Soft tissue

Foreign oesophagal bodies

- Foreign bodies ingested can be bones, toys, pig ears...

- An endoscope and forceps are usually used to remove an oesophagal foreign body.

- If endoscopy does not allow removal of the foreign body, surgery is necessary.

- Early treatment gives the best results.

Anatomy

• The oesophagus is a muscular tube that extends from the back of the throat to the stomach.
• The oesophagus passes through the neck and thorax.
• The oesophagus can move water and food to the stomach.

Oesophageal foreign bodies

The foreign bodies that dogs ingest are pig bones, toys and ears.

Foreign bodies are likely to get stuck mainly in 3 areas:

• The base of the neck is at the entrance of the thoracic cavity.
• Heart base.
• At the diaphragm level.

At these levels, the oesophagus is sometimes narrower than elsewhere because of the structures surrounding it.

Clinical signs of oesophagal foreign bodies

• Drool.
• Regurgitation.
• Anorexia.
• Apathy and sometimes fever.

Removal of oesophagal foreign bodies

An endoscope and forceps are usually used to remove them. Most foreign bodies are thus extractable. If the foreign body has sharp reliefs, as in the case of a bone, it can be stuck.

If the foreign body cannot be removed by endoscopy, surgery is necessary.

The surgery must be performed fairly quickly because the more the object gets stuck in the oesophagus, the more it will be damaged.

To remove it, surgical intervention is necessary:

• If the object is located at the base of the neck, the incision is located on the lower face of the neck.
• If the object is lodged at the base of the heart, the thorax is open on the right side.
• If the object is located at the level of the diaphragm, the thorax is open on one side or the other. It is also possible to open on the abdomen in the front ventral and to remove the object by making it pass it in the stomach.

Possible Complications

- As with any surgery, complications can occur. Although rare, death during anaesthesia may occur. The use of modern anaesthetic protocols and monitoring equipment (ECG, pulse oximetry) minimises the risk.

- Infection is possible because the "contaminated" oesophagus is incised. Antibiotics will be administered during the procedure and post-operatively to prevent infection. If it occurs, the signs appear 2 to 5 days after the procedure. Emergency surgery is then necessary.

- Intense esophagitis or heartburn may occur in the clinical form of liquid or food regurgitation.

- An accumulation of liquid or seroma under the skin may occasionally appear. It resolves itself over time, but may sometimes require a puncture.

- Shortness (narrowing) of the oesophagus can prevent food from passing through. The risk of stenosis is linked to lesions generated by the foreign body. The major sign is the presence of regurgitation. In this case, a special catheter with a balloon is used to dilate the oesophagus.

Perineal hernia

- Perineal hernia exists in dogs and cats and consists of a movement of pelvic and/or abdominal organs (small intestine, rectum, prostate, bladder or fat) in the area surrounding the anus and is called the perineum.

- The best treatment method uses a technique using an internal obturator muscle flap.

- Castration must always be performed to allow regression of the size of the prostate and a reduction of efforts during the emission of stool.

- Success depends in part on the surgeon's experience.

Anatomy

• A pelvic diaphragm is a group of muscles attached that surround the anus.
• The pelvic diaphragm consists of the elevating muscles of the tail, lateral coccygeal and external anal sphincter.
• This diaphragm is an obstacle that holds internal organs such as the intestines, prostate and bladder in place.

Perineal hernia, definition and clinical signs

• A perineal hernia is a condition affecting dogs like cats and consists of a movement of the pelvic and/or abdominal organs (small intestine, rectum, prostate, bladder or fat) in the area surrounding the anus and is called the perineum.
• This pathology appears following a weakening of the muscles constituting the pelvic diaphragm.
• The evocative signs are difficulty urinating or passing stools, constipation, and swelling around the anal area.

Causes of perineal hernia

• The causes of this pathology are not yet fully known.
• The vast majority of cases involve uncastrated middle-aged or older male dogs. The most likely cause is an increase in prostate size under the hormonal influence in unsterilised animals. The stress caused by this prostate weakens the pelvic diaphragm.
• Other theoretical causes of perineal hernia include anatomical factors, hormonal disorder, pelvic diaphragm nerve damage, and stress due to rectal disease.

