Surgery within the abdominal cavity is performed for many reasons, and we are well equipped and able to deal with most of these scenarios. Often patients will require prolonged supportive care, for example oesophageal tube feeding, to make a full recovery. We have 24-hour nursing facilities on-site for these cases.
Biopsies
Patients may require an intestinal biopsy in order to determine causes of symptoms including chronic diarrhoea, vomiting, weight loss, an intestinal mass or protein-losing enteropathy. Intestinal biopsies may be collected endoscopically from the stomach and duodenum. However, full thickness biopsies of the intestinal tract will require a coeliotomy (opening up the abdominal cavity).
Foreign body removal
Diagnostic imaging is almost always necessary to diagnose and locate foreign bodies, particularly those of a linear form such as string. Whilst some smooth or small foreign bodies may be able to pass through relatively easily, others may become lodged in the intestine or stomach, inducing symptoms such as vomiting, lack of appetite, abdominal discomfort and lack of faeces. Early diagnosis with the help of our ultrasound and x-ray facilities can help prevent complications such as peritonitis due to gastric or intestinal perforation, or ultimately death, if the foreign body is not removed. The removal procedure is dependent on the location, duration, degree of obstruction and material of foreign body. Gastric foreign bodies may be removable using endoscopy, but most require surgical exploration of the abdomen.
Intestinal Resection and Anastomosis
Intestinal resection and anastomosis is a procedure used to repair severely damaged sections of the intestinal tract (including stomach, colon and rectum) caused by complications such as foreign body obstruction, trauma, intussusceptions or torsions and neoplasia. Resection describes the removal of the abnormal tissue (which may be sent away for histopathological examination if required) and anastomosis is the suturing or stapling of the two healthy ends of gastrointestinal tract back together again. Radiography and abdominal ultrasonography are useful modalities to identify affected areas and to support decision making regarding the surgical approach. Success of this procedure is relatively high but also dependent on the extent of the removed portion and whether the underlying cause will be resolved from the surgery (e.g. in cases where a tumour has metastasised). The aim during surgery is to avoid any leakage at the site of incision, which could lead to peritonitis. After-care is equally as important, with 24-hour care available for in-patients requiring continued treatment and monitoring, as well as many patients receiving a restricted diet of some form post-surgery.
Colectomy
A colectomy is considered a ‘salvage procedure’ (i.e. the last resort) for the treatment of feline chronic constipation (in its severe form known as megacolon), the removal of colonic tumours, or severe colonic conditions such as intussusception. Involving a complete or partial removal of the colon, it is considered ‘salvage’ as there is a risk of serious complications such as peritonitis and chronic diarrhoea post-surgery. A colectomy may be performed once other treatments such as enemas, laxatives, colonic prokinetic agents, and highly digestible diets have been exhausted to no avail. Abdominal imaging may identify any predisposing factors such as a narrowing of the pelvis or an intestinal foreign body, which may affect surgical decisions.
Treatment of peritonitis
Peritonitis (or inflammation of the peritoneum) exists in both primary forms (such as feline infectious peritonitis) and secondary forms. Primary peritonitis occurs when bacterial or fungal infection spreads to the peritoneum via lymph nodes or the blood stream. The more common secondary peritonitis is caused by infection entering the peritoneum via either perforation of the gastrointestinal tract or penetration of the abdominal wall, such as a foreign body obstruction or trauma (see Intestinal resection and anastomosis). Peritonitis is a life-threatening condition if left untreated. Its diagnosis may be achieved through blood tests and imaging. In many cases, aggressive surgical treatment is required. The abdomen is opened up and explored. The cause, such as a perforated bowel, is identified and treated, and the abdominal contents lavaged with sterile saline. Suction drains are then used to remove fluid from the abdomen over the following few days. Serious septic peritonitis, unfortunately, may occur a couple of days after intestinal surgery, such as foreign body removal. For patients suffering feline infectious peritonitis, therapy is palliative and directed towards reducing inflammation.
Enterotomy/enterectomy
Our soft tissue surgical team are able to perform both enterotomies and enterectomies for a variety of intestinal disorders. An enterotomy is a surgical opening of intestine, predominantly used in foreign body obstruction or to obtain a full thickness biopsy for histopathological examination. An enterectomy involves the removal of a segment of intestine (see Intestinal resection and anastomosis) and is commonly used on patients suffering peritonitis. Fluid therapy is vital for intestinal surgery patients and in-patients will receive 24-hour nurse care to provide treatment and monitor for post-operative complications such as peritonitis.
Nephrectomy
A nephrectomy (or removal of a kidney) may be used in cases such as renal neoplasia, hydronephrosis, trauma to the kidney, severe pyelonephritis or congenital abnormality.
Blood and urine analysis, and imaging prior to surgery will determine the function of the contralateral kidney and thus help to decide whether the patient will be able to manage should the affected kidney be removed.
In cases of renal neoplasia, ultrasound may be used to identify the presence of a tumour, as well as guiding any fine needle aspirates or biopsies that are taken for analysis. The majority of renal tumours are malignant, and so a chest x-ray or CT may also be a useful tool to help identify the extent of the cancer and any metastatic spread within the lungs. Surgery may be the treatment of choice if the tumour has not metastasised, depending on the patient, tumour type, kidney involvement and other clinical signs. This involves the blood vessels and ureter of the affected kidney being tied off prior to removal of the kidney. Post-surgery patients will be able to benefit from 24-hour care, intravenous fluid and electrolytes as required. Patients may also be referred to our oncology team for chemotherapeutic treatment. Abdominal ultrasound check-ups and repeat bloods periodically may be recommended to assess for metastatic disease.
GDV
Gastric dilation and volvulus (GDV) is a sudden onset, life-threatening condition during which the stomach dilates and twists, causing an increased pressure that can lead to rupture of the stomach wall, loss of blood flow to the stomach and the heart, and difficulty breathing. It rapidly leads to circulatory shock and death. Prior to surgery it will be necessary to stabilise the patient and take abdominal radiographs to differentiate between GDV and gastric dilation without torsion. If GDV has occurred, a gastropexy can be performed, where the stomach is returned to its normal position and attached to the wall of the abdomen, in order to prevent volvulus (rotation) should gastric dilation occur again. This is typically a disorder of large and giant dog breeds. It tends to occur at night but is a true emergency with patients likely to die within a few hours if left untreated. Post-operative care will involve monitoring for signs of cardiac arrhythmia, intravenous fluids to maintain perfusion to surrounding tissues, limiting physical activity and ensuring portion sizes in future are controlled.
Biliary diversion and cholecystectomy
Biliary diversion is the re-direction of bile back to the gastrointestinal tract by an alternative route. A cholecystectomy, or surgical removal of the gallbladder, is sometimes required in cases of cholecystitis – infection or inflammation of the gallbladder. Cholecystoenterostomy is a biliary diversion procedure where the gallbladder and the small intestine are joined. This allows bile to pass from the liver to the intestine when the bile duct is obstructed permanently. This is occasionally required following a severe bout of pancreatitis.