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TUGAS MATA KULIAH

ILMU BEDAH KHUSUS VETERINER


“TEKNIK OPERASI COLOPEXY”

Halaman Muka
Disusun Oleh :
1. Derfina Lijung 1609511078
2. Raisis Farah D. A 1609511080
3. Vanesya Yulianti 1609511082
4. Ach Moch Abd Muhsi 1609511097

LABORATORIUM BEDAH VETERINER


FAKULTAS KEDOKTERAN HEWAN
UNIVERSITAS UDAYANA
TAHUN 2019
i
RINGKASAN

Colopexy adalah operasi yang dilaksanakan untuk melekatkan secara tetap permukaan
serosa kolon dan dinding abdomen sehingga mencegah pergerakan kolon dan rektum. Indikasi
operasi ini ditujukan untuk mencegah timbulnya prolapsus rektal berulang. Salah satu kasus
gangguan saluran pencernaan yang sering terjadi adalah prolapsus rektal yang dapat disebabkan
oleh distokia, urolithiasis, neoplasma intestinal, hernia perineal, konstipasi, dan pasca operasi anus
atau perineal. Teknik menginsisi maupun tidak menginsisi menunjukkan hasil yang efektif.
Kemungkinan komplikasi adalah infeksi karena penetrasi jahitan pada lumen kolon.

Operasi ini dilakukan di bawah anestesi umum atau epidural anelgesia. Operasi
diusahakan agar tidak terkontaminasi oleh feses atau kotoran lain. Colopexy dilakukan dengan
menggunakan catgut chromik untuk melekatkan colon dengan dinding abdomen. Untuk dapat
menemukan kolon, dapat dilakukan dengan menggeser usus kecil ke arah kanan. Kolon descenden
akan tampak pada sisi kiri flexura colic sinister menuju pelvis. Kolon descenden akan mencapai
pelvis dengan melewati dorsal uterus atau vesica urinaria. Lapisan kolon sama seperti usus kecil
yaitu mukosa, submukosa, muskularis, dan serosa.

Kata Kunci : Colopexy, Anestesi

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SUMMARY

Colopexy is an operation carried out to permanently attach the colonic serous surface and
abdominal wall to prevent colonic and rectal movements. Indications of this surgery are intended
to prevent recurrence of rectal prolapse. One of the most common cases of gastrointestinal
disorders is rectal prolapse which can be caused by dystokia, urolithiasis, intestinal neoplasms,
perineal hernia, constipation, and postoperative anus or perineal surgery. Both the incision and
non-incision techniques show effective results. Possible complications are infection due to suture
penetration in the colonic lumen.

This operation is done under general anesthesia or epidural anelgesia. Operations are made
to avoid being contaminated with feces or other impurities. Colopexy is done by using chromic
catgut to attach the colon to the abdominal wall. To be able to find the colon, can be done by sliding
the small intestine to the right. The descending column will appear on the left side of the flexura
colic sinister towards the pelvis. The descending colon will reach the pelvis by passing through the
dorsal uterus or urinary vesica. Colonic layer is the same as the small intestine namely mucosa,
submucosa, muscularis, and serosa.

Keywords: Colopexy, Anesthesia

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KATA PENGANTAR

Puji syukur penulis panjatkan kepada Tuhan Yang Maha Esa karena berkat rahmat-Nyalah
penulis dapat menyelesaikan paper untuk memenuhi tugas mata kuliah Ilmu Beda Khusus
Veteriner yang berjudul “Teknik Operasi Colopexy” dengan tepat waktu.

Penulis mengucapkan terima kasih kepada pihak-pihak yang telah turut membantu dalam
penyelesaian paper ini. Penulis menyadari bahwa paper ini masih sangat jauh dari kesempurnaan,
maka dari itu penulis mengharapkan kritik dan saran yang membangun serta bantuan dari semua
pihak agar terciptanya susunan paper yang jauh lebih baik, akhir kara penulis mengucapkan
terimakasih.

Denpasar, 22 Oktober 2019

Hormat Kami,

Penulis

iv
DAFTAR ISI

HALAMAN MUKA ...................................................................................................................... 1


RINGKASAN ................................................................................................................................. 2
SUMMARY .................................................................................................................................... 3
KATA PENGANTAR ................................................................................................................... 4
DAFTAR ISI .................................................................................................................................. 5
DAFTAR GAMBAR ..................................................................................................................... 6
DAFTAR LAMPIRAN.................................................................................................................. 7
BAB I PENDAHULUAN .............................................................................................................. 1
1.1 Latar Belakang ..............................................................................................................1
1.2 Rumusan Masalah .........................................................................................................1
BAB II TUJUAN DAN MANFAAT PENULISAN .................................................................... 2
2.1 Tujuan Penulisan ...........................................................................................................2
2.2 Manfaat Penulisan.........................................................................................................2
BAB III TINJAUAN PUSTAKA.................................................................................................. 3
3.1 Pengertian Colopexy .....................................................................................................3
3.2 Tujuan dan Manfaat Pembedahan Colopexy .............................................................3
BAB IV PEMBAHASAN .............................................................................................................. 4
4.1 Pre-Operasi ....................................................................................................................4
4.2 Teknik Operasi Colopexy .............................................................................................4
4.3 Perawatan Pasca Operasi Colopexy .......................................................................... 10
BAB V PENUTUP ....................................................................................................................... 12
5.1 Simpulan ...................................................................................................................... 12
5.2 Saran ............................................................................................................................ 12
DAFTAR PUSTAKA .................................................................................................................. 13

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DAFTAR GAMBAR

Gambar 1. (a) Prolapsus rektal di anjing German Sheperd………………………………………...5


(b) Perlekatan kolon ke dinding abdomen kiri …………………………………………5
Gambar 2. Insisi longitudinal melalui lapisan serosa dari kolon desendens ………………………..6
Gambar 3. Perlekatan lipatan serosa terinsisi pada abdomen kiri………………………………….6
Gambar 4. Menggores serosa kolon dengan pisau scalpel ………………..……………………….7
Gambar 5. Kolon ditarik secara kranial untuk mengurangi sakulasi rektum atau prolaps, kemudian
membuat insisi melalui peritoneum dari dinding abdominal lateral, berdampingan
dengan lokasi perlukaan atau insisi serosa …………………………………………….7
Gambar 6. Perlekatan kolon ke dinding abdomen dengan pola terputus ………………………….8
Gambar 7. Prosedur bedah colopexy pada kucing ……………………..………………………….9

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DAFTAR LAMPIRAN

Lampiran 1. Surgical Management Of Reccurent Rectal Prolapse In A Pug Pup.

Lampiran 2. Case Report : Surgical Treatment of Recurrent Rectal Prolapse in an Adult Female
Black‑crested Mangabey (Lophocebus aterrimus) by Colopexy.

Lampiran 3. Colopexy as A Treatment for Recurrent Rectal Prolapse in A Dog.

Lampiran 4. Case Report : Surgical Management of Recurrent Rectal Prolapse in a Domestic Kitten
(Felis catus).

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BAB I
PENDAHULUAN

1.1 Latar Belakang

Penyakit yang terjadi dalam tubuh hewan salah satunya dapat terjadi pada sistem
pencernaan. Gangguan pada sistem pencernaan merupakan salah satu dari berbagai masalah
yang dapat terjadi pada hewan. Ilmu bedah adalah cabang ilmu pengobatan atau terapi yang
mengusahakan pulihnya keadaan normal akibat suatu gangguan atau penyakit dengan
menggunakan alat (instrument), tangan (manual), dan mekanis. Terapi dapat dibedakan
menjadi: terapi medis (medical therapy) yaitu terapi yang menggunakan obat-obatan dan
terapi bedah (surgery therapy) yaitu terapi yang menggunakan operasi/ pembedahan untuk
tujuan penyembuhan dari suatu penyakit atau gangguan.

