TUGAS MATA KULIAH

ILMU BEDAH KHUSUS VETERINER

“TEKNIK OPERASI COLOTOMY DAN COLECTOMY”

OLEH :
Putu Angga Prasetyawan 1609511052
Putu Ayu Dina 1609511054
Aurellia Dewi Rosalina Adeliriani 1609511055
Putu Jodi Wiraguna Tangkas 1609511057

LABORATORIUM BEDAH VETERINER

FAKULTAS KEDOKTERAN HEWAN
UNIVERSITAS UDAYANA
2019
 KATA PENGANTAR

Puji syukur kami panjatkan kehadirat Tuhan Yang Maha Esa atas segala
limpahan rahmat dan hidayah-Nya sehingga Paper “Teknik Operasi Colotomy dan
Colectomy” ini dapat diselesaikan tepat waktu. Makalah ini dibuat dalam rangka
menyelesaikan tugas yang akan dijadikan landasan dalam penilaian softskill pada
proses pembelajaran Mata Kuliah Ilmu Bedah Khusus Veteriner Fakultas Kedokteran
Hewan Universitas Udayana.
Ucapan terima kasih dan penghargaan yang setinggi-tingginya kami sampaikan
kepada dosen pengajar yang telah memberikan banyak bimbingan dan arahan kepada
kami dalam penyusunan makalah ini. Tidak lupa penulis juga mengucapkan terima
kasih kepada semua pihak yang telah membantu dan memberikan dukungan pada kami.
Kami menyadari bahwa tulisan ini masih banyak kekurangan baik dari segi
materi, ilustrasi, contoh, maupun sistematika penulisan. Oleh karena itu, saran dan
kritik dari para pembaca yang bersifat membangun sangat kami harapkan. Besar
harapan kami karya tulis ini dapat bermanfaat baik bagi pembaca pada umumnya
terutama bagi dunia kedokteran hewan di Indonesia.

Denpasar, 27 Oktober 2019

Penulis

i
 DAFTAR ISI

KATA PENGANTAR ........................................................................................ i

DAFTAR ISI ...................................................................................................... ii
BAB I PENDAHULUAN
1.1 Latar Belakang ......................................................................................... 1
1.2 Rumusan Masalah……............................................................................. 2
1.3 Tujuan Penulisan ...................................................................................... 2
1.4 Manfaat Penulisan…………………………………………………......... 2
BAB II PREOPERASI DAN ANASTESI
2.1 Pre Oprasi.................................................................................................. 3
2.2 Premedikasi dan Anastesi ......................................................................... 4
BAB III PROSEDUR OPERASI
3.1 Prosedur Operasi Colotomy……………………………………………... 5

3.2 Teknik Operasi Colectomy……………………………………………… 7

BAB IV HASIL DAN PASCA OPERASI

4.1 Perawatan Pasca Operasi Colotomy dan Colectomy…………………………….... 9

BAB V PENUTUP
5.1 SIMPULAN ............................................................................................. 10
5.2 SARAN .................................................................................................... 10
DAFTAR PUSTAKA ......................................................................................... 11

ii
 DAFTAR GAMBAR

Gambar 1. Proses pengeluaran colon dengan bantuan endoskopi…………. 5

Gambar 2. Megacolon pada anjing yang akan dilakukan colotomy……….. 6

Gambar 3. Proses pengeluaran isi colon…………………………………… 6

Gambar 4. Penguncian bagian batas atas dan bawah colon………………… 7

Gambar 5. Ligasi pembuluh darah sekitar colon…………………………… 8

Gambar 6. Proses pemotongan bagian colon yang diklemp Penutupan……….. 8

iii
 BAB I

PENDAHULUAN

1.1 Latar Belakang

Hewan kesayangan ataupun hewan ternak lainnya dapat mengalami
gangguan pada saluran pencernaannya, terkhususnya colon. Gangguan yang
dimaksud disini seperti bila terjadi sumbatan (obstruksi), dan perforasi pada colon
sehingga menghambat proses keluarnya feses dari dalam usus besar. Selain itu
dapat juga terjadi kasus dekompersi usus dan colon berukuran kecil.
Kasus gangguan pada kolon dapat ditangani dengan operasi bedah colotomy
ataupun colectomy, tergantung dari permasalahan atau indikasi apa yang dialami
pasien. Colotomy adalah tindakan bedah yang dilakukan untuk menginsisi bagian
colon. Hal ini dilakukan untuk mengeluarkan benda asing, kotoran ataupun yang
lainnya dari dalam colon yang menyebabkan obstruksi colon sehingga mengganggu
sistem pencernaan ataupun menghambat proses keluarnya feses dari dalam usus
besar. Sedangkan Colectomy adalah tindakan bedah yang dilakukan untuk
memotong sebagian kolon (colecomy subtotal) atau seluruh bagian colon
(colectomy total) tergantung dari besar-kecilnya kerusakan yang pada kolon
tersebut.
Colectomy subtotal adalah prosedur bedah yang diindikasikan untuk kasus-
kasus sembelit kronis non-responsif terhadap intervensi medis. Tujuan dari
colectomy subtotal adalah untuk menghilangkan bagian colon yang mengalami
kerusakan, sehingga menghasilkan feses yang lebih lembut, kotoran yang
semisolid, yang kemudian dapat melewati pelvis yang mengalami penyempitan.
Setelah colectomy subtotal atau total, kompensasi vili akan meningkat,
begitu pula dengan ketinggian dan density enterocyte juga meningkat, feses
biasanya menjadi lebih lembut pada 3 bulan pertama setelah operasi. Namun secara
klinis, fungsi usus masih berada dalam keadaan normal.

