The Management of Rectal Tears in Horses

Abstract

Rectal trauma in horses is usually iatrogenic and carries a high mortality. Partial thickness tears heal without surgical assistance. Full thickness tears require surgical repair through the anus or a ventral laparotomy or, if these are not possible because of difficulty in gaining access to the tear in its usual site at the pelvic inlet, a diverting colostomy to allow the rectum to heal is necessary. This paper describes the management of 15 cases of rectal injury, only 3 of which survived. Two of these were partial thickness tears not treated surgically and the third had a temporary diverting colostomy.

The medical management of eight horses with Grade 3 rectal tears

“…However, successful primary suture closure of Grade 3 tears has been reported (Watkins et al 1989). If the tear is close to the anus, it may be sutured per rectum in the standing or anaesthetised horse using either a one-handed suturing technique or via an adjustable speculum (Speirs et al 1980;Spensley er al. 1985;Sayegh et al 1996).…”

Non‐surgical management of rectal tears in two mares

“…3 A horse showing signs of abdominal pain or shock within 2 hours of rectal examination, enema or breeding should also be suspected of having a rectal tear. 15 Contamination of the tear with faecal matter is prevented by administration of epidural anaesthesia and/or anti-spasmodic drugs such as hyosine or propantheline to reduce straining. Sedation, usually with an alpha-2 agonist with or without an opiate, may also reduce rectal contractions, as well as assisting re-examination of the rectum and manual evacuation of faeces.…”

Rectal tears of horses

“…The most obvious sign that the rectum has been damaged is the presence of blood in the rectal lumen. Sanguinous material on the palpator's sleeve usually indicates that only the rectal mucosa has been damaged, but a copious amount of fresh blood on the sleeve indicates that the horse has incurred a grade 3 or 4 tear (Fig 9) Speirs et al 1980). Signs displayed by horses that have incurred a g r a d e 3 or 4 tear are those of septic peritonitis, and include signs of colic, sweating, tachycardia, reluctance to move, and fever Speirs et al 1980;Sayegh et al 1996).…”

“…Sanguinous material on the palpator's sleeve usually indicates that only the rectal mucosa has been damaged, but a copious amount of fresh blood on the sleeve indicates that the horse has incurred a grade 3 or 4 tear (Fig 9) Speirs et al 1980). Signs displayed by horses that have incurred a g r a d e 3 or 4 tear are those of septic peritonitis, and include signs of colic, sweating, tachycardia, reluctance to move, and fever Speirs et al 1980;Sayegh et al 1996). Horses displaying these signs following some procedure or activity that could have damaged the rectum, such as palpation per rectum, administration of an enema, or breeding, should be examined for rectal damage by careful palpation of the rectum with the hand ungloved or covered with a surgery glove.…”

“…Tears close to the anus can be sutured through the rectum with the horse standing, using a one-handed suturing technique, or an expandable speculum that allows visual and surgical access to rectal lumen (Spensley et al 1985). Anal sphincterotomy has been recommended to improve access to tears sutured through the lumen of the rectum (Speirs et al 1980) but is usually unnecessary if caudal epidural anaesthesia has been administered. Suturing the tear with one hand is difficult and, when performed by a surgeon inexperienced in this technique, may increase contamination and size of the tear.…”