Diagnosis

• Diagnosis is made by digested rectal palpation.
• X-rays and/or an ultrasound scan are used to define the hernial content.

The procedure of the intervention

A perineal hernia is not emergency surgery, but if the bladder is in the hernia, emergency treatment is necessary because the animal can no longer urinate.

The best treatment method uses a technique using an internal obturator muscle flap. This technique recreates a pelvic diaphragm using the transposed muscle. This muscle is an external rotator muscle of the hip that can be removed without affecting the use of the limb.

Other techniques are performed in addition:

• Colopexia: the colon is fixed on the left of the abdominal wall which prevents it from coming back to press on the repaired diaphragm.
• Cystopexy: the bladder is fixed on the right side of the abdominal wall to prevent the prostate and bladder from migrating into the pelvis.
• Deferentopexy: the vas deferens (ducts going to the testicles) are fixed for the same purpose.

These operations are not performed alone but in addition to the hernia repair technique.

Castration must always be performed to allow regression of the size of the prostate and a reduction of efforts during the emission of stool.

Prognosis

• Surgery is a success in 80% of cases.
• The success of the procedure depends in part on the surgeon's experience.
• Failure leads to hernia recurrence and requires further intervention.

Post-operative and convalescent care

• Within 10 to 15 days after surgery, the inflammation on the surgical site will have disappeared.
• Difficulties in passing stool are present for about a week.
• In 6 to 8 weeks, healing is complete.
• Laxatives reduce stress and constipation.
• Analgesics are administered for the comfort of your animal.
• Lick the wound will be avoided by wearing a collar.
• A restricted activity of 3 to 4 weeks must be set up. Walks are only hygienic and on a leash, jumping and running games are prohibited.

Possible Complications

- As with any surgery, complications can occur. Although rare, death during anaesthesia may occur. The use of modern anaesthetic protocols and monitoring equipment (ECG, pulse oximetry) minimises the risk.

- Infection.

- Difficulties in passing faeces may be encountered by irritation and inflammation of the rectum which is located next to the surgical site; treatment is possible, and this can be quickly resolved.

- Fecal incontinence is possible if the hernia is bilateral by the weakening of the anal sphincter. This is generally transitory.

- Urinary incontinence is rarely encountered unless the bladder has been in the hernia for a long time and nerve stretching is present. This is generally reversible.

Exploratory Laparotomy

- Abdominal exploration is a diagnostic and sometimes therapeutic procedure.

- Vomiting is the first sign of a variety of diseases affecting the digestive tract.

- Once the procedure is complete, intensive care is required to ensure optimal recovery.

Introduction

Stomach and intestinal surgery are common. The reasons for intervention on the digestive tract include ingestion of foreign bodies, tumours, intestinal torsion, intussusception, dilation, and intestinal biopsies. Various diagnostic tests are performed beforehand to determine the nature of the problem.

First, a blood test is performed to determine whether liver, kidney, pancreatic or electrolyte abnormalities. A blood count is taken to look for signs of infection or anaemia. X-ray images can be very useful to indicate the existence of a digestive problem. However, they do not give a definitive diagnosis and abdominal ultrasound or contrast x-rays may be necessary.

Sometimes these examinations do not allow to conclude on the nature of the problem and an exploratory surgery is necessary. This can be negative, the organs all seem normal. In this case, biopsies are performed because the lesions that cause the clinical signs may be microscopic. It may seem surprising not to find anything surgically curable, but it is better to explore than ignore a lethal problem without intervention. Fortunately, most abdominal explorations reveal an operable condition.

Signs of gastrointestinal illness

Vomiting is the first sign of a multitude of diseases affecting the digestive tract. If an intestinal obstruction is present, there is usually no associated diarrhoea, although this is possible. If the problem is acute (such as ingestion of a foreign body, acute vomiting is almost always present. Chronic signs such as intermittent vomiting or diarrhoea, possibly associated with weight loss, may be due to inflammatory or tumour disease.