Salah satu kasus gangguan saluran pencernaan yang sering terjadi adalah prolapsus
rektal yang dapat disebabkan oleh distokia, urolithiasis, neoplasma intestinal, hernia
perineal, konstipasi, dan pasca operasi anus atau perineal. Terapi bedah yang bisa
digunakan untuk penyakit yang terjadi pada sistem digesti khususnya pada kasus prolapsus
rektum adalah terapi bedah colopexy. Colopexy merupakan suatu cara untuk menciptakan
perlekatan permanen antara serosa kolon dan dinding perut yang bertujuan untuk mencegah
pergerakan caudal kolon dan rektum. Colopexy paling sering digunakan untuk mengatasi
prolap rektum berulang. Prolaps rectum berulang yang tidak responsive terhadap
penggunaan jahitan pola purse string suture sangat memerlukan tindakan colopexy (Kumar
et al., 2012).

1.2 Rumusan Masalah

Adapun rumusan masalah yang didapatkan adalah sebagai berikut:

1. Apa yang dimaksud dengan teknik operasi colopexy?


2. Apa saja tujuan dan manfaat dari teknik operasi colopexy?
3. Bagaimana persiapan pre-operasi colopexy?
4. Bagaimana teknik operasi colopexy?
5. Bagaimana perawatan pasca operasi colopexy?

1
BAB II
TUJUAN DAN MANFAAT PENULISAN

2.1 Tujuan Penulisan


Adapun tujuan dari penulisan ini, antara lain:
1. Untuk mengetahui tujuan dan manfaat dari teknik operasi colopexy.
2. Untuk mengetahui persiapan pre-operasi colopexy.
3. Untuk mengetahui dan memahami teknik operasi colopexy.
4. Untuk mengetahui perawatan pasca operasi colopexy.

2.2 Manfaat Penulisan


Penulis berharap paper ini dapat bermanfaat bagi pembaca khususnya mahasiswa
Fakultas Kedokteran Hewan yang mengambil mata kuliah Bedah Khusus Veteriner, agar
memahami perihal colopexy serta teknik pembedahannya. Selain itu juga diharapkan paper
ini mampu menjadi referensi pembuatan paper lainnya dengan topik serupa.

2
BAB III
TINJAUAN PUSTAKA

3.1 Pengertian Colopexy

Prolaps rektum biasnya merupakan akibat dari ketegangan yang parah atau
persisten. prolapsus rectum biasanya terjadi pada anjing dan kucing muda yang
terparasitisasi (Kumar et al., 2012). Pada anjing prolapse rektum merupakan konsekuensi
dari gangguan seperti diare, tenesmus,penyakit saluran bawah urinary dan penyakit prostat
yang menyebabkan adanya tegangan persisten (Dewangan et al., 2017). Prolapse rektum
mungkin hanya terjadi secara parsial yang melibatkan eksternalisasi jaringan mukosa
rektum saja, atau bisa terjadi secara lengkap yang mengakibatkan terjadi tonjolan silindris
dan melibatkan semua lapisan dari jaringan rektum (Goodall et al., 2018).

Perawatan prolapse rektum sangat bervariasi, tergantung pada keparahan dan


perkembangan gangguan. Prolaps sebagian dapat berkurang secara spontan atau
membutuhkan penanganan manual dengan bantuan pelumas, kompres hipertonik, dan
jahitan pursestring. Kasus yang lebih parah yang berhubungan dnegan infeksi, nekrosis,
atau trauma yang irreversible mungkin memerlukan reseksi jaringan yang rusak dengan
jahitan pada perinal untuk mencegah kejadian terulang (Goodall et al., 2018). Saat jahitan
pursestring gagal mengehentikan prolapses rektum, selama jaringan rektum masih sehat,
colopexy disrankan sebagai pilihan perawatan bedah untuk hewan kecil (Goodall et al.,
2018). Colopexy merupakan suatu cara untuk menciptakan perlekatan permanen antara
serosa kolon dan dinding perut yang bertujuan untuk mencegah pergerakan caudal kolon
dan rektum (Kumar et al., 2012). Mukosa dubur, lapisan muscularis dan serosal dijahit
dengan serangkaian jahitan terputus. Usus ditarik dengan jahitan antrerior ke sfingter.
Pembuluh darah yang ada di ligasi. Garis bekas jahitan dan area rektum dilumasi dengan
salep antibiotik (Dewangan et al., 2017).

3.2 Tujuan dan Manfaat Pembedahan Colopexy

Tujuan dan manfaat dari operasi ini adalah untuk melekatkan secara permanen
permukaan serosa kolon dan dinding abdomen agar supaya pergerakan dari kolon maupun
rektum dapat di cegah dan di batasi agar tidak terjadi prolapsus yang berulang - ulang.

3
BAB IV
PEMBAHASAN

4.1 Pre-Operasi
a) Persiapan hewan
Sebelum operasi, dilakukan pemeriksaan terhadap hewan meliputi pemeriksaan
fisik dan pemeriksaan rutin darah. Hewan harus dipuasakan makan minimal 12 jam
dan puasa minum minimal 6 jam sebelum operasi.

b) Persiapan meja dan alat operasi


Meja operasi disterilkan dengan cara di lap dengan lap basah lalu dikeringkan
kemudian disemprot dengan alkohol atau dengan spritus. Alat-alat operasi dalam
keadaan steril diletakkan di meja khusus serara berurutan dan rapi di dekat meja
operasi.

c) Persiapan operator dan co-operator


Operator dan co-operator harus dalam keadaan steril sebelum dan selama operasi
berlangsung. Tangan dicuci dengan air sabun kemudian dicelupkan dalam larutan
Kalium Permanganat. Selama operasi operator dan co-operator menggunakan sarung
tangan, masker, dan gaun operasi untuk meminimalkan kontaminasi.

d) Persiapan Anestesi
Anjing German Sheperd dengan berat 8 kg dipuasakan makan selama 24 jam dan
minum selama 12 jam sebelum pembedahan. Premedikasi dilakukan dengan atrofin
sulfat (0,04 mg/kg secara intramuskular), ceftriaxone (25 mg/kg secara intravena),
pentazocine (1 mg/kg secara intravena), dan diazepam (0,5 mg/kg secara intravena)
kurang lebih 30 menit sebelum pembedahan. Anastesi diinduksi dan dipertahankan
dengan thiopental sodium secara intravena.

4.2 Teknik Operasi Colopexy


Anjing diposisikan dorsal recumbency, dan abdomen ventral dipersiapkan secara
aseptik. Laparotomi pada paramedian kiri bagian kaudal dilakukan. Kolon desendens
kemudian dijahit di dinding abdomen kiri (Gambar 1) kurang lebih setengah dari jarak
antara linea alba dan otot sublumbar menggunakan 2 baris longitudinal tersusun atas 6
jahitan sederhana terputus tiap barisnya dengan 2-0 polygactin 910 (Ethicon). Jahitan
4
ditempatkan 5-10 mm antar satu sama lain dengan arah dari ventral ke dorsal melalui otot
transversus abdominal dan dengan arah transversal melalui kolon. Dimulai dari dorsal,
barisan-barisan tersebut dipisahkan 5 mm dengan baris pertama diletakkan sepanjang tepi
antimesenterik. Jahitan ditempatkan menembus lapisan seromuskular dan submukosal
untuk mencegah memasuki lumen dari kolon (Kumar et al., 2012).

Gambar 1. (a) Prolapsus rektal di anjing German Sheperd (b) Perlekatan kolon ke
dinding abdomen kiri (Kumar et al., 2012)

Dengan teknik tersebut, hewan awalnya mengalami kesembuhan. Kemudian


prolapsus kembali terjadi dalam waktu 6 minggu. Anjing pun dibedah kembali
menggunakan protokol anastesi yang sama. Laparotomi ventral paramedian kaudal
dilakukan pada lokasi yang asma dan kolon dikeluarkan. Insisi longitudinal dibuat pada
lapisan serosa dari kolon desendens (Gambar 3.) Penutup serosal kemudian dijahit ke
dinding abdomen kiri menggunakan 2-0 nylon, menggunakan teknik yang sama dengan
sebelumnya (Gambar 4.). Setelah pembedahan colopexy, dilakukan penarikan kaudal
lembut pada kolon untuk mengevaluasi kekuatan dari penempelan. Kolon akhirnya
melekat pada dinding badan, tanpa pergerakan kaudal selama penarikan (Kumar et al.,
2012).