1
1.2 Rumusan Masalah
1. Apa definisi dari episiotomi dan episiostomi?
2. Bagaimana prosedur pre-operasi episiotomi dan episiostomi?
3. Bagaimana prosedur operasi episiotomi dan episiostomi?
4. Bagaimana penanganan pascaoperasi episiotomi dan episiostomi?

1.3 Tujuan Penulisan

Tujuan dari dibuatnya paper ini yaitu agar mahasiswa dapat mengerti dan
memahami :
1. Definisi dari episiotomi dan episiostomi.
2. Prosedur pre-operasi episiotomi dan episiostomi.
3. Prosedur operasi episiotomi dan episiostomi.
4. Penanganan pascaoperasi episiotomi dan episiostomi.

1.4 Manfaat Penulisan

Manfaat dari dibuatnya paper ini untuk mengetahui dan bisa mengaplikasikan
episiotomi dan episiostomi. Memahami perbedaan mendasar anatar episiotomi dan
episiostomi.

2
 BAB II
PRE OPRASI DAN ANASTESI

2.1 Pre Operasi

Persiapan sebelum operasi dimulai dengan mempersiapkan operator, alat

dan bahan operasi, pasien serta ruangan operasi. Alat dan bahan yang digunakan
meliputi alat dan bahan yang merupakan kebutuhan umum pada operasi seperti
scalpel, gunting, jarum, spuit, iodine, obat-obatan premedikasi dan anastesi, dan
semua alat penunjang pada meja operasi. Operator disiapkan secara mental dan
psikologis untuk melakukan operasi. Pasien atau hewan disiapkan dengan cara
disterilkan bagian yang akan dilakukan operasi dengan mencukur bulu. Peneguhan
diagnosa agar memastika tataletak maupun posisi benda asing dapat menggunkana
USG maupun foto Rontgen.
Usia, jenis, jenis kelamin, tanda-tanda klinis (misalnya, kesan umum,
peredaran darah dan parameter pernapasan, tanda-tanda perut, tenesmus dan
konstipasi), durasi tanda-tanda klinis, data laboratorium (hematologis dan
penilaian biokimiawi), perioperative acara dan klinikopatologis Temuan dicatat.
Tindak lanjut jangka panjang didasarkan (1) pada review dari catatan klinis dan
(2) di telepon wawancara dengan pemilik. (Nameth, 2008).
Pada pre operasi untuk memperbaiki keseimbangan elektrolit dan energy,
pasien perlu dirawang denga diberikan larutan-larutan seperti Laktat Ringer (500
ml), 5% Larutan glukosa (500 ml), dan larutan Aminosteril (30ml) (Abedi, 2012).
Selain itu, 2—3 sebelum operasi berlangsung, sehari sekali hewan diberikan
antibiotic dan vitamin untuk menunjang operasi tersebut. Dapat diberikan Penisilin
800.000 UI secara IV dan vitamin B-com 3-5 ml secara IV. Menurut penelitian
(Nameth, 2008) pasien dapat diberikan treatmen antibiotic secara parenteral
dengan 10 mg / kg amoksisilin / asam klavulanat, ditambah 30 mg/kg enrofloxacin.

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2.2 Premedikasi dan Anastesi
Anastesi yang digunakan adalah anastesi umum. Sebelumnya hewan
diberikan juga premedikasi. Pemberian anastesi dan premedikasi dapat beragam
dari campuran beberapa obat-obatan anastesi.
Premedikasi yang diberikan dapat berupa atropine (0.02-0.04 mg/kg)
ataupun kombinasi atropine dan acepromazine (0.1-0.2 mg/kg) yang diberikan
secara subkutan. Dapat juga diberikan berupa 0.01 mg/kg IV acepromazine dan
0.05 mg/kg IV fentanyl.
Anastesi yang diberikan dapat berupa Ketamine HCl (4-6 mg/kg IM), atau
bisa juga dengan 4 mg/kg Propofol. Untuk menjaga kesetabilan anastesi dan
sebagai kontrol dapat diberikan kombinasi oxygen dan isofluren ataupun hanya
isofluren tunggal (Nameth, 2008).
Semua dosis diatas merupakan dosis yang diberikan untuk anjing.

4
 BAB III
PROSEDUR OPERASI

3.1 Prosedur Operasi Colotomy

Penentuan lokasi pembedahan dapat ditentukan menggunakan alat bantu

yaitu alat endoskopi , yang dimana alat endoskop ini memiliki kamera dan juga
senter untuk melihat keadaan organ di dalam tubuh. Alat endoskopi pada operasi
Colotomy ini digunakan untuk eksplorasi cavum abdomen untuk menemukan
colon

Gambar 1. Proses pengeluaran colon dengan bantuan endoskopi

Sumber: Bustamante-Lopez et al., 2016

Jika posisi colon menggunakan endoskopi , lakukanlah penandaan pada

kulit yang sudah ditentukan dapat dilakukan incisi pada bagian ventral
abdomen sesuai dengan lokasi yang tepat / yang di tandai. Jika abdomen sudah
terbuka, bagian colon dapat diangkat ke permukaan untuk mempermudah
proses pengeluaran.

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 Gambar 2. Megacolon pada anjing yang akan dilakukan colotomy.

