this content is made by collection of photographs and literature from different sources about veterinary gastrointestinal surgery

1. • Veterinary Gastrointestinal surgery
• Presented by
• Dr. Rekha Pathak
• Senior scientist , IVRI
The photographs have been collected from
different sources i.e. Internet, text books
etc

2. Gastric ulcer / Abomasal ulcer:
• assoc. with chronic
renal / hepatic
• mast cell neoplasia
• gastrin producing
neoplasia
• gastric neoplasia
• coagulation disorder
• FB / gun shot wound
• ICH

3. • Uremia
• Poison
• Snakebite
• Primary ulcers are
less common
• Ulcers secondary –
common
• Aspirin:
experimentally to
produce ulcers

4. • Pathophysiology:
• Gastric/ duodenal
mucosa/ covered
with mucus layer
(sulfated mucin
bound to epi. cells)

5. • Offers protection –
against –
corrosive /
digestive effects of
gastric acid and
pepsin (auto
digestion and
ulceration)

6. • Reduced mucosal
bl. Flow- local
ischemia – sepsis/
hemorrhagic shock
– sudden expulsion
of apical mucin –
circumscribed popn
of cells

7. • Reflux of bile salts
from duodenum to
stomach – bile salts –
more destructive than
pancreatic juices- act
as detergents that
solubilize lipid - cell
memb and inhibit the
ion transport sys.

8. • bile content – greatest – pyloric antrum –
ulcer region of stomach
• hyper secretion of HCL
– gastrinoma ie non beta islets cell tumour of
pancreas and hypergastinemia
– in renal failure (gastrin is removed by
kidneys)

9. – increased histamine: mastocytoma and Endotoxemia
and hemorrhagic shock
– NSAIDS- reduced secretion of mucus
• alters the biochemical composition of mucin
• ingestion of chemicals(arsenic ,cresote)
• Signs: vomiting (not immediately after
ingestion)
• eating – gastric pain- relieved by vomiting
• Hemet emesis and melena
• slow bleeding: coffee colored blood
• sudden - massive and semi clotted blood

10. • generalized peritonitis: gastric perforation
(mostly doesn’t occur due to effective sealing
with omentum)
• wt. loss – hepatic/ neoplastic
• additionally in calves : due to bleeding ulcers –
recumbent suddenly – cold extremity- subnormal
temp. tachycardia and dehydration- hypovolemic
shock and death 24 hrs

11. • Abomasal ulcers :
suckling calves and
adult cattle
(buffaloes)
• adult: 1st few wks of
partu.(stress and
lactation)
• Stress related
(summer months
independent of
partu.)

12. • Calves: dietary
transition from low
DM to high DM
• Trichobezoars
• Asso. With impaction
also

13. • Type I erosion and
ulcers with slight
hemorrhage
• Type II bleeding
ulcers
• Type III perforation
with acute
circumscribed
peritonitis
• Type IV perforation
with diffuse peritonitis

14. • Diagnosis:
• TRP ; pain on left
of xiphoid
• Abomasal ulcer:
pain on rt. side

15. • RG: double contrast:
create
pneumoperitoneum
and give barium
meal
• Barium: ulcers appear
as outpouchings from
lumen containing the
contrast material

16. • Fluoroscopy: helps in variable
positioning and pin point the site

17. • Endoscopy: not
in threatened
bleeding cases
(allows biopsies)
• Exploratory:
laparotomy if life
threatening
hemorrhage

18. Treatment
• Surgical excision
• Cranial midline incision
• Carefully palpate from fundus to pylorus
• If ulcers then – adhesion, serosal scarring
and irregular thickened areas on gastric
wall

19. • Inspect the
pancreas-
gastrinoma- p.
nodules
• If gastrinoma- en
block resection of a
lobe or complete
pancreas(90%
removal – no
endocrinal
insufficiency)

20. • If no ulcers found
• Open stomach- find the bleeding site- also
on pyloric antrum(equidistant from lesser /
greater curvature)
• Extend to duodenum if necessary

21. • Small ulcers :
elliptical incision-
mucosa closed –
simple continuous
– 3/0 or 4/0
absorbable chromic
and interrupted
Lambert on serosa
and muscularis
• Multiple ulcers on
pyloric part –
bilroth I
gastrectomy
technique

22. • Bilroth technique I :
ligate the rt. Gastric
artery near pylorus on
the lesser curvature
• Rt. Gastroepiploic
vessels ligated
• Take care not to injure
the pancreas
• Pyloric and gastric
branches supplying the
area to be resected are
ligated

23. • 2 st. intestinal
clamps are placed
across the pyloric
antrum
• another 2 are
placed distal to the
pylorus and avoid
the common bile
duct.
• Excise the pyloric
sphincter and canal

