Chapter 11: Table of Contents
- 11.1 Intestinal Biopsy
- 11.2 Intestinal Biopsy Quiz
- 11.3 Intestinal Resection and Anastomosis
- Intestinal Apposition and Closure
- Suture the mesenteric rent, leak test, and omentalize
- Video: Intestinal Resection and Anastomosis
- How to accommodate discrepancies in luminal size when performing a resection-anastomosis
- Decision-making in the management of gastrointestinal foreign bodies
- Decision-making in the management of gastrointestinal foreign bodies: continued
- Decision-making in the management of gastrointestinal foreign bodies continued
- Enterotomy vs. Resection-Anastomosis
- Assessing Intestinal Viability
- Where to incise when removing a focal foreign body via enterotomy?
- Linear foreign body removal
- Where to cut when performing a resection-anastomosis
- Prognosis- foreign body
- Use of Antibiotics?
Linear foreign body removal
A gastrotomy is usually required to remove the anchored portion of foreign body at the level of the pylorus. At that point, the surgeon should resist the temptation to pull the foreign body out of the intestine since this might saw/cut through the mesenteric portion of the intestine. Multiple enterotomy incisions are often required to atraumatically remove the intestinal portion of the linear foreign body. An alternative technique described to remove linear foreign bodies in cats (Anderson 1992) involves suturing the transected, distal portion of the linear foreign body to a red rubber tube via a gastrotomy or single enterotomy incision. With this method, the foreign body and the red rubber catheter are manipulated along the intestinal tract into the distal colon where an unsterile assistant can retrieve the foreign body and catheter through the rectum. This technique is interesting in that it reduces the number of enterotomy sites and possibly the risk of dehiscence but it is much more difficult to accomplish than it sounds. In several instances, the foreign body bunches-up making it difficult to move it along the intestine; this is especially true in dogs with large linear foreign bodies such as carpet or fabric. In addition, transmural manipulation of the foreign body can be quite traumatic to the tissues. Regardless of the technique used to remove the foreign body, it is common to find several small perforations along the mesenteric border once the intestinal plication is relieved by removal of the foreign material. Perforation was reported in 40% of dogs treated for linear foreign bodies (Evans 1994). Debridement and closure of a few small perforations is possible if these are accessible but resection-anastomosis of the affected intestine is often a better option.