Sumber: Abedi et al., 2012

Berikan stay suture pada bagian yang akan dibedah sebagai patokan atau
penanda agar tidak berpindah. Lakukan incisi perlahan, lalu arahkan luka incisi
pada wadah tampung guna menampung seluruh isi colon, aplikasikan dengan
bersih guna mencegah adanya beberapa partikel yang masuk kedalam cavum
abdomen.

Gambar 3. Proses pengeluaran isi colon.

Sumber: Abedi et al., 2012

Tutup bekas incisi dengan benang absorable secara simple continuous

pada mukosa dan dilanjutkan dengan lambert suture pada sisi bagian luar.
Reposisi colon dan tutup kembali abdomen dari peritoneum, subcutan sampai
kutan. Penutupan sayatan dilakukan dengan jahitan yang absorbable simple

6
 continous, diikuti oleh jahitan jenis cushing interrupted pada baris kedua.
Kemudian colon dijahit dengan 4 jahitan mattress horizontal ke otot kiri psoas
mayor dan minor di dekat aauda kaudal dan kaudal vena cava. Rongga perut
ditutup dengan teknik standar simple interrupted menggunakan benang non
absorbable (Abedi et al., 2012).

3.2 Teknik Operasi Colectomy

Pembedahan colectomy juga dapat dilakukan dengan bantuan alat endoskopi
seperti pada colotomy. Eksplorasi cavum abdomen dan identifikasi colon.
Langkah pertama yang dilakukan membuat incisi pada bagian ventral abdomen
yang tepat sesuai dengan bantuan alat endoskopi. Colon yang sudah teridentifikasi
dapat diangkat keluar permukaan tubuh. Kunci bagian batas atas colon (ilio colon
junction) dan bagian bawah colon (colo rectal junction) dengan menggunakan
forcep klemp dengan jarak beberapa segmen.

Gambar 4. Penguncian bagian batas atas dan bawah colon

Ligasi semua pembuluh darah sekitar colon dan semua vena mesenterika
yang berada pada colon. Jika ligasi sudah dilakukan, pemotongan bagian colon
dapat dilakukan. Gunting bagian colon yang akan diangkat dari mesenterium.

7
 Gambar 5. Ligasi pembuluh darah sekitar colon

Gunting bagian colon yang telah diklemp mengunakan mentzbaum dan

temukan kedua bagian. Sambungkan rektum-illium dengan jahitan simple
interrupted. Untuk bagian rektum yang lebih diberi jahitan lambert.

Gambar 6. Proses pemotongan bagian colon yang diklemp Penutupan

Abdomen pada colectomy dilakukan sama seperti pada colotomy. Reposisi

colon yang sudah dibedah dan tutup kembali abdomen dari peritoneum,
subkutan sampai kutan. Penutupan sayatan dilakukan dengan jahitan yang
absorbable simple continous, diikuti oleh jahitan jenis cushing interrupted pada
baris kedua. Kemudian usus besar dijahit dengan 4 jahitan mattress horizontal
ke otot kiri psoas mayor dan minor di dekat aauda kaudal dan kaudal vena cava.
Rongga perut ditutup dengan teknik standar simple interrupted menggunakan
benang non absorbable (Abedi et al., 2012).

8
 BAB IV

HASIL DAN PASCA OPERASI

4.1 Perawatan Pasca Operasi Colotomy dan Colectomy

Paca operasi Hewan dimonitor perkembangannya tiap 3 jam. Daerah incisi
dibersihkan dan diolesi dengan iodium tincture 3%. ke dalam daerah bekas operasi
disemprotkan penisilin oil, kemudian hewan diberi penisilin G dengan dosis 4000
– 10.000 IU/kgBB dan vitamin B-complex secara IM disertai pemberian
antiinflamasi nonsteroid.
Antibiotik spectrum luas diberikan sampai 48 jam pasca operasi. Penutupan
dengan perban juga dilakukan pada bekas insisi di abdomen. Hewan juga diberi
cairan infus secara IV sebanyak 40-60ml/kgBB dan buprenorfin (Buprecare;
Animalcare) selama 24 jam setelah operasi dengan metronidazole (Metronidazole;
Marco Pharma) dan amoksisilin / klavulanat (Augmentin; GlaxoSmithKline
Inggris) dilanjutkan selama 5 hari. (Darren C. 2012.) Pemberian minum air hangat
dilakukan beberapa jam setelah operasi dan harus diulang tiap setengah jam
(maintenance: 20L/450 kg BB/hari). Jangan diberi makan hingga 12-24 jam pasca
operasi, Pakan dalam jumlah sedikit dapat diberikan sesegera mungkin jika hewan
sudah mau makan dengan sendirinya dengan diberi suplemen lemak untuk
meningkatkan kalori. Setelah 30 hari, hewan sedikit demi sedikit diberikan
exercise.

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 BAB V
PENUTUP

5.1. Kesimpulan
Colotomy adalah pembedahan untuk membuka usu besar yaitu pada
bagian colon , dimana bertujuan untuk mengeluarkan benda asing atau
tumor atau hal hal yang abnormal / tidak seharusnya pada colon. Colectomy
merupakan pengangkatan sebagian organ colon yang mengalami kerusakan
atau abnormalitas pada organnya sehingga harus di potong / di angkat.

5.2. Saran
Penulis berharap mahasiswa mampu memahami dan mengerti dan bisa
membedakan apa yang dimaksud dengan colotomy dan colectomy dan juga
mengetahui teknik operasi colotomy dan colectomy.