24. • Gastric mucosa is
apposed with 3-0
synthetic
absorbable suture
in an Cushing
pattern starting
from the lesser
curvature and
continuing towards
the greater
curvature

25. • Equal in size to the
duodenal dia
• Apposed – 3-0 –
synthetic absorbable,
polypropylene, or
nylon – lamberts
pattern
• Duodenum is then
anastamosed with
stomach

26. Gastric acute dilatation and
torsion
• Gastric dilatation-
volvulus (GDV)
• Only dilation common
in puppies
• Overeating/
parasitism
• Larger and giant
breeds – deep
chested

27. • Overeating –
relieved by induced
vomiting or passing
stomach tube
• Parasitism
• Pica
• Postprandial
activity
• Delayed gastric
emptying-
pyloromyotomy

28. • Pathophysiology
• Rotation after dilation
• Aerophagia – source
of intragastric gas
• Distended stomach
(gas + fluid) – more
prone to rotation
• Prevents eructation –
esophagus and
emptying from
duodenum
• Distension increases

29. • Presses the caudal vena/ portal vein –
reduced venous return – red. CO. –
red. Tissue perfusion and shock
• Ischemic bowel – release toxins-
endotoxemia-shock and hypotension
• Red. Ventilation- pressure on
diaphragm

30. • Acid base and electrolyte disturbance
• Myocardial ischemia
• Rotation of stomach – strangulation
of gastric vessels- edema and anoxia
–gastric wall ulceration and necrosis

31. • Clinical signs
• Acute onset of cranial abd. Distention
• Vomiting
• Profuse salivation-pain
• Prolonged CRT, Pallor, weak pulse
• Shock (pooling of blood in spleen due to rotation
of splenic vessels, hypovolemia and
hypotension)
• Dyspnea

32. • RG signs: differentiate simple gastric
distension from GDV
• Gas filled stomach- 50-75% - splenic
position is normal if no volvulus
• In GDV –pylorus is located cranial/dorsal –
fundus
• Position of spleen may not be normal

33. • A tissue density line
dividing the gas filled
stomach into
compartments
• VD - pylorus is near
or near to the left of
the midline
• Gastric perforation-
pneumoperitoneum
• Clockwise 270
• Anticlockwise 90

34. • Preoperative care
• Gastric
decompression
• Needle
trocarization 18 G
needle
• Thrust on rt. Or
left wall – point of
greatest distension

35. • 2-3 needles – relieves
gas component of
distension
• Alternatively – if not
effectively reduced –
stomach
• Pass the s.tube
through mouth gag-
resistance is
encountered in gastro
esophageal junction –
rotate and advance

36. • Removal of
intragastric gas –
trocarization- corrects
the gastro esophageal
angle-allows passage
of S. tube
• Passage of st doesn’t
mean absence of g.
rotation
• Withdraw the tube
after decompression

37. • Sometimes for
decompression –
temporary Gastrotomy is
constructed
• Close the Gastrotomy
wound and proceed for
surgical correction of
rotation (Decompression
doesn’t always result in
normal gastric position)
• Shock therapy

38. • Surgical correction of volvulus
• If surgery is delayed – gastric necrosis worsens
• Reposition the stomach by derotating it
• Avoid injury to splenic v. (digital palpation of
esophagus reveals the direction of rotation
• Pylorus is a good / useful landmark – firm
consistency)
• See the viability of gastric tissue – necrosed
and non-viable – esp. the greater curvature is
damaged

39. • Serosal color,
thickness of wall and
vascular patency
• Partial gastrectomy
• Hemoperitoneum -
centesis of abdominal
cavity- splenic torsion
and gastric torsion
• Blue-black
areas/diffuse
petechial /ecchymotic
stomach- gastrectomy
not indicated –
becomes normal after
decompression

40. • Spleenectomy – damaged
• Gastropexy- red. Rate of
GDV
• Pyloric antral region is
fixed to the adjacent rt.
abdominal wall
• Gastropexy is always
performed on the rt. Side
of the stomach – some
rotation – still occur-
bet.left gastric wall and
left abd.wall

41. G. neoplasm
• Avg. age 8 y
• Alimentary tract: oral
cavity – rarely in
stomach
• Persistent vomiting
unrelated to eating

42. • Within the antrum on the lesser
curvature
• Metastasis: liver, lungs, spleen
• Leiomyoma/ rhabdomyosarcoma/
polyps (solitary or multiple)

43. • Polyps – due to
sharp fragment of
bones- resting for
long in antrum -
injure mucosa –
herniation of sub
mucosa
• Clinical signs;
anorexia