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Gambar 2. Insisi longitudinal melalui lapisan serosa dari kolon desendens

(Kumar et al., 2012).

Gambar 3. Perlekatan lipatan serosa terinsisi pada dinding abdomen kiri

(Kumar et al., 2012).

Menurut Tobias, colopexy diawali dengan insisi abdomen melalui garis tengah
kaudal. Untuk meningkatkan kemungkinan adhesi permanen, serosa kolon dan muskularis
bisa diinsisi atau serosa dapat dilukai dengan blade atau spons kasa sebelum usus besar
(kolon) dijahit ke dinding abdomen. Berikut merupakan prosedur colopexy secara
bertahap (Tobias, 2019) :

1. Penempatan retraktor Balfour atau memegang dan mengangkat tepi bebas dari sayatan
dinding abdomen kiri dengan klem handuk untuk mengekspos permukaan lateral kiri
peritoneal.

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2. Merusak permukaan antimesenterika dari kolon desendens beberapa sentimeter kranial
dari pubis dengan mengikisnya menggunakan pisau bedah atau spons kasa kering.
Sebagai alternatif dapat dilakukan insisi pada serosa kolon.

Gambar 4. Menggores serosa kolon dengan pisau scalpel (Tobias, 2019).

Gambar 5. Kolon ditarik secara kranial untuk mengurangi sakulasi rektum atau prolaps,
kemudian membuat insisi melalui peritoneum dari dinding abdominal lateral,
berdampingan dengan lokasi perlukaan atau insisi serosa (Tobias, 2019).

3. Menarik kolon desendens ke kranial untuk menghilangkan sakulasi rektum, deviasi,


atau prolaps.
a. Jika diinginkan, asisten melakukan pemeriksaan dubur digital secara bersamaan
untuk memverifikasi apabila rektum lurus dan prolaps berkurang.
b. Memeriksa warna kolon desendens dan pembuluh untuk memastikan ketegangan
tidak berlebihan seiring ditariknya kolon secara kranial. Jika terlalu banyak
ketegangan, usus besar akan memutih dan arteri-arteri akan berdenyut kuat.

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4. Membuat sayatan 4-6 cm di peritoneum melalui dinding abdomen kiri bagian
ventrolateral sejajar dengan perlukaan (scarify) kolon atau sayatan kolon. Sayatan
biasanya terletak di kranial dari sayap ileum.
5. Menempatkan jahitan terputus dari dinding tubuh yang diinsisi hingga ke dinding
kolon desenden yang telah dilukai.
a. Menggunakan bahan jahit absorbable monofilamen pada jarum taper
b. Menyertakan otot transversus abdominis dalam gigitan dinding abdomen.
c. Pada jahitan di kolon, submukosa ikut dijahit tanpa menembus mukosa.
d. Mengambil gigitan selebar 1 cm dari setiap struktur, dan mengikatkan jahitannya
dengan lembut untuk mengaposisi jaringan tanpa mengakibatkan nekrosis.
e. Menempatkan total 4-8 jahitan yang berjarak sekitar 1 cm antar satu sama lain.

Gambar 6. Perlekatan kolon ke dinding abdomen dengan pola terputus (Tobias, 2019).

6. Menutup abdomen secara rutin.


7. Melakukan pemeriksaan rektum digital untuk memverifikasi bahwa rektum telah
diluruskan dan lipatan yang prolaps atau redundan telah dieliminasi.

8
Gambar 7. Prosedur bedah colopexy pada kucing (Monsang et al., 2014).

Pembedahan colopexy dilakukan terhadap primata mangabey dengan berat 7,56 kg.
Sebuah sayatan 1 cm dibuat garis tengah di atas umbilikus menggunakan pisau bedah
no.15. Diseksi tumpul dengan forsep jaringan dan diseksi tajam dengan skalpel digunakan
untuk menembus dinding tubuh untuk memasukkan laparoskop 5 mm 0 °(pendekatan
Hasson yang dimodifikasi). Tekanan intra-abdomenen 8 mmHg tercapai dan
dipertahankan. Terdapat banyak adhesi intra-abdominal antara sekum dan dinding tubuh
dan mencegah insuflasi yang memadai dengan CO2 dan mengurangi ruang untuk
memfasilitasi diseksi laparoskopi. Maka dari itu ditentukan bahwa laparotomi akan
menjadi pendekatan yang lebih cocok untuk Mangabey tersebut (Goodall et al., 2018).

Sayatan 4 cm dibuat di tengah-tengah antara umbilikus dan pubis dengan


menggunakan pisau bedah no.10. Diseksi tumpul dan tajam digunakan untuk menembus
dinding tubuh. Linea alba tidak mudah terlihat, dan otot rectus abdominus pada garis
sayatan dibedah secara lateral untuk mempermudah visualisasi fasia rektus internal untuk
akses masuk ke abdomen. Di akses masuk abdomen, ovarium kiri terlihat dan nampak
sangat sehat. Beberapa adhesi nampak tetapi mudah dipisahkan oleh diseksi digital.
Kolon ditemukan dan ditarik secara kranial. Serosa dari sisi antimesenterika usus besar
dilukaindengan menggunakan pisau bedah, dan electrocautery digunakan untuk

9
mengganggu permukaan peritoneum dinding tubuh kaudal kiri. Colopexy dicapai dengan
menggunakan tiga jahitan polydioxanone 3-0 dalam pola cruciate (Gambar 1). Abdomen
dibilas dengan saline steril, dan lapisan jaringan subkutan dan lapisan intradermal ditutup
secara terpisah. Bupivacaine enkapsulasi liposomal (5,3 mg / kg; Nocita, Aratana
Therapeutics, Leawood, KS) diinfiltrasi di sepanjang semua lapisan penutupan. Lokasi
umbilikus ditutup dengan cara yang sama. Jahitan besi bedah dan staples ditempatkan ke
dalam kulit (Goodall et al., 2018).

4.3 Perawatan Pasca Operasi Colopexy


Analgesik biasanya diberikan 1 sampai 3 hari. Pasien mungkin membutuhkan
pelunak feses atau laktulose, tergantung dari kondisi. Komplikasi paling sering adalah
kekambuhan dari tanda klinis akibat teknik bedah yang buruk. Penetrasi pada lumen kolon
saat perlekatan (pexy) menyebabkan kontaminasi dari ruang abdomen. Hal ini lebih mudah
dihindari ketika serosa dilukai daripada diinsisi. Tegangan berlebih dapat menyebabkan
nekrosis dinding kolon atau runtuhnya lokasi perlekatan (pexy). Pasien yang mengalami
letargi, anoreksia, demam, atau tanda penyakit sistemik lainnya harus dievaluasi untuk
peritonitis (Tobias, 2019).

Pada pembedahan colopexy pada anjing German Sheperd dengan berat 8 kg,
analgesia diberikan pasca operasi dengan meloxicam (0,2 mg/kg intramuskuler, sekali
sehari) selama tiga hari. Ceftriaxone (10 mg/kg intramuskuler, dua kali sehari) diberikan
selama lima hari. Antiseptik pada jahitan dilakukan dengan pemberian solusi povidone
iodine selama 10 hari. Jahitan pada kulit dihilangkan pada 10 hari pasca operasi (Kumar et
al., 2012).

Pada seekor kucing berumur 3 bulan dengan berat 1,5 kg, ceftriaxone pasca operasi
plus tazobactum disarankan untuk 5 hari sementara 5% DNS (250 ml dua kali setiap hari)
dan analgesik diberikan selama 3 hari. Istirahat diet ketat disarankan untuk 4 hari berikutnya
diikuti dengan pemberian susu dan bubur dari hari ke-4 seterusnya dan kemudian secara
bertahap mengubah pola makan menjadi makanan normal. Selain itu, pemberian pencahar
oral (Cremaffin plus) dimulai setelah 4 hari pasca operasi dan dilanjutkan selama 10 hari
untuk memungkinkan lewatnya feses dengan mudah dan mencegah ketegangan saat buang
air besar. Ganti perban secara teratur pada luka kulit dilakukan dengan menggunakan
larutan povidone iodine 5% dua kali sehari selama 7 hari.