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 DAFTAR PUSTAKA

Abedi, Gholamreza., Asghari, A., Alizadeh, Rahim., Shayan, Navid. 2012. Colon
Surgical Stabilization on Psoases Muscles for Treatment of Megacolon in
Dog. Department of Surgery, Faculty of Veterinary Medicine, Science and
Research Branch, Islamic Azad University, Tehran, Iran .

Barnes, Darren C. 2012. Subtotal colectomy by rectal pull-through for treatment of

idiopathic megacolon in 2 cats : case report. Can Veterinary J. United
Kingdom.

Bustamante-Lopez, L. A., Sulbaran, M., Nahas, S. C., de Moura, E. G. H., Nahas,

C. S., Marques, C. F., Sakai, C., Ceconello, I., Sakai, P. 2016. Endoscopic
colostomy with percutaneous colopexy: an animal feasibility study.
Department of Gastroenterology. Surgical Division. University of São
Paulo Medical School. São Paulo, Brazil.

Nemeth T., Solymosi And N., Balka G. 2008. Long-term results of subtotal
colectomy for acquired hypertrophic megacolon in eight dogs. Journal of
Small Animal Practice (2008). 49, 618–624

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LAMPIRAN JOURNAL

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Global Veterinaria 9 (2): 232-236, 2012
ISSN 1992-6197
© IDOSI Publications, 2012
DOI: 10.5829/idosi.gv.2012.9.2.6541

Colon Surgical Stabilization on Psoases Muscles for Treatment of Megacolon in Dog

1
Gholamreza Abedi, 1Ahmad Asghari, 1Rahim Alizadeh and 2Navid Shayan

1
Department of Surgery, Faculty of Veterinary Medicine,
Science and Research Branch, Islamic Azad University, Tehran, Iran
2
Graduated from the Faculty of Veterinary Medicine,
Garmsar Branch, Islamic Azad University, Garmsar, Iran

Abstract: Megacolon refers to an abnormal dilatation of the colon. Although it seems to be more common in
cats, megacolon may also occur in dogs. This study included fourteen large-breed dogs affected with
megacolon, aged 6 - 11 years. Colotomy and colopexy were performed in all dogs. The results of this study
showed that symptoms do not improve in five dogs and so they were needed to subtotal colectomy surgery.
Also, due to late referral and old age two other dogs were died. Seven dogs were successfuly recovered with
colopexy. The aim of colopexy in this study is to create a direct way for the transit of stool in the colon and also
removal the angle between the damaged and healthy colon which is created at the pelvic cavity inlet.
Furthermore, the contractions of vascular (caudal aorta and caudal vena cava) and muscles area stimulate colon
movements.

Key words: Megacolon Psoases Muscles Dog

INTRODUCTION On the other hand, hypertrophic megacolon refers to the

The large intestine is responsible for absorption of
water and salt and the storage of feces. The large
intestine is relatively short in dogs and cats,
approximately 10 - 20% of the length of the small intestine,
reflecting the fact that the large intestine plays a less
significant role in nutrient digestion [1]. Megacolon is a
condition that is uncommonly described in dogs. It refers
to an abnormal dilatation of the colon that may be acute,
chronic or toxic. Chronic megacolon can be classified as
congenital (also known as Hirschsprung's disease in
humans) or acquired and may be either primary or
secondary. The cause of primary megacolon is unknown,
so it is also termed idiopathic. The pathogenesis of
idiopathic megacolon is still a subject of controversy,
although it has been historically attributed to a primary
neurogenic or degenerative neuromuscular disorder [2].
Secondary megacolon can occur as the result of intestinal
wall lesions or various conditions that prevent defecation
for a prolonged period of time [3]. Two pathological
mechanisms are implicated in megacolon development:
dilatation and hypertrophy. Dilated megacolon represents
the end-stage of colonic dysfunction in idiopathic cases.
functional disorder that develops as a result of chronic
obstructive lesions (stenosis of the pelvic canal, tumor,
foreign body, etc.) [4]. The therapy for megacolon
depends on several factors including the severity of
constipation and fecal impaction and the underlying
cause. The initial treatment is aimed to establish and/or
maintains a fluid and electrolyte balance, as well as to
eliminate the possible causes of constipation. In addition,
medical therapy with stool softeners is the first-line
treatment for this condition. In this respect, animals
should be appropriately hydrated and then an enema
should be performed. Thereafter, medical management
with laxatives should be initiated. Intestinal transit and
other motility disorders in both dogs and cats [5, 6].
When medical therapy is no longer effective, surgery is
recommended. Although surgery is usually referred to
as a subtotal colectomy, in some cases colonotomy
with fecal mass removal may also be considered as the
treatment of choice [7]. Postoperatively, parenteral
antibiotic and vitamin therapy should be continued.
Prognosis depends on early recognition and management
of megacolon [8]. This study is an evaluation of colopexy
in treatment of megacolon to prevent removal of the colon

Corresponding Author: Ahmad Asghari, Faculty of Veterinary Medicine, Department of Surgery, Science and Research Branch,
Islamic Azad University, Tehran, Iran. Mob: +98-9144147924.
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 Global Veterinaria, 9 (2): 232-236, 2012

Fig1: Psoas major & minor muscle

and the recurrence of megacolon, because one of the

reasons of subtotal colectomy is the prevention of
megacolon recurrence. Instead of removing the colon in Fig 2: Radiographic image of dilated colon
colopexy, first colotomy is conducted and then the colon
is fixed in the lumbar muscle (Psoas major & minor)
(Figure 1), because the accumulation of feces in the
distended colon and increase of the volume and weight of
the feces, the colon is oriented toward the bottom of the
abdominal cavity and an angle near 90 degrees is created
between the affected and normal colon in the pelvic cavity
inlet that prevents the movement of feces into the rectum.
If the angle can be omitted by fixing colon in lumbar, it is
possible to prevent from recurring megacolon due to the
created direct path.