Age can indicate the type of problem. Foreign bodies are more common in young dogs and tumours in older dogs. The underlying problem of an animal may require abdominal exploration and sometimes biopsies of different organs.

Abdominal exploration and gastrointestinal surgery

The decision to have an exploratory laparotomy is often based on an x-ray or ultrasound examination. These tests are often suggestive of a specific problem affecting the stomach or intestines. The surgery is then performed to confirm the suspicion. Sometimes the abnormal gas filling found on the x-ray is not due to an obstruction of the intestine and no major abnormalities are encountered. In this case, the animal may have some form of viral or tumour infiltration or bacterial infection. Biopsies are then performed to look for these pathologies.

Although it can be confusing to find nothing surgical, it is better to explore the abdomen than ignore a lethal problem without intervention. Fortunately, most abdominal explorations reveal a surgically curable condition.

If a foreign body is found in the stomach or intestines, the object is removed by making an incision at its level. If a portion of the intestine is in the process of necrosis due to the foreign body, it is then necessary to remove a portion of the digestive tract.

In the event of a gastric or intestinal tumour, its removal will be carried out if possible.

A feeding tube may be necessary, especially in undernourished animals with chronic diseases. It is usually removed 10 days later if the animal is better.

Post-operative and convalescent care

• After surgery, intensive care is needed to ensure a successful outcome. Infusions and antibiotics are administered for at least 24 hours.
• Analgesics are administered for the comfort of your animal. Surveillance is maintained to ensure that the animal does not develop peritonitis (abdominal infection), especially if the digestive tract has had to be incised.
• Re-feeding is started 24 hours after surgery depending on vomiting.
• Most animals feel better in 2 to 4 days. Recovery is complete in 2 weeks, but tissue healing takes longer.
• A restricted activity of 3 to 4 weeks must be set up. Walks are only hygienic and on a leash, jumping and running games are prohibited.
• If your pet has cancer and chemotherapy is needed, it is usually started 2 weeks later, sometimes earlier. It is traditionally performed in 5 treatments spaced 2 to 3 weeks apart.

Possible Complications

- As with any surgery, complications can occur. Although rare, death during anaesthesia may occur. The use of modern anaesthetic protocols and monitoring equipment (ECG, pulse oximetry) minimises the risk.

- Infection is an infrequent complication since strict sterility techniques are used during the procedure and antibiotics are administered peritonitis is a serious but fortunately rare disorder. It is due to a release of the intestinal sutures at the incision and the presence of digestive contents in the abdomen.

- The risk period is between the second and fifth postoperative days. Emergency surgery is then necessary.

- Intussusception may follow abdominal surgery. The intestine then invaginates itself when the transit resumes. A re-intervention is then necessary.

- If a tumour portion of the intestine has been removed, recurrence is possible. Metastases may also occur.

Stomach torsion dilatation syndrome

- Stomach dilation is a serious and potentially fatal disease if prompt treatment is not implemented.

- Emergency decompression of the stomach and fixation of the stomach to the abdominal wall is necessary.

- The survival rate after surgery is 90% if the stomach is not in the process of necrosis. If a portion of the stomach is devitalized, the survival rate is only 50% despite medical and surgical treatment.

- Preventive surgery under laparoscopy is possible in dogs whose breed is predisposed to this condition.

Introduction

The stomach is located in the cranial part of the abdomen and is the first part of the gastrointestinal tract of the abdomen. Stomach torsional dilation syndrome (STDS) is a condition that begins with the distension of the stomach by food, liquids such as drinking water, or air due to panting breathing. The stomach then turns clockwise when dilated. The oesophagal entry route and the exit route to the intestine are blocked and food, liquids and air cannot escape. Unproductive vomiting efforts follow.

Because of the twisting and displacement of the stomach, the blood supply may be blocked and all or part of the stomach wall may die. The longer the torsion time before emergency treatment, the greater the risk of gastric necrosis.

Another consequence is the occlusion of the vena cava which brings back blood from the whole back of the body and causes a shock. Shock is a situation in which inadequate organ perfusion is fatal if left untreated. Clinical signs are pale mucous membranes, tachycardia, weak pulse. SDTE animals are generally very weak and require immediate aggressive treatment.