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Pada pembedahan primata mangabey berumur 13 tahun dengan berat 7,56 kg,
perawatan pascaoperasi meliputi pemberian meloxicam (0,20 mg / kg SC), sitrat maropitan
(0,92 mg /kg SC), dan ampisilin (22mg /kg IV) segera setelah pembedahan. Pemulihan
anestesi lancar, dan hewan memanjat dengan nyaman dalam 1 jam setelah penghentian
isoflurane. Dosis tambahan midazolam (0,28 mg / kg IM) diberikan begitu mangabey telah
dikeluarkan dari kandang jepit dan kembali ke kandangnya yang biasa. Trimethoprim (31,4
mg/kg PO setiap hari selama 14 hari), fluoxetine (1,3 mg / kg PO setiap hari untuk 14 hari),
dan ibuprofen (7 mg/kg PO dua kali sehari selama 7 hari) diresepkan untuk manajemen rasa
sakit dan peradangan (Goodall et al., 2018).

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BAB V
PENUTUP

5.1 Simpulan

Colopexy merupakan tindakan operasi penempelan kolon terhadap dinding


abdomen dalam upaya mengatasi terjadinya prolapsus pada rektum. Colopexy dilakukan
untuk menciptakan perlekatan permanen antara serosa kolon dan dinding perut yang
bertujuan untuk mencegah pergerakan caudal kolon dan rektum. Tujuan dan manfaat dari
operasi ini adalah untuk melekatkan secara permanen permukaan serosa kolon dan dinding
abdomen agar supaya pergerakan dari kolon maupun rektum dapat di cegah dan di batasi
agar tidak terjadi prolapsus yang berulang - ulang.

5.2 Saran

Dalam melakukan operasi colopexy disarankan untuk memperhatikan umur hewan,


metode atau teknik yang digunakan, pemilihan alat yang sesuai ukuran tanduk untuk
mengurangi cidera dan infeksi pasca pembedahan.

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DAFTAR PUSTAKA

Dewangan R., Raju S., Kalim M. O., Nutan P., Dhaleshwari S., dan Sidar S. K. 2017. Surgical
Management Of Reccurent Rectal Prolapse In A Pug Pup. International Journal of Science,
Environment and Technology. Vol. 6 (1) : 845-848

Goodall, Sophie V., Chinnadurai, Sathya K., Kwan, Toni., dan Copper A. (2018). Case Report :
Surgical Treatment of Recurrent Rectal Prolapse in an Adult Female Black‑crested
Mangabey (Lophocebus aterrimus) by Colopexy. Comparative Medicine. Vol. 68 (1) : 80-83.

Kumar, Vineet., Ahmad, Raja A., dan Amarpal. (2012). Colopexy as A Treatment for Recurrent
Rectal Prolapse in A Dog. Indian Journal of Canine Practice. Vol. 4 (2) : 138-140.

Monsang, Shongsir W., Singh, Jasmeeth., Madhu, Doddhadasarahalli N., Amarpal., Pawde, Abhijit
M., dan Prakash K. (2014). Case Report : Surgical Management of Recurrent Rectal Prolapse
in a Domestic Kitten (Felis catus). Journal of Advanced Veterinary Research. Vol. 4 (3) :
142-144.

Tobias, Karen M. (2019). Manual of Small Animal Soft Tissue Surgery. Blackwell Publishing :
Iowa.

13
International Journal of Science, Environment ISSN 2278-3687 (O)
and Technology, Vol. 6, No 1, 2017, 845 – 848 2277-663X (P)

Clinical Article
SURGICAL MANAGEMENT OF RECCURENT RECTAL PROLAPSE
IN A PUG PUP
Rukmani Dewangan, Raju Sharda, M.O. Kalim, Nutan Panchkhande,
Dhaleshwari Sahu and S.K. Sidar
Department of Veterinary Surgery and Radiology
College of Veterinary Science and A.H., Anjora, Durg (C.G.)

Abstract: A 3 month old male Pug pup was brought to the Department of Veterinary Surgery
and Radiology with history of straining and protruded anus from last 2 days. The pup had
history of severe diarrhoea from the last 5 days. Clinical examination revealed a red colored
rosette like mass protruding through the anal orifice. A probe was passed between rectal wall
and prolapsed mass for differential diagnosis from intestinal intussusception. On the basis of
this differential diagnosis along with history and clinical findings, it was diagnosed to be a
case of rectal prolapse and it was decided to correct the prolapse surgically. The prolapsed
mass was cleaned with Normal saline and betadine solution and Lignocaine jelly was applied.
Following amputation of the mass, the suture line and the anal area was lubricated with
antibiotic ointment. Post-operatively, Inj. Ampiclox (250 mg I/M for 3 days), Inj. Melonex
and Inj. Conciplex (0.5 ml I/M for 3 days) were administered. The wound was dressed daily
with silver sulphadiazine ointment for 7 days. The animal was given liquid diet for another
seven days and then gradually shifted to its normal diet. The animal recovered completely
and uneventfully in a time period of 10 days.
Keywords: pup, purse string suture, rectal prolapsed.

Introduction

Rectal prolapse is the protrusion of the rectal mucosa through the anal opening. It is
principally associated with endoparasitism or enteritis in young animals (Fossum, 2002).
Rectal prolapse in dogs is a consequence of disorders such as diarrhoea, tenesmus, lower
urinary tract and prostatic diseases that produce persistent straining (Sherding, 1996).
Clinically, it appears as a pink to red elongated cylindrical or rosette like mass (Slatter, 1993).
Prolapse of rectum is commonly prevalent in very young and very old animals due to
loosening of sphincter ani and rectal mucous membrane (Venugopalan, 2000). The present
case deals with successful surgical management of rectal prolapse in a Pug pup.
Case history and Clinical Observation:-
A 3 month old male Pug pup was brought to Department of Veterinary Surgery and
Radiology with the history of hanging of tubular pink mass protruding from anus after 5 days
of severe diarrhoea. The prolapse mass was reduced manually earlier ones by local practicing
Received Jan 22, 2017 * Published Feb 2, 2017 * www.ijset.net
846 Rukmani Dewangan, Raju Sharda, M.O. Kalim, N Panchkhande, Dhaleshwari Sahu and S.K. Sidar

veterinarian. No history of previous deworming and pups always exhibited symptoms of


straining and licking of prolapsed mass. On clinical examination, a red colored rosette like
mass was visible protruding through the anal opening (Fig.1). A probe was passed between
the prolapsed mass and rectal wall for differential diagnosis from prolapse of intussusceptum
mass which confirmed it to be rectal prolapse as the probe could not be inserted. On physical
examination the prolapsed rectal mass did not show any necrosis or ulceration. Physiological
parameters were within the normal range. Pain evinced on palpation of abdomen. On the
basis of this differential diagnosis along with history and clinical findings, it was diagnosed
to be a case of rectal prolapse and it was decided to correct the prolapse surgically with
manual reduction and placement of purse-string sutures around the anus.
Treatment and Discussion:
The animal was given intravenous fluid therapy in the form of Dextrose saline solution (150
ml) and the prolapsed rectal mass was washed with warm normal saline and betadine
solution. Lignocaine jelly and ice cubes were applied on the prolapsed mass for reducing the
swelling. The rectum was extended posteriorly and a series of 4-5 interrupted mattress sutures
using chromic catgut size No. 0 with full curved atraumatic needle were inserted around the
circumference of the bowel. Then the prolapsed portion of the bowel was removed with an
incision the rough the tissues about 1 cm posterior to the suture. The rectal mucosa,
muscularis and serosal layers were sutured with series of interrupted sutures. The remainder
of the bowel retracted pulling the suture antrerior to the sphincter. The bleeding vessels were
carefully ligated. The suture line and anal area was lubricated with antibiotic ointment. After
amputation of prolapse the animal was treated with 250 ml of inj. DNS I/V, Inj. Ampiclox
(250 mg I/M for 3 days), Inj. Melonex and Inj. Conciplex (0.5 ml I/M for 3 days) were
administered. The wound was dressed daily with silver sulphadiazine ointment for 7 days.
The animal was given liquid diet for another seven days and then gradually shifted to its
normal diet. The animal recovered completely and uneventfully in a time period of 10
days. There was no recurrence of prolapsed mass even after one week. Deworming of pup
was done with Easypet tablet. Rectal prolapse occur due to severe straining during
constipation and chronic diarrhoea (Venugopalan, 2000) and inflammatory conditions of the
rectum and colon. Proplased rectal mass was due to severe endoparasitism which induced
chronic diarrhoea (Slatter, 2003). The cause of rectal prolapse has been reported to be due to
malnutrition, debility, constant straining, irritation of rectum, intestinal obstruction,
prolonged tenesmus, unthriftiness and endoparasites in dogs and cats (Slatter, 1993).
Surgical Management of Reccurent Rectal Prolapse …. 847