44. • Loss of wt.
Obstructing
gastric out flow
• Normal
peristalsis is
interfered
• Anemia
• Abd. Pain

45. • Emesis unrelated to
ingestion of food /water
• Melena
• palpation
• Exploratory laparotomy

46. • RG: contrast – filling
defect

47. • Endoscope
• Ultrasonography
• Adenocarcinoma:
most common
• Sex predilection for
males
• Treatment
• Chemotherapy: not
successful

48. • Surgical
• Gastrectomy: Partial
gastrectomy is done
• Removal of any portion of
the stomach and up to
(30-40%) in antrectomy
• Partial gastrectomy –
40-70%
• Subtotal gastrectomy : 70-
90%
• Antrectomy: reconstruction-
gastroduodenostomy
(bilroth I ) or
gastrojejunostomy(II)

49. • Two variations of partial
gastrectomy
• A-C : stay sutures are
placed to elevate the
stomach and to minimize
leakage
• Necrotic tissue is excised
with a rim of viable tissue
• A two layer inverting
closure is used
• D-I : atraumatic forceps
are placed across viable
tissue and necrotic tissue
is excised

50. • The stomach body is
subsequently closed with
a parker- Kerr line
• The first inverting layer
suture is placed over the
clamps
• Remove clamps, pull and
invert the suture line
• Second inverting suture
row

51. • End to end
anastomosis of
stomach

52. • Bilroth II –
performed if more
radical gastrectomy
is required, if there
is excessive
duodenal
involvement or
both

53. Bloat
• Bloat : Major problems- GIT – cattle and
buffaloes
• Higher in buffaloes
• Acute/chronic
• Gaseous bloat – free gas - dorsal part of
rumen
• Frothy bloat – gas trapped with ingesta-
dispersed throughout the rumen content

54. • Acute: rapid feeding and sudden diet
change – large ruminants
• s. ruminants – large quantities of grain
ingestion/cereals
• More pressure on diaphragm –
hypoventilation and red. Venous return to
the heart

55. • signs: bulge on Para lumbar fossa
• Abdominal distension
• Cyanotic mm
• v. serious – lying down – asphyxiated –
open mouth- protruded tongue and
tachycardia

56. • Treatment: puncture wall – left side with
trocar and canula
• if frothy – antifoaming agents – turpentine
oil (80ml) + mustard oil (500-1000 ml)
• antifroth prepn. – bloatosil
• gives immediate relief to ailing animal
• avoid conc. – 2-3 days and leguminous
fodder

57. • Resort to rumenotomy / rumenostomy
• S. animal: IV- RL or oral soda bicarb
• Chronic bloat: TRP (FBS) – reticuloperitonitis/
fibrinous pneumonia – pleuritis involving the
vagus nerve
• Liver abscess, splenic cyst and abscess, enlarged
mediastinal lymph nodes, pyloric stenosis
• Rumen fistulation / rumenotomy can be done

58. • Rumen fistulation:
• Anesthesia and
surgical prepn.:
standing position
• Sternal recumb. –
Camel
• Left Para lumbar
fossa
• Circular area – ventral
to transverse process
of lumbar vertebrae-
approx 10 cm dia.-
infiltrated

59. • A circular piece of
skin (4cm) –
removed to expose
the underlying
abdominal mus.
• Bluntly dissect and
expose rumen –
grasp – pulled in a
cone fashion to the
skin surface

60. • Anchor with 4
horizontal
mattress suture
through rumen
and skin

61. • Remove central
portion of rumen
• Incised edge of
rumen is sutured to
the skin with simple
interrupted and non-
absorbable
• Alternately – all the
layers – apply
interrupted mattress
sutures in circular rim

62. • Rumenotomy:
• Indications: FB,
ruminal impaction,
bloat, atony of
omasum or
abomasum
• Inverted L – block
• Local infiltration
along line of
incision

63. • Para vertebral
block
• Surgical technique:
20 cm incision-
middle of tuber
coxae and last rib
5 cm ventral to
lumbar process

64. • Caudal to last rib
(close to reticulum)
• Esp. in deep
bodied animals

65. • Anchor rumen to
the incision to
avoid
contamination of
abdominal m. and
peritoneum

66. • Continuous inverting
pattern – non-
absorbable

67. • Alternatively use
weingarts ring
(quicker)
• Incise rumen with
scalpel

68. • Evacuate and
explore for FB in
reticulum and
remove
• Try to feel for
abscess in reticular
area
• Reticulum is swept
with a magnet to
retrieve the iron FB
• Rumen cud + soda
bicarb= mineral oil

69. • Scrub and discard the
soiled instruments
• Close with double row
of lamberts or
inversion sutures
• Antibiotic and fluid
therapy