Temporary end‐on colostomy as a treatment for anastomotic dehiscence after a transanal rectal pull‐through procedure in a dog

Abstract

Objective To describe a temporary end‐on colostomy to treat the dehiscence of a transanal rectal pull‐through in a dog. Study design Case report Animal A 7‐year‐old intact female Australian shepherd dog that was treated for a rectal adenocarcinoma with a transanal rectal pull‐through. Methods Partial dehiscence of the previous end‐to‐end colorectal anastomosis and formation of a perianal sinus tract were diagnosed 4 days after surgery. A pararectal approach was used to revise the surgery with debridement of the sinus tract, rectal wall reconstruction with single interrupted sutures, and placement of a passive drain. Dehiscence occurred 2 days later. The colon was transected cranial to the pelvic brim, and each stump was oversewn prior to salvage temporary end‐on colostomy. Postoperative care included analgesia, antibiotic therapy, and local care of the perineal/perianal area and colostomy site. After 90 days, the perineal/perianal sinus tract had healed, the colostomy was eliminated, and an end‐to‐end anastomosis of the colon was performed. Results Management of postoperative complications focused on dermatitis of the stoma and perineal/perianal area, stoma incontinence, and perineal/perianal medications of the sinus tract. One year after the final surgery, the dog had occasional episodes of fecal incontinence and a good quality of life without other complications. Conclusion Use of a temporary end‐on colostomy prior to revision surgery led to a satisfactory outcome but required long and challenging postoperative management. Clinical significance Temporary end‐on colostomy may be an option to manage dehiscence and potential recurrent stenosis after transanal rectal pull‐through in dogs.

Evaluation of short-term loop colostomy in dogs using conventional and supporting subcutaneous silicone drain techniques

“…Regardless of the tissue type, the incisions’ healing process starts with tissues breaking down and strength loss before becoming more robust. In the initial stage of healing, when the inflammatory phase prevails and there is a tremendous loss of structural integrity, the healing process depends on the sutures and their capacity to engage the remaining tissue [ 23 ]. The early reduction in tissue strength rears, while the repair phase starts and fibroblasts and smooth muscle cells start to produce new collagen, with subsequent characteristic quick healing of healthy small intestine by the second week of surgery with a healing rate 75% [ 24 ].…”

The use of a vascularized pedicle jejunal graft as a treatment for anastomosis dehiscence after transanal pull-trough, with a combined approach, in two dogs.

“…Complications following rectal pull-through procedures are tenesmus, 1,9,10 rectal bleeding, 1,9,10 rectal stricture, 1,9 suture dehiscence, 6,9 and transient or permanent fecal incontinence. 1,9,10 In the literature, the incidence rates reported for each of these complications are highly variable.…”

“…Although the procedure was successful, it required extensive postoperative management by the dog's owner. 6 In humans, several types of jejunal and ileal grafts (pedicled, augmented, free segment, or a combination of these) have been used for the reconstruction of large anatomical defects. 16 The most common jejunal grafting procedures involve the reconstruction of pharyngolaryngectomy defects 14 .…”

“…To date, colostomy 6,7 is the only surgical technique described as an alternative to euthanasia for the treatment of colorectal anastomotic dehiscence after a transanal pull-through procedure. Recently, Cinti et al reported a case of a temporary end-on colostomy as a rescue technique to repair an anastomotic dehiscence after a transanal pull-through procedure in a dog 6 ; the procedure allowed for fecal diversion, with the aim of reducing tension on the anastomotic site and allowing for the healing of the distal colorectal area.…”

“…1 A transanal pull-through procedure is one of the most common surgical approaches used to resect colorectal neoplasms. 6 A transanal pull-through or combined abdominal-transanal approach are well-described procedures. The postoperative complications after rectal amputation and anastomosis using a transanal pull-through procedure are tenesmus, 1,9,10 stricture formation, 1,9 dehiscence, 6,9 infection, 9,10 and fecal incontinence.…”