Repeated rectal eversion causes atony of sphincter ani, loosening of rectal mucosa, loosening
of the attachment of peri-rectal tissue and leads to rectal prolapse (Venugopalan, 2000).
These findings also simulates with the findings of Amarpal et al. (2010) in pups which were
successfully treated by surgery. Thus, it is concluded that treatment of fresh rectal prolapsed
manually alongwith anal purse string suture is one of the effective method for successful
treatment of rectal prolapsed in canines.
References
[1] Amarpal, Singh, J., Saxena, A.C., Kinjavdekar, P. and Madhu, D.N. (2010). Colopexy for
the treatment of rectal prolapsed in a male Pug dog. Intas Polivet. 11 (II): 355-357.
[2] Fossum, T.W. (2002). Small Animal Surgery, 2nd edn. Mosby Publication, Missouri. pp.
372-425
[3] Sherding, R.G. (1996). Diseases of colon, rectum and anus, In Todd. R. Tams., Hand
Book of Small Animal Gastroenterology. W. B. Saunders, Philadelphia, pp362-363.
[4] Slatter, D. (2003). Textbook of Small Animal Surgery, 3rd Ed. W.B. Saunders Publication,
Philadelphia, pp 686
[5] Venugopalan, A. (2000). Essentials of Veterinary Surgery, 8th ed. Oxford and IBH
Publishing Co. Pvt. Ltd. Pp 332-333.

Figure 1. Showing red colored rosette like mass protruding through the anal opening
848 Rukmani Dewangan, Raju Sharda, M.O. Kalim, N Panchkhande, Dhaleshwari Sahu and S.K. Sidar

Figure 2. Showing surgical correction of prolapsed mass


Comparative Medicine Vol 68, No 1
Copyright 2018 February 2018
by the American Association for Laboratory Animal Science Pages 80–83

Case Report

Surgical Treatment of Recurrent Rectal Prolapse


in an Adult Female Black‑crested Mangabey
(Lophocebus aterrimus) by Colopexy

Sophie V Goodall,1 Sathya K Chinnadurai,2,* Toni Kwan,3 and Copper Aitken-Palmer2

A 13-y-old, multiparous female black-crested mangabey (Lophocebus aterrimus) underwent surgical treatment for chroni‑
cally recurring rectal prolapse by laparotomy and subsequent colopexy. Initially, a laparoscopic approach was attempted
but was converted to an open approach after intraabdominal adhesions were noted. The colopexy was performed through a
ventral midline incision, with no complications intraoperatively or postoperatively. The predisposing factors responsible for
the development of this condition likely were related to pelvic floor weakness due to multiple past pregnancies. Transport-
associated stressors likely contributed to the acute worsening of this patient’s condition. Rectal prolapse is a common condition
in laboratory-housed NHP. This case report describes an effective surgical treatment for recurring or otherwise nonreducible
rectal prolapse in these species.

In humans and NHP, rectal prolapse can occur secondary Case Report
to diseases that lead to tenesmus or increased intraabdominal A 13-y-old, 7.56-kg, female black-crested mangabey (Lopho-
pressure due to straining, such as neoplasia of the lower gas- cebus aterrimus) was received into quarantine at the Brookfield
trointestinal tract, prostatitis, urolithiasis, parasitic or bacterial Zoo (Chicago, IL). This animal had a 3-y history of intermit-
infections leading to colitis, chronic diarrhea, rectal foreign tent rectal prolapse at the previous institution. For the first
bodies, and trauma.6,11 In NHP, environmental or social distress occurrence, pursestring sutures were placed for 2 d before re-
can trigger rectal prolapse.11 Although perhaps more likely in moval. On subsequent episodes, the condition reportedly re-
young animals, rectal prolapse can occur in animals of any age solved spontaneously within 2 to 3 h on each occasion, with
or sex.11 This clinical condition has been reported in a variety only mild sporadic bleeding. At that time, serum biochemistry
of animals, including domestic dogs and cats, ferrets, rabbits, and CBC revealed no abnormalities, and the mangabey was
mice, hamsters, sheep, goats, horses, cattle, swine, and several treated with an antiinflammatory, antiparasitic, and postop-
species of NHP.4,5,11,13 Rectal prolapse may be partial, involving erative antibiotics. A recent abortion and hormonal influences
externalization of the rectal mucosal tissue only, or complete, were the suspected cause of these episodes. Consequently, a
which presents as a cylindrical protrusion and involves all lay- melengesterol acetate contraceptive implant was placed in an
ers of the rectal tissue.4,11 attempt to reduce the incidence of rectal prolapse. Over the next
The treatment of rectal prolapse varies greatly, depending on 3 y, self-correcting rectal prolapse was reported on 6 occasions,
the severity and progression of the disorder. A partial prolapse with 4 to 12 mo between incidents. Repeated fecal examinations
may reduce spontaneously or require manual reduction with were consistently negative for parasites. An additional preg-
the aid of lubricants, hypertonic compresses, and pursestring nancy and birth occurred during this time between periods of
sutures. More severe cases that are associated with infection, contraceptive control with melengesterol acetate implants and
necrosis, or irreversible trauma may necessitate resection of the medroxyprogesterone acetate injections.
damaged tissue in conjunction with a perianal pursestring su- On arrival to the zoo, the mangabey was placed in quaran-
ture to prevent recurrence.11 This procedure has been performed tine housing with her 2 female offspring (ages, 1 and 3.5 y),
in both free-ranging gorillas and long-tailed macaques in a lab- with the younger intermittently nursing still. One day after
oratory setting, with variable outcome.7,9 When a pursestring arrival in quarantine, a rectal prolapse of approximately 5 to
suture fails to stop recurrence, and as long as the rectal tissue 7cm accompanied by considerable bleeding was discovered.
is healthy, colopexy is suggested as a surgical treatment option Over the course of 5 d, rectal prolapse was either directly ob-
for small animals and NHP.11 However, to our knowledge, the served or strongly suggested by the presence of blood in the
surgical correction of recurrent rectal prolapse in a NHP by us- enclosure on 3 separate occasions. The prolapse resolved
ing colopexy has not previously been reported. spontaneously each time. An increase in aggressive behavior,
resulting in injury to the oldest offspring, along with keeper ob-
servations of agitation initiated the pursuit of a more permanent
Received: 02 Jul 2017. Revision requested: 06 Aug 2017. Accepted: 16 Aug 2017. treatment solution.
1
Ontario Veterinary College, Guelph, Ontario, Canada; 2Chicago Zoological Society, The following full examination of the mangabey was per-
Brookfield Zoo, Brookfield, Illinois; and 3Veterinary Specialty Center, Buffalo Grove, formed under general anesthesia 8 d prior to the surgical pro-
Illinois
*
Corresponding author. Email: Sathya.chinnadurai@czs.org
cedure. After oral premedication with diazepam (0.33 mg/kg

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Repair of rectal prolapse in a mangabey

