gauze sponges. The results demonstrate the value of a TIRL to divert faeces and appropriate first aid measures in treating rectal tears.

A review of equine rectal tears and current methods of treatment

“…First aid was considered adequate if there was no accumulation of particulate faecal material in the diverticulum formed by the tear or if the tear did not worsen, resulting in particulate faecal material in the peritoneal cavity (Watkins et al . ).…”

“…Conservative management is mainly reserved for grade I and II tears, although grade III tears have also been successfully managed conservatively (Watkins et al . ; Mair ; Alexander and Gibson ). Conservative management includes administration of broad‐spectrum antimicrobial drugs (penicillin, 22,000 iu/kg bwt i.v.…”

Hand-assisted laparoscopic repair of a grade IV rectal tear in a postparturient mare

“…Treatment may be direct repair, fecal diversion techniques, or a combination of the 2. [4][5][6]15 An experimental study 20 of the use of laparoscopic repair of rectal tears in anesthetized horses evaluated bursting strength of the repair for a direct suture pattern, an automatic suturing device, and a hernia stapler. 16 Fecal diversion can be achieved by placement of a temporary indwelling rectal liner 5,17 or by performing a loop colostomy 4,5,18,19 and is often performed in conjunction with direct repair.…”

“…Rectal tears are reportedly more common in young horses and males, 2,8 with a breed predilection in Arabians, 2,8 and tears are usually located in a dorsolateral or ventral location, 5,6,8 presumably because of the anatomic narrowing and ventral direction of the rectum at this level. Rectal tears are reportedly more common in young horses and males, 2,8 with a breed predilection in Arabians, 2,8 and tears are usually located in a dorsolateral or ventral location, 5,6,8 presumably because of the anatomic narrowing and ventral direction of the rectum at this level.…”

Direct intraluminal closure of artificial grade four rectal tears in horses

“…Der Grund hierfür war, dass die Abstände zwischen den einzelnen Heften zu groß waren und dass die Einstichstellen der gegenüberlie-genden Wundränder gegeneinander verschoben lagen. Watkis et al (1989), Eastman et al (1999) und Huskamp (1994 führten die transrektale Naht an lebenden Pferden mit einer iatrogenen Rektumläsion dritten Grades durch. Watkins et al (1989) therapierten sieben Pferde mit dieser Methode, von denen sechs als geheilt entlassen wurden.…”