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Rectal Tears:                   Treatment by Repeated Manual

Lisa M. Katz, DVM and Claude A. Ragle, DVM, Dipl. ACVS, Dipl. ABVP

                              Repeated manual evacuation is a successful technique for the treatment of grade 3B rectal tears.
                              This method should be considered as an alternative to current management techniques. Authors’
                              address: Dept. of Veterinary Clinical Sciences, Washington State University, Pullman, WA
                              99164-6610.   1997 AAEP.

1.    Introduction                                               the size of the defect was estimated, and the distance
Rectal tears are potentially fatal injuries that often           from the anus to the rectal tear was recorded. All
create an emotionally charged atmosphere with fre-               horses had blood drawn and submitted for a com-
quent liability concerns.1 They are technically diffi-           plete blood count and chemistry profile and had an
cult to evaluate and treat. Methods of treatment                 abdominocentesis performed. All horses were
include direct suturing, rectal liners, and temporary            treated with systemic antibiotics and anti-inflamma-
colostomy.2–5 This paper describes a technique of                tories; intravenous fluids were used as needed. The
repeated manual evacuation for the treatment of                  horses were treated with mineral oil and water via
grade 3 rectal tears.                                            nasogastric intubation as needed to maintain soft
                                                                 fecal consistency, and they were held off of food
2.    Materials and Methods                                      initially and then placed on a low-bulk, pelleted diet.
                                                                 All horses had the rectal tear defect and rectum
Between July 1994 and June 1996, four horses were                evacuated every 1–2 h; a caudal epidural was admin-
treated for grade 3B rectal tears by using a repeated            istered as needed to minimize straining during evacu-
manual evacuation technique. The age, breed, de-                 ation and the person evacuating used bare-arm
scription of the tear, and treatment prior to presenta-          palpation with lubrication.
tion were recorded. All horses were restrained in
stocks and administered xylazinea (1.1 mg/kg IV)
and butorphanolb (0.1 mg/kg IV) for sedation and                 3.   Results
analgesia during the initial evaluation of the tear.             Horses ranged in age from 4 to 21 years of age; there
A caudal epidural was performed to prevent strain-               were one gelding and three mares. Breeds repre-
ing during examination, using a 1.5 in. ( 4 cm) 18               sented were Quarter Horse cross (1/4), Morgan (1/4),
gauge needle; xylazine (90 mg) diluted in sterile                and Arabian (2/4). All three of the mares sustained
saline to a total volume of 10 ml was used. Follow-              rectal injury during transrectal reproductive exami-
ing evacuation, the rectal tear was evaluated by                 nation; the gelding suffered a rectal tear as a result
palpation and endoscopy. Rectal tears were graded,               of a rectal impaction secondary to a tumor within the


154      1997   Vol. 43   AAEP PROCEEDINGS

                                 Proceedings of the Annual Convention of the AAEP 1997
 Reprinted in the IVIS website with the permission of the AAEP                                    Close window to return to IVIS

                                                                                                   HOW-TO SESSION

wall of the rectum. The three mares were referred                grade 3 to a grade 4. Grade 3 rectal tears involve all
to the teaching hospital with suspected tears and                of the layers of the rectum except for the mesorectum
were treated with systemic antibiotics prior to refer-           (3B) or the serosa (3A); grade 4 tears involve all
ral; the gelding was referred for removal of a rectal            layers. Other treatment methods have attempted
melanoma and colic, with the rectal tear being                   to address this problem by direct repair of the injury
diagnosed during the physical exam after arrival.                or by diverting feces from the defect by either loop
All three mares were referred to the teaching hospi-             colostomy or a rectal liner. These methods require
tal within 12 h of suspected rectal tear; the gelding            extensive surgical intervention and are associated
was referred 2 days following evaluation of the rectal           with significant complications aside from the pri-
mass by the referring veterinarian. All four of the              mary injury.6 The manual evacuation technique
horses were diagnosed with a grade 3B rectal tear                reported in this paper has the advantage of allowing
based on rectal palpation and endoscopy. Three out
                                                                 frequent monitoring of the rectal defect, which would
of four horses had abdominocentesis results that
                                                                 allow institution of more invasive treatments if
indicated the presence of a suppurative effusion; no
fluid could be obtained from the fourth horse. All                indicated by progression of the lesion. Repeated
four horses were treated with systemic antibiotics               manual evacuation can be used successfully to man-
consisting of potassium penicillin (3/4), gentamicin             age grade 3B rectal tears.
sulfate (3/4), trimethoprim-sulfa (1/4) or metronida-
zole (1/4). All four of the horses also received either
flunixin meglumine (4/4) or phenylbutazone (1/4).                 References and Footnotes
Two horses out of the four exhibited signs of endotox-           1. Taylor TS, Watkins JP, Schumacher J. Temporary indwelling
emia and shock at presentation, consisting of tach-                 rectal liner for use in horses with rectal tears. J Am Vet Med
ypnea, tachycardia, and tacky mucous membranes                      Assoc 1987;191:677–680.
with evidence of a toxic line. All horses were treated           2. Speirs VC, Christies BA, van Veenendaal JC. The manage-
with repeated manual evacuation of the rectum for                   ment of rectal tears in horses. Aust Vet J 1980;56:313–317.
an average of 1 week. An average of five epidurals                3. Watkins JP, Taylor TS, Schumacher J, et al. Rectal tears in
were given within the first 72 h of presentation.                    the horse: an analysis of 35 cases. Equine Vet J 1989;21:
The average size of the rectal defect was 10 cm in                  186–188.
diameter, with the average distance being 20 cm
                                                                 4. Freeman DE, Martin BB. Rectum and anus. In: Auer JA,
from the anus. All four horses were discharged
                                                                    ed. Equine surgery. Philadelphia: Saunders, 1992;407–415.
within 2 weeks of presentation. 1 year following
discharge, three out of the four horses were reported            5. Baird AN, Taylor TS, Watkins JP. Rectal packing as initial
to be clinically normal. The fourth horse presented                 management of grade 3 rectal tears. Equine Vet J 1989;
to the teaching hospital 1 year following discharge                 7(suppl):121–123.
for acute enterocolitis and was euthanized; the area             6. Blikslager AT, Bristol DG, Bowman KF, et al. Loop colostomy
of the defect palpated normally at that time.                       for threatment of grade-3 rectal tears in horses: seven cases
                                                                    (1983–1994). J Am Vet Med Assoc 1995;207:1201–1205.
4.   Discussion
In the past, grade 3 rectal tears have carried a poor              aPhoenix   Scientific, Inc., St. Joseph, MO 64503.
prognosis and could frequently progress from a                     bFort   Dodge Laboratories, Inc., Fort Dodge, IA 50501.

                                                                                  AAEP PROCEEDINGS          Vol. 43 / 1997    155

                                Proceedings of the Annual Convention of the AAEP 1997

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