PO) 2 h before surgery, anesthesia was induced with ketamine A 1-cm incision was made midline over the umbilicus by
(3.93 mg/kg IM), midazolam (0.13 mg/kg IM), and me- using a no.15 scalpel blade. Blunt dissection with tissue for-
detomidine (0.026 mg/kg IM) and maintained with 0.75% ceps and sharp dissection with the scalpel were used to pen-
to 3% isoflurane delivered in oxygen (flow rate, 1.5 L/min) etrate the body wall for insertion of a 5-mm, 0° laparoscope
through a 4.5-mm endotracheal tube. Diagnostics included (a modified Hasson approach).8 An intraabdominal pressure
a complete physical exam, CT with contrast enhancement, of 8 mmHg was reached and maintained. Numerous intraab-
whole-body lateral and ventrodorsal digital radiographs, ab- dominal adhesions between the cecum and body wall were
dominal ultrasonography, ultrasound-guided cystocente- present and prevented adequate insufflation with CO 2 and
sis for urinalysis, gastric and rectal endoscopy and biopsies, space to facilitate laparoscopic dissection. We therefore deter-
femoral venipuncture for CBC and serum biochemistry, and mined that laparotomy would be a more suitable approach for
rectal culture. this animal.
A moderate normocytic, hypochromic regenerative anemia, A 4-cm incision was made midway between the umbilicus
with a PCV of 24% was noted on CBC, and serum was icteric. and pubis by using a no.10 scalpel blade. Blunt and sharp dis-
Endoscopic visualization of the rectum and distal colon re- section were used to penetrate the body wall. The linea alba
vealed diffusely pale mucosa, with several focal ulcerations and was not readily visible, and the rectus abdominus muscle along
diffuse edema. Biopsies of gastric fundic and rectal mucosa re- the incision line was dissected laterally to better visualize the
vealed morphologic diagnoses of moderate gastric fibrosis with internal rectus fascia for entry into the abdomen. On abdominal
Helicobacter spp. and minimal to mild multifocal, eosinophilic entry, the left ovary was visible and appeared grossly healthy.
proctitis, respectively. Overall, no specific change to account Some adhesions were present but were easily broken apart by
for recurrent rectal prolapse was found. On ultrasonography, digital dissection. The colon was located and retracted crani-
the uterus was moderately enlarged, with possible cystic endo- ally. The serosa of the antimesenteric side of the colon was scari-
metrial changes and large, dilated uterine vessels. Results of all fied by using a surgical blade, and electrocautery was used to
other diagnostic tests were within normal limits. disrupt the peritoneal surface of the left caudal body wall. The
After completion of diagnostic evaluations, the mangabey colopexy was achieved by using three 3-0 polydioxanone su-
was started on meloxicam (0.13 mg/kg daily for 5 d), fluoxetine tures in a cruciate pattern (Figure 1). The abdomen was flushed
(1.6 mg/kg daily for 7 d), diazepam (0.65 mg/kg twice daily with sterile saline, and the subcutaneous and intradermal tissue
for 7 d), and trimethoprim–sulfadiazine (31.4 mg/kg daily for layers were closed separately. Liposomal encapsulated bupiva-
7 d) to manage pain, reduce inflammation, and reduce anxiety caine (5.3 mg/kg; Nocita, Aratana Therapeutics, Leawood, KS)
until the surgery could be performed 1 wk later. We decided was infiltrated along all layers of the closure. The umbilical port
to perform the colopexy surgery laparoscopically, if possible, site was closed in the same manner. Surgical steel sutures and
given this species’ tendency to dismantle sutures, and to limit staples were placed into the skin. Four additional staples were
postoperative discomfort as much as possible. placed at the base of the extremities to distract from the inci-
Anesthesia for surgical colopexy was induced by using ket- sion site. Bupivacaine (0.07 mg total) was injected subcutane-
amine (4.22 mg/kg IM), dexmedetomidine (0.025 mg/kg IM), ously into the distal pads of the second and third digits of each
and midazolam (0.24 mg/kg IM) administered by using a hand to desensitize fingertips, thereby reducing potential tactile
blowdart while the managabey was contained alone in a quar- stimulation from the incision site.
antine enclosure after overnight fasting. An additional dose of Meloxicam (0.20 mg/kg SC), maropitant citrate (0.92 mg/kg
ketamine (2.11 mg/kg IM) and topical lidocaine (0.2 mL) were SC), and ampicillin (22mg/kg IV) were given immediately after
used to facilitate intubation. A surgical anesthetic plane was surgery. Anesthetic recovery was smooth, and the animal was
maintained by using isoflurane delivered in oxygen at 1% to 2% climbing comfortably within 1 h after discontinuation of isoflu-
through a 4.5-mm endotracheal tube, and analgesia was pro- rane. An additional dose of midazolam (0.28 mg/kg IM) was
vided by using long-acting buprenorphine (Simbadol, Zoetis, given once the mangabey was removed from a recovery squeeze
Kalamazoo, MI) in 2 doses (0.20 mg/kg SC and 0.01 mg/kg cage and returned to her regular enclosure. Trimethoprim
SQ, respectively) throughout the procedure. A saphenous cath- (31.4 mg/kg PO daily for 14 d), fluoxetine (1.3 mg/kg PO daily
eter was placed after induction, and 2 boluses (60 mL each) for 14 d), and ibuprofen (7 mg/kg PO twice daily for 7 d) were
of lactated Ringer solution were given intravenously over the prescribed for the management of pain and inflammation. The
course of surgery. Prior to surgery, a blood sample was ob- animal was housed separately from both of her offspring for
tained from the mangabey’s femoral vein, and right and left 24 h after surgery, to prevent unnecessary exertion. She was
lateral and ventrodorsal abdominal radiographs were taken to reintroduced with her youngest daughter thereafter with no
evaluate the fullness of the distal colon. Although the mang- incident, but she was kept separate from her older daughter to
abey spontaneously ventilated successfully at the start of the remove the risk of fighting during recovery. The surgical inci-
anesthetic period, insufflation of the abdomen with CO2 made sion remained intact, with moderate swelling and dependent
spontaneous ventilation more difficult after placement of the edema during the first week.
laparoscope. Therefore, the animal’s breathing was maintained The mangabey remained hospitalized for 4 wk, during which
by using a ventilator during laparoscopic insufflation of the ab- time neither recurrence of rectal prolapse nor rectal bleeding
domen; normal spontaneous ventilation resumed after conver- occurred. Appetite and stool production remained normal. The
sion to an open approach. Temperature, heart rate, respiratory animal was reevaluated under general anesthesia at 1 mo after
rate, end-tidal CO2, oxygen saturation, and blood pressure were surgery, when the anemia had resolved, the surgical site had
measured every 5 to 10 min throughout anesthesia. Brief hypo- healed without complication, and the sutures were removed.
thermia (35.5 °C) was successfully corrected by using warmed
airway, forced-air thermal support, and warmed fluids, all of
which were discontinued on resolution near the end of the sur-
Discussion
Although surgical correction with colopexy is suggested
gical procedure. Total anesthetic time was approximately 3 h,
as a treatment for recurrent rectal prolapse when other treat-
with no other anesthetic complications observed.
ments are unsuccessful,11 a report of this procedure in NHP was