MATERIALS AND METHODS

This study included 14 large-breed dogs affected

with megacolon, aged 6-11 years. After recording the
profile of all dogs and the diagnosis of megacolon using
the clinical examination and abdominal radiographic
findings, colotomy and colopexy was performed in all
dogs. Abdominal radiography of all examined dogs before
surgery showed colonic distension with stool retention.
Dilated colon was evident on all radiographic images
(Figure 2). In most cases, enlarged colon extended from Fig. 3: Gross appearance of megacolon before and after
the epigastric region to the pelvic canal. colotomy

Preoperative Care: Immediately after the diagnosis was
established, over a period of 2 - 3 days, all dogs were
subjected to an initial treatment for restoration of their
general health condition and for surgical procedure
preparation. In order to correct electrolyte and energy
imbalance, the animals were treated with infusions of
Ringer's lactate solution (500 milliliter), 5% glucose
solution (500 ml) and aminosteril solution (30 ml).
In addition, once a day for three days, all animals were
treated with preoperative antibiotics and vitamin therapy
(penicillin G, 800,000 International unit Intra Venous;
vitamin B-complex, 3-5 ml Intra Muscular). Before surgery,
the animals were premedicated with atropine sulphate
(subcutaneous) and acepromazine (IV) and then
anesthetized with ketamine hydrochloride (IM) and
maintained with isoflurane inhalation.
Surgical method; all animals underwent a median
laparatomy. After pulling out the colon, extra-abdominal
incision was created in the anti-mesenteric border of colon
and followed by manual extraction of the intestinal
contents (Figure 3).
Closure of the incision was accomplished by a
continuous absorbable, synthetic, braided suture
(polyglactin 910 3-0), followed by a second row
interrupted cushing type suture. Then the colon was
sutured by 4 horizontal mattress sutures to the left psoas

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 Global Veterinaria, 9 (2): 232-236, 2012

major & minor muscles near the caudal aorta and caudal
vena cava. After lavage the abdominal cavity, the
abdomen was closed with standard technique.

Postoperative Care: All dogs during the postoperative

period (8 days after surgery), antibiotics, electrolyte
solutions and vitamin therapy (penicillin G, Ringer's
lactate and vitamin B-complex) were continued and dogs
were closely monitored for infection. The animals were
deprived of water for two days after surgery. On the third
postoperative day, all animals were given water only
(3 x 150 mL). In addition to water, for the next four days
(4th - 8th postoperative day), animals were fed with chicken
soup (2 x 200 mL, concentrate). Thus, the daily amount of
fluid, given per os, was 1 liter. During this period, the
animals were deprived of solid food. Eight days after
surgery, both medicament and vitamin therapy were
interrupted. Starting from the 9th postoperative day, solid
food (raw minced beef 2 x 150 g and corn bran 2 x 50 g,
per day) was introduced to the diet and dogs were
allowed access to water. During the third postoperative
week, in addition to raw beef, fresh bread (2 x 50 g, per
day) was introduced to the diet. In all animals were given
an increased amount of food (meat 2 x 200 g, bread
2 x 50 g, corn bran 50 g and soup concentrate 2 x 200 mL). Fig. 4: Radiographic image after colopexy of colon
Animals were fed twice a day, during the period of 30
days after surgery. The Elizabethan collar was placed DISCUSION
around the animal's neck to prevent them from licking or
biting wounds. Skin sutures were removed on the Patients with intractable constipation can be divided
12th postoperative day, while the protective collar was into those with normal gut diameter and those with a
removed three days later. dilated gut. The former includes slow-transit constipation,
pelvic outlet obstruction and the latter includes
Evaluation Methods: Appetite and feces of all dogs were congenital megacolon (Hirschsprung disease), colonic
evaluated for 30 days. 30 days after surgery, all dogs were pseudo-obstruction and acquired megacolon. The
submitted to radiographic evaluation. pathophysiology of constipation in these entities is
poorly understood, although there have been several
RESULTS investigations on this matter [3, 9- 13]. It was previously
thought that megacolon commonly affects older cats.
The results of this study showed that symptoms do However, recent studies show that both feline and canine
not improve in five dogs and so they were needed to megacolon may be seen at any age [14]. According to a
subtotal colectomy surgery. Also, due to late referral and review of 120 cases published in English veterinary
old age two other dogs died. At all seven dogs recovered literature, most cases of megacolon are observed in
due to doing colopexy and 20 days after surgery had a middle-aged, male cats (70%). These data also suggest
good appetite. Comparison of fecal in all dogs showed 7 that megacolon commonly affects domestic shorthair
dogs had normal fecal 10 days after surgery. Radiographic (46%), domestic longhair (14%) and Siamese breeding [4].
evaluation results showed that the descending colon An extensive list of differential diagnosis for the
lumen diameter decreased in all dogs with colopexy obstipated cat includes numerous factors associated with
surgery (Figure 4). a prolonged constipation, such as: neuromuscular,