Less frequently, the nerves in the stomach are damaged by ETS and cause paralysis of the muscles in the stomach wall. Chronic dilatation follows which does not respond to any treatment.

Treatment of the SDTE

Venous lines are placed and fluids and medications are administered in an attempt to counter the state of shock. Decompression procedures are then implemented. An anaesthetic is administered and a tube is passed into the stomach via the oesophagus to empty the stomach to the maximum. If the tube cannot be passed into the stomach because of the twisting of the oesophagus, a large needle is placed in the stomach through the abdominal wall to initiate decompression.

When his condition allows it, the animal is operated on. Signs of necrosis are being looked for on the organs. The stomach is repositioned and can be anchored on the right side of the abdomen to prevent a recurrence. Sometimes, an area of necrosis is detected on the stomach and requires removal. When too much stomach is affected, euthanasia may be recommended. If the stomach could not be emptied by the oesophagal tube, it is then opened to be emptied.

Sometimes the spleen is also twisted and blood clots have developed in its vessels. The removal of the spleen (splenectomy) is then necessary. Dogs can live normally without a spleen. The animal may also have heart rhythm disorders. They are present in about 40% of cases if a spleen problem requires its removal. These disorders can be lethal and require special treatment.

Post-operative and convalescent care

• After surgery, intensive care is needed to hope for a successful outcome. Infusions and antibiotics are administered for at least 24 hours. Blood pressure is monitored regularly The ECG is monitored during and after surgery to detect arrhythmias early and treat them if necessary as they can be, although infrequently, fatal.
• Signs of disseminated intravascular coagulation (DIC) are sought. In this case, the clotting mechanism gets out of control and clots from anywhere, a multi-organ failure then appears with a clotting defect. DIC is often fatal, hence the need for early treatment
• In general, about 90% of animals with ETS survive if treated promptly. 10 to 14 days later, most patients are doing very well. If a portion of the stomach is dead and must be removed, the survival rate is only about 50%.
• A restricted activity of 3 to 4 weeks must be put in place so that the stomach sutures do not give way. Walks are only hygienic and on a leash, jumping and running games are prohibited.
• After the animal has presented an SDTE, the feed ration must be divided into 2 to 3 meals and limited exercise 2 hours after the meal to avoid bloating (torsion can no longer occur because of the operation). Chronic dilation is a possible problem following such an episode.

Possible Complications

- As with any surgery, complications can occur. Although rare, death during anaesthesia may occur. The use of modern anaesthetic protocols and monitoring equipment (ECG, pulse oximetry) minimises the risk.

- Infection is an infrequent complication since strict sterility techniques are used during the procedure and antibiotics are administered.

- Cardiac arrhythmia.

- DIC results in multi-organ failure, bleeding disorders and often death.

- Release of the stomach attachment on the wall (gastropexy) in less than 5% of cases.

- Chronic dilation. Infrequent, it is due to a functional defect of the stomach muscle. Medications can be administered, but efficacy is limited to 50% of cases. The clinical appearance is similar to the SDTE, but the stomach does not twist.

- Due to the wide variability in the condition of animals with ETS, it is difficult to predict whether your animal will develop postoperative complications. In general, animals with gastric necrosis do much worse than those with minimal trauma.

Prognosis

• In the case of rapid treatment, about 90% of treated and operated dogs survive.
• If at the time of surgery a portion of the stomach is dead, the chances of survival are 50%.

Prophylactic surgery (preventive)

- Preventive surgery can be performed to minimize the risk of SDTE in at-risk individuals such as Great Danes, German Shepherds, Irish Wolfhounds, Dobermans and other large thorax dogs. Great Danes are the most at risk and a study shows that 25% of them dilate during their lifetime.

- This surgery can be done from the age of 6 months. It presents few risks, anaesthetic time and hospitalisation are shorter, and the cost is less than with SDTE.

- However, it must be kept in mind that the best prevention of the SDTE remains the use of a good quality diet, the splitting of meals and the prohibition of exercise after meals and especially after the evening meal.