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Vol 68, No 1
Comparative Medicine
February 2018

case. However, stress appeared to be an inciting factor, given the


increased frequency of prolapse after the animal’s transporta-
tion to a new facility. Furthermore, we suspect that changes in
reproductive anatomy and physiology postpartum left this ani-
mal predisposed to the development of rectal prolapses, given
that she appeared to develop this chronic condition later in life
after several parities. Other potential causes such as neoplasia,
chronic diarrhea, and urolithiasis were ruled out, on the basis of
the animal’s history and presurgical work-up.
Although spontaneously resolving rectal prolapse had oc-
curred sporadically in this mangabey in the past, leaving her
untreated was inappropriate in this case for several reasons.
First, the animal’s increased aggressive behavior and general
agitation indicated that the prolapses may have been causing
her considerable distress and discomfort. In addition, the as-
sociated bleeding likely led to the anemia, signifying a potential
worsening of her condition. Finally, the animal was scheduled
to be on exhibit in a large mixed-species habitat, where the risk
Figure 1. Completed colopexy of an adult, multiparous, female black-
of trauma should the prolapse recur would be very high, thus
crested mangabey (Lophocebus aterrimus) viewed through the 4-cm
ventral midline incision. Cranial is to the left of this image, and caudal affecting quality of life.
is to the right. Sutures attaching the colon to the body wall can be seen. This reported case presented several challenges relevant to
the treatment of rectal prolapse in NHP. The first challenge was
unavailable previously. This dearth is somewhat surprising, the discussion of which procedure would be most appropri-
given that NHP are a primary animal model for the study of ate in light of the animal’s anatomy and behavior. The next
pelvic organ prolapse due to birth-associated injuries of the sup- challenge was the presence of intraabdominal adhesions, thus
porting soft tissue structures in the pelvis of women.1 In hu- leading to a change in surgical approach. The procedure we
mans, rectal prolapse can occur along with vaginal prolapse in described here can be applied to other similar NHP species and
these scenarios, but NHP research focuses mainly on the biome- may be useful to clinicians who are considering surgical treat-
chanics of vaginal prolapse.3,12 ment of rectal prolapses in NHP.
One report 4 describes a colopexy procedure via laparotomy
that can be extrapolated to suit most small animal species. How- References
ever, the treatment for recurring rectal prolapse in humans is 1. Abramowitch SD, Feola A, Jallah Z, Moalli PA. 2009. Tissue
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or do not include the use of mesh implants to assist in attaching
abdominal conditions. p 69–103. In: Courtney A, editor. Pocket
the rectum to the sacral–pelvic wall.12 The reason for the dis- handbook of nonhuman primate clinical medicine. Boca Raton
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likely due to differences in pelvic orientation and bipedal ambu- 3. Couri BM, Lenis AT, Borazjani A, Paraiso MF, Damaser MS. 2012.
lation, which places increased pressure on a compromised struc- Animal models of female pelvic organ prolapse: lessons learned.
tural support system. In contrast to most small animal species, Expert Rev Obstet Gynecol 7:249–260.
NHP display a range of pelvic positions—one reason why NHP 4. Fossum TW. 2013. Small animal surgery, 4th ed. p 536–537.
are considered an ideal model for the study of pelvic organ pro- St. Louis (MO): Elsevier.
5. Halland SK. 2015. Rectal prolapse in ruminants and horses. p
lapse.3 Black-crested mangabeys often rest sitting in an upright
841–842. In: Smith BP, editor. Large Animal Internal Medicine, 5th
position but typically ambulate by using all 4 limbs. Therefore, ed. St. Louis (MO): Elsevier.
we decided to perform a colopexy to the caudal aspect of the 6. Kahn CM, editor. 2005. The merck veterinary manual, p 151. 9th
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Journal of
Advanced Veterinary Research
Volume 4, Issue 3 (2014) 142-144 Case Report
Surgical Management of Recurrent Rectal Prolapse in a Domestic Kitten
(Felis catus) – Case report
Shongsir Warson Monsang1*, Jasmeet Singh2, Doddhadasarahalli Nanjappa Madhu2, Amarpal2, Abhijit
Motiram Pawde2, Prakash Kinjavdekar2

1
Department of TVCC (Surgery), C. V. Sc. and A.H., R.K. Nagar-799008 Tripura (W), India
2
Division of Surgery, IVRI, Izatnagar, Bareilly-243122 (U.P.), India

Accepted 04 July 2014

Abstract

A case of recurrent rectal prolapse in a domestic 3 months old kitten was presented to the Referral Veterinary Polyclinic,
Indian Veterinary Research Institute, Izatnagar, with the complaint of protruded tubular pink mass through the anus along
with mild signs of mucosal necrosis since last 5 days. Reduction and retention of the prolapsed mass by conventional purse-
string suture technique was attempted earlier on 2 occasions by the attending veterinarian with no good results. Hence, the
case was referred for second opinion and treatment. Surgical reduction was done under ketamine-xylazine anesthesia and
the animal recovered uneventfully in 7 days.

Keywords: kitten; Rectal prolapse; Recurrent

Introduction Case history and Clinical Examination

Rectal prolapse is a double layer evagination of the A three months old domestic female cat of non-de-
rectum through the anal canal which may be either script breed, weighing about 1.5 kg was presented
partial or incomplete in nature. In kittens, it is most to the Referral Veterinary Polyclinic, Indian Veteri-
commonly associated with severe endoparasitism, nary Research Institute, Izatnagar, with the com-
enteritis, and associated tenesmus (Fossum, 2002). plaint of tubular pink mass along with mild signs
In older queens, rectal prolapse occur secondary to of mucosal necrosis protruding through the anus
dystocia, while it has been reported secondary to since last 5 days (Fig. 1). Reduction and retention
urethral obstruction in tom cats. The initial treat- of the prolapsed mass by conventional purse-string
ment is usually directed at the conservative man- suture technique was attempted earlier on 2 occa-
agement, and surgical intervention is required in sions by the attending veterinarian with no success-
recurring or long-standing cases (Johnston, 1985). ful results. Therefore, it was referred for the second
In clinical cases where chances of recurrence are opinion and subsequent treatment.
very high, prophylactic colopexy as the modality On record, urination was normal with abnormal
of choice should be considered (Sherding, 1996). episodes of inappetence and absence of defecation
This paper describes a rare case of recurrent rectal for the past days. Clinical examination revealed
prolapse and its successful surgical management in subnormal temperature (36.8 0C), tachycardia (190
a kitten. beats per minute) and tachypnea (36 breaths per
minute). The abdomen was markedly distended
*Corresponding author: Shongsir Warson Monsang
with an arched back appearance. Ultrasonography
E-mail address: warsonmonsang@gmail.com revealed negative for any signs of intussusception.

ISSN: 2090-6277/2090-6269, www.advetresearch.com


Shongsir Warson Monsang et al. /Journal of Advanced Veterinary Research 4 (3) (2014) 142-144

Based on the history, clinical findings and ultra- (Fig. 2). The abdominal cavity was explored and
sonographic findings, the case was confirmed as gentle traction was placed on the descending colon
rectal prolapse. Hence, laparotomy was done and in cranial direction for reduction of the prolapsed
surgical correction was resorted immediately. rectum. Colopexy was performed by placing 4 sim-
ple interrupted sutures in the antimesentric border
Surgical Procedure into the seromuscular wall of the descending colon
and transverse abdominal muscle with Vicryl No.
1 (Fig. 3 and 4). The abdominal muscular layer was
Supportive therapy consisting of 200 ml DNS so-
closed layer by layer using Catgut No.1 (Fig. 5) fol-
lution IV (5% DNS – Baxter India Pvt. Ltd., Gur-
lowed by skin suture application in horizontal mat-
goan) followed by broad spectrum antibiotics
tress pattern using braided silk (Fig. 6).
ceftriaxone and tazobactum combination at 25 mg/
Postoperative ceftriaxone plus tazobactum was
kg IV (Intacef Tazo) along with vitamin B com-
advised for 5 days while 5% DNS (250 ml twice
plex injection 0.5 ml IM (Tribivet), was carried daily) and analgesic was administered for 3 days.
out for patient stabilization before the surgery. Strict dietary rest was advised for another 4 days
Premedication with diazepam at 0.5 mg/kg followed by feeding of milk and gruel from 4th day
body wt. IV (Calmpose) was done followed 10 onwards and then gradually changing the diet to
minutes later by pentazocine at 0.5 mg/ kg IV normal food. Additionally, oral administration of
(Fortwin). The animal was induced with ketamine laxative (Cremaffin plus) was started after 4 days
at 7.5 mg / kg body wt. IV (Ketmin) and main- post-operatively and continued for 10 days to allow
tained with keta-diazepam (1:1) throughout the easy passage of faeces and prevent any straining
procedure. In dorso-ventral recumbency, a ventral during defecation. Regular dressing of the skin
midline incision of 2 inches length was given in the wound was done using 5 % povidone iodine solu-
caudal abdominal area to expose abdominal organs tion twice daily for 7 days.