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 Global Veterinaria, 9 (2): 232-236, 2012
mechanical, metabolic, endocrine, inflammatory and
environmental factors. Although in some cases
differential diagnosis may be of critical importance the
majority of cases of obstipation are accounted for
idiopathic megacolon (62%), pelvic canal stenosis (23%),
nerve injury (6%) or Manx sacral spinal cord deformity
(5%). In addition, in a small number of cases, obstipation
was a result of complications of colopexy (1%) or colonic
neoplasia (1%), while hypoganglionosis/ aganglionosis
was suspected in 2% of cases, but not proven [4, 14].
However, the importance of differential diagnoses for the
obstipated dog is not well documented. The goal of
treatment is to maintain a soft stool and to improve
colonic motility. Recent studies confirmed that feline
megacolon is characterized by a generalized dysfunction
of colonic smooth muscle and that treatments aimed at
stimulating colonic smooth muscle contraction might
improve colonic motility [15]. In cats the disease is
characterised by repeated episodes of constipation or
prolonged obstipation that may result in complete
absence of defecation. Affected cats are presented with
anorexia, dehydration, weight loss, vomiting and lethargy.
Occasionally, chronically constipated cats have
intermittent episodes of diarrhea. Cats affected with
idiopathic dilated megacolon usually have a history of
recurrent constipation culminating in obpstipation. On the
contrary, animals affected with hypertrophic megacolon
usually have a history of automobile or other trauma
[16, 17]. Several surgical techniques for the management
of feline megacolon have been described, including
coloplasty and partial or subtotal colectomy [18]. The aim
of colopexy in this study is to create a direct way for the
transit of stool in the colon and also removal the angle
between the damaged and healthy colon which is created
at the pelvic cavity inlet. Furthermore, the contractions of
vascular (caudal aorta and caudal vena cava) and muscles
area stimulate colon movements. Diet was also an
important part of postoperative treatment. Constipated
patients are usually fed a standard diet high in fiber to
help attract water to the stool, improving its consistency.
Consumption of high-fiber foods contributes to optimal
surgery outcome and helps to prevent postoperative
constipation.
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1. Guilford, G.W., 1996. Nutritional management of
gastrointestinal disease. In: Strombeck’s Small
Animal Gastroenterology, Eds. Guilford, G.W.S.A.
Center, D.R. Strombeck, D.A. Williams and
D.J. Meyer, W.B. Saunders, 3rd ed, pp: 889-910.
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2. Meier-Ruge W.A., H. Müller-Lobeck, F. Stoss and
E. Bruder, 2006. The pathogenesis of idiopathic
megacolon. Eur. J. Gastroenterol Hepatol,
18: 1209-1215.
3. Bharucha, A.E. and S.F. Philips, 1999. Megacolon:
acute, toxic and chronic. Curr Treat Options
Gastroenterol, 2: 517-523.
4. Washabau, R.J. and A.H. Hasler, 1996. Constipation,
obstipation and megacolon. In: Consultations in
Feline Internal Medicine, Ed. August, J.R. W.B.
Saunders, 3rd ed, pp: 104-113.
5. Wiselman, L.R. and D. Faulds, 1994. Cisapride.
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therapeutic efficacy as a prokinetic agent in
gastrointestinal motility disorders. Drugs, 47:
116-152.
6. Washabau, R.J., 2003. Gastrointestinal motility
disorders and gastrointestinal prokinetic therapy. Vet
Clin. North. Am. Small. Anim. Pract, 33: 1007-1028.
7. Webb, S.M., 1985. Surgical management of acquired
megacolon in cat. J Small Anim Pract, 26: 399-405.
8. Nemeth, T., N. Solymosi and G. Balka, 2008.
Long-term results of subtotal colectomy for acquired
hypertrophic megacolon in eight dogs. J. Small Anim
Pract, 12: 618-624.
9. Galvez, Y., R. Kaba, R. Vajtrova, A. Frantlova and
J. Herget, 2004. Evidence of secondary neuronal
intestinal dysplasia in rat model of chronic interstinal
obstruction. J. Investig Surg, 17: 31-39.
10. Lee, J.I., H. Park, M.A. Kamm and I.C. Talbot, 2005.
Decreased density of interstitial cells of Cajal and
neuronal cells in patients with slow-transit
constipation and aquired megacolon. J.
Gastroenterol. Hepatol, 20: 1292-1298.
11. Matsuda, H., J. Hirato and M. Kuroiwa 2006.
Nakayato, H i st o p at h o l o g i c al an d
immunohistochemical study of the enteric
innervations among arious types of aganglionoses
including isolated and syndromic Hirschsprung
disease. Neuropathology, 26: 8-23.
12. Da Silveira, A.B.M. D. D’Avila Reis, E.C. Oliveira,
S.G. Neto, A.O. Luquetti and D. Poole, 2007a.
Neurochemical coding of the enteric nervous system
in chagasic patients with megacolon. Dig. Dis. Sci.,
52: 2877-2883.
13. Da Silveira, A.B., E.M. Lemos, S.J. Adad, R.
Correa-Oliveira, J.B. Furness and D. D’Avila Reis,
2007b. Megacolon in Chagas disease: a study of
inflammatory cells, enteric nerves and glial cells. Hum
Pathol, 38: 1256-1264.
 Global Veterinaria, 9 (2): 232-236, 2012