143
Shongsir Warson Monsang et al. /Journal of Advanced Veterinary Research 4 (3) (2014) 142-144

Results and Discussion should be managed either by mucosal resection or


complete resection and anastomosis. Colopexy
The animal recovered uneventfully from anaesthe- does not affect intestinal function adversely
sia and showed progressive signs of improvement (Popovitch et al. 1994). Moreover, there is forma-
under the umbrella of therapy given in the post op- tion of permanent fibrous adhesion after colopexy
erative period. The skin sutures were removed 10th which maintains reduction of the prolapsed mass
day post operatively and the animal made an un- (Mattieson and Maretta, 1985).
eventful recovery.
Prolapse of rectum has been found to arise as a Conclusion
consequence of disorders such as diarrhoea, tenes-
mus, lower urinary tract and prostatic diseases that It can thus be concluded that recurrence of rectal
produce persistent straining and incidence is re- prolapse can be easily prevented by colopexy.
ported to be higher in young, unthrifty parasitized However, the underlying cause of tenesmus should
animals with severe diarrhoea (Sherding, 1996). be diagnosed and resolved as soon as possible.
The incomplete rectal prolapse arises due to the This technique is very simple and can be consid-
backward gliding of sub-mucosa and mucous ered as viable option in companion animals where
membrane on the muscular coat to form a circular purse string technique proves to be ineffective and
protrusion while a completely prolapsed mass is the risks of suture line dehiscence or rectal stricture
generally larger and more cylindrical in shape be- after amputation are high. Therefore, colopexy
cause it involves eversion of other visceral organs should be considered with priority in the manage-
(O’ Connor, 1985). ment of recurrent rectal prolapse.
Management of rectal prolapse depends on the
degree of tissue viability and number of recur- References
rences. Clinical cases presented at the first occur-
rence along with signs of viable rectal mucosa can Fossum, T.W., 2002. Small Animal Surgery. 2nd Edn. Mosby
be effectively treated by manual reduction followed Publication. Missouri. pp. 372-375.
Johnston, D.E., 1985. Surgical diseases- rectum and anus. In:
by application of purse string suture. If the rectal Text Book of Small Animal Surgery. Slatter, D., (Ed).
prolapse is viable but not digitally reducible or 2nd Edn. W. B. Saunders, Philedelphia, pp 770-794.
there is a history of multiple recurrences, then Mattieson, D.T., Maretta S.M., 198). Diseases of the anus and
colopexy can be considered as better option than rectum. In: Text Book of Small Animal Surgery. Slat-
any other surgical technique (Cynthia, 2005). ter, D., (Ed). 2nd Edn. W. B. Saunders, Philedelphia,
pp 629.
In prolonged as well as recurrent cases, repeated Cynthia M.K., 2005. Merck Veterinary Manual. Ninth Edi-
eversion of protruded mass causes loss of tone of tion, Merck and Co., INC. White house Station, N.J.,
anal sphincter, loosening of rectal mucosal mem- U.S.A. pp.151-152.
brane and loosening of attachment of peri-rectal tis- Niebauer, G.. 1993. Rectoanal diseases. In: Current Tech-
sue which can further aggravate the condition niques in Small Animal Surgery. Bojrab, M. J, (Ed).
4th Edn. Lea and Febiger, Philedelphia. pp. 271-284.
(Venugopalan, 1999). Various treatment modalities O’Connor, J.J., 1985. Dollar’s Veterinary Surgery. 9th Edn.
have been proposed which include both surgical as CBS Publishers and Distributors, New Delhi. pp. 699-
well as non-surgical methods. In cases of prolapsed 707.
mass of longer duration with clinically visible signs Popovitch. C.A., Holt, D., Bright, R., 1994. Colopexy as a
of mucosal necrosis, amputation of prolapsed rectal treatment for rectal prolapse in dogs and cats: A ret-
rospective study of 14 cases. Vet Surg. 23.115
stump can be performed (Fosum, 2002). Since Sherding, RG., 1996. Diseases of colon, rectum and anus. In:
there were only mild signs of mucosal necrosis and Hand Book of Small Animal Gastroenterology. Tams,
hence amputation was not carried out in the present T. R., (Ed). W. B. Saunders, Philedelphia. pp. 362-
clinical case. 363.
The surgical outcome of present clinical case go Venugopalan, A., 1999. Essentials of Veterinary Surgery. 7th
Edn. IBH Publishing Co., New Delhi. p 321.
in favour with the findings of Johnston (1985) who
reported colopexy to be rewarding in preventing
the recurrence of prolapse of the rectum. In con-
trast to this, Niebauer (1993) stated that prolapse
of longer duration with poorly viable rectal mucosa
144

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TEKNIK OPERASI
COLOPEXY
DERFINA LIJUNG 1609511078
RAISIS F. D. AL’ALIYYA 1609511080
VANESYA YULIANTI 1609511082
ACH MOH ABD MUHSI 1609511097
KELAS 2016 D

FAKULTAS KEDOKTERAN HEWAN


UNIVERSITAS UDAYANA
TUJUAN DAN PERSIAPAN
DEFINISI MANFAAT PRE-OPERASI

TEKNIK PENANGANAN
OPERASI PASCA OPERASI
DEFINITION

Colopexy adalah tindakan operasi yang


dilaksanakan untuk melekatkan secara
tetap permukaan serosa kolon dan
dinding abdomen sehingga mencegah
pergerakan kolon dan rectum.

INDICATION
Picture with
Terjadinya prolapsus berulang Caption Layout
Caption
TUJUAN DAN MANFAAT

Melekatkan secara permanen permukaan serosa kolon dan dinding


abdomen

Pergerakan kolon atau rectum dibatasi

Menghindari terjadinya prolapsus berulang.


PERSIAPAN PRE-OPERASI

Persiapan
alat dan
bahan
Premedikasi:
Atropin Sulfat 0,025%  dosis 0,04
mg/kg BB (SC)

Anestesi: Persiapan Persiapan


ruang pasien/
Ketamine HCl 10%  dosis 15 operasi hewan
mg/kg BB
Xylacine 2%  2 mg/kg BB (IM)

Persiapan
Premedikasi operator
+ anestesi
Teknik Operasi Colopexy

Insisi abdomen pada garis tengah


kaudal

Penempatan retraktor Balfour pada


tepi bebas sayatan dinding abdomen
kiri
-Merusak permukaan antimesenterika dari kolon
desendens  DIKIKIS
-Alternatif dapat dilakukan insisi pada serosa
kolon.

Menarik kolon desendens ke kranial 


menghilangkan sakulasi rektum, deviasi,
atau prolaps.
Membuat insisi pada dinding
abdominal lateral  Sejajar dengan
perlukaan (scarify) kolon
sebelumnya

Menempatkan jahitan terputus dari :


-Dinding tubuh yang diinsisi hingga ke
-Dinding kolon desenden yang telah
dilukai

-Bahan jahit absorbable monofilamen


jarum taper
-JAHITAN DD. ABDOMEN : otot
transversus abdominis disertakan
-JAHITAN KOLON : submukosa dijahit
tanpa menembus mukosa.
Perawatan Pasca Operasi Colopexy

• Analgesik biasanya diberikan 1 sampai 3 hari  Meloxicam.


• Pemberian antibiotic selama 5 hari pasca-operasi  Ceftriaxone.
• Pasien mungkin membutuhkan pelunak feses atau lactulose.
• Istirahat diet ketat 4 hari berikutnya  Susu dan bubur  Bertahap pola makan menjadi
makanan normal.
• Letargi, anoreksia, demam, atau tanda penyakit sistemik lainnya harus dievaluasi untuk
peritonitis.
• Antiseptik jahitan  Pemberian solusi povidone iodine 10 hari.
• Jahitan kulit dihilangkan pada 10 hari pasca operasi.
THANK YOU ☺
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