14. Washabau, R.J. and J.A. Hall, 1997. Diagnosis and
management of gastrointestinal motility disorders in
dogs and cats. Compend Contin Educ. Pract. Vet.,
19: 721-737.
15. Washabau, R.J. and I.H. Stalis, 1996. Alterations in
colonic smooth muscle function in cats with
idiopathic megacolon. Am. J. Vet. Res., 57: 580-587.
16. Burrows, C.F., 1996. Constipation, obstipation and
megacolon in the cat. Waltham Internat Foc., 6: 9- 14.
17. Washabau, R.J. and D. Holt, 1999. Pathogenesis,
diagnosis and therapy of feline idiopathic megacolon.
Vet Clin North Am Small Anim Pract, 29: 589-603.
18. White, R.N., 2002. Surgical menagment of
constipation. J. Fel. Med. Sur., 4: 129-138.

236
1130-0108/2017/109/4/273-278
Revista Española de Enfermedades Digestivas
© Copyright 2017. SEPD y © ARÁN EDICIONES, S.L.
ORIGINAL PAPERS
Endoscopic colostomy with percutaneous colopexy: an animal feasibility study
Leonardo Alfonso Bustamante-Lopez, Marianny Sulbaran, Sergio Carlos Nahas, Eduardo Guimaraes Horneaux de Moura,
Caio Sergio Nahas, Carlos Federico Marques, Christiano Sakai, Ivan Ceconello and Paulo Sakai
Department of Gastroenterology. Surgical Division. University of São Paulo Medical School. São Paulo, Brazil
ABSTRACT
Background: Indications for colostomy in colorectal diseases
are obstruction of the large bowel, such as in cancer, diverticular
disease in the acute phase, post-radiotherapy enteritis, complex
perirectal fistulas, anorectal trauma and severe anal incontinence.
Some critically ill patients cannot tolerate an exploratory
laparotomy, and laparoscopic assisted colostomy also requires
general anesthesia.
Objective: To evaluate the feasibility, safety and efficacy of
performing colostomy assisted by colonoscopy and percutaneous
colopexy.
Materials and methods: Five pigs underwent endoscopic
assisted colostomy with percutaneous colopexy. Animals were
evaluated in post-operative days 1, 2, 5 and 7 for feeding acceptance
and colostomy characteristics. On day 7 full colonoscopy was
performed on animals followed by exploratory laparotomy.
Results: Average procedure time was 27 minutes (21-
54 min). Postoperative mobility and feeding of animals were
immediate after anesthesia recovery. Position of the colostomy,
edges color, appearance of periostomal area, as well as its function
was satisfactory in four animals. Retraction of colostomy was
present in one pig. The colonoscopy and laparotomy control
on the seventh day were considered as normal. A bladder
perforation that was successfully repaired through the colostomy
incision occurred in one pig. The main limitation of this study is
its experimental nature.
Conclusion: Endoscopic assisted colostomy with percutaneous
colopexy proves to be a safe and effective method with low
morbidity for performing colostomy in experimental animals, with
possible clinical application in humans.
Key words: Colostomy. Endoscopy. Colopexy.
INTRODUCTION
A colostomy is a surgical procedure that aims to divert
the fecal stream to the outside through an orifice made in
the abdominal wall, which may be temporary or permanent
(1). Colorectal surgical procedures have been performed
via minimally invasive techniques with increasing frequen-
cy (2). Although colostomy has traditionally required for-
Received: 05-03-2016
Accepted: 22-12-2016
Correspondence: Leonardo Alfonso Bustamante-Lopez. Department of Gas-
troenterology. Surgical Division. University of São Paulo Medical School.
São Paulo, Brazil
e-mail: leonardoabustamante@gmail.com
Rev Esp Enferm Dig
2017, Vol. 109, N.º 4, pp. 273-278
mal laparotomy, this procedure could be performed via an
trephine, endoscopic or laparoscopic approach (3-8).
Endoscopic-assisted colostomy without general anes-
thesia and laparotomy was first reported by Mattingly and
Mukerjee (3). However, percutaneous colopexy facilitates
fixation of the colon to the abdominal wall on its anti-mes-
enteric side, adding important benefits.
The indications for the use of colostomy in colorectal
diseases are colon, rectum or anus obstruction, diverticular
disease in the acute phase, post-radiation enteritis, complex
perirectal fistula, anorectal trauma, severe anal inconti-
nence, non-healing sacral decubitus ulcers in patients with
spinal cord injury, complicated anal Crohn’s disease, recur-
rent rectovaginal fistula, pelvic floor dysfunction, and a
dehisced coloanal anastomosis (2). This procedure is often
necessary in critically ill patients who may not be able to
tolerate a laparotomy or general anesthesia.
The aim of this study is to evaluate the feasibility, safety
and efficacy of performing colostomy under colonoscopic
visualization and the use of colopexy without additional
morbidity of abdominal exploration and general anesthesia
in laboratory animals.
METHODS
This was a prospective, experimental, phase-I, survival animal
study. The study was conducted between May and July 2014 at the
Experimental Surgery Unit, University of São Paulo Medical School,
Brazil. The study was approved by the Institutional Animal Care and
Use Committee of the University of São Paulo Medical School, and
conducted in accordance with current legislation with regard to the
care and use of laboratory animals.
Animal preparation
Five healthy domestic female Yorkshire race pigs were used. Ani-
mals had an average pre-procedure weight of 35 kg (range 31.4 to
Bustamante-Lopez LA, Sulbaran M, Nahas SC, Guimaraes Horneaux de
Moura E, Nahas CS, Marques CF, Sakai C, Ceconello I, Sakai P. Endoscopic
colostomy with percutaneous colopexy: an animal feasibility study. Rev Esp
Enferm Dig 2017;109(4):273-278.
DOI: 10.17235/reed.2017.4201/2016
274 L. A. BUSTAMANTE-LOPEZ ET AL. Rev Esp Enferm Dig
40.8 kg), and no previous surgery. Pigs were prepared at the exper-
imental laboratory of the Clinics Hospital Complex, University of
São Paulo Medical School. Animals were kept fasting 24 hours
before the intervention, and received an enema one hour before the
procedure to clean the rectum and distal colon.
In the lithotomy position with opened legs, all animals were sub-
mitted to tracheal intubation and mechanical ventilation, and main-
tained under general anesthesia with Ketamine Base® (intravenous
5 mg/kg) and Thiopental® (intravenous 10-30 mg/kg), followed by
inhalation of Isoflurane®. All animals were kept alive 7 days after
intervention for follow up.
Colostomy technique
Standardization of the technique was achieved by procedures
performed in a pilot protocol prior to initiating the study.
Fig. 1.
Fig. 2.
Colonoscopic examinations were performed by a single endosco-
pist with advanced skills. Colostomies were done by an experienced
colorectal surgeon.
The following steps were followed:
  1. Transanal introduction to the descending colon with a gas-
troscope (Pentax EG - 290) (Fig. 1).
  2. Identification of the anterior colonic wall and the best site
for trans-illumination on the abdominal wall, suitable for
colopexy (Fig. 1).
  3. Cleansing and anti-sepsis of the abdominal wall with povi-
done-iodine and saline.
  4. Puncture of the abdominal wall at the previously identified
best place for trans-illumination with the Loop Fixture II
Gastropexy Kit® (Fig. 2). In brief, this device has two nee-
dles, one which has a suture inserted immediately before the
tip of the needle, and the other which has a suture-holding
loop placed on it (Fig. 2).
Rev Esp Enferm Dig 2017;109(4):273-278
2017, Vol. 109, N.º 4 ENDOSCOPIC COLOSTOMY WITH PERCUTANEOUS COLOPEXY: AN ANIMAL FEASIBILITY STUDY 275
  5. Under endoscopic visualization, the suture-holding needle
was pushed down to form a loop for holding the suture (Fig.
3).
  6. The suture was advanced down so that its distal end passed
through the suture-holding loop.
  7. After endoscopic visualization that the distal end of the
suture had passed through the suture-holding loop, the loop
was placed back in the puncture needle and pushed down to
form a loop to release the suture. The free suture was knotted
against the abdominal wall to hold the colon to the parietal
peritoneum.
  9. The endoscope was further withdrawn and a small disc of
skin was removed proximal to the colopexy. A loop colosto-
my was performed in the anti-mesenteric wall, and the prox-
imal-to-distal orientation of the intestinal loop was clearly
identified aided by the colonoscope (Fig. 4).
Fig. 3. Under endoscopic visualization, the suture-holding needle was pushed down to form a loop for holding the suture.
Fig. 4. A loop colostomy was performed in the anti-mesenteric
wall, and the proximal-to-distal orientation of the intestinal
loop was clearly identified aided by the colonoscope.
Rev Esp Enferm Dig 2017;109(4):273-278
10. The colostomy was fixed by stitching the anterior colonic
wall to the aponeurosis and subcuticular layer circumferen-
tially with polyglactin 910 (vycril 2-0) (Fig. 5).
Postoperative management
Oral feeding and mobility were started when animals were com-
pletely awakened. All animals were carefully observed and exam-
ined during a seven-day follow-up period to evaluate any changes
in general condition, behavior and eating habits.
Animals received prophylactic antibiotic therapy and analgesia
with dipirone 1 g intramuscular. During postoperative days 1, 2, 5
and 7, animal feeding and movements, presence of feces in the colos-
tomy, color of the edges of the mucosa and sinking of the colostomy
were evaluated.
Fig. 5. The colostomy was fixed by stitching the anterior colonic
wall to the aponeurosis and subcuticular layer circumferentially
with polyglactin 910 (vycril 2-0).
276 L. A. BUSTAMANTE-LOPEZ ET AL. Rev Esp Enferm Dig

On day 7 all animals were sedated to perform colonoscopy and
an exploratory laparotomy. At colonoscopy, periostomal mucosa
and colopexy were evaluated. Exploratory laparotomy confirmed
the absence of peritonitis and peritoneal abscess, and allowed direct
observation of intraperitoneal colostomy. Finally, animals were sac-
rificed.
tive colopexy in all animals. Exploratory laparotomies
excluded the presence of a localized abscess or diffuse
peritonitis (Fig. 5). Fixation of the colonic wall to the
parietal peritoneum was excellent and colon integrity was
confirmed.

Statistics
Results were reported as descriptive statistics, with means and
ranges for quantitative variables.
RESULTS
A pilot protocol was conducted to learn the steps of
the technique, observing potential problems in order to
improve the procedure efficacy.
Five endoscopic colostomies were performed in five
pigs. All procedures were completed as planned (Figs. 3
and 4). The average procedure time was 27 minutes (range
21-54 min).
Diet tolerance and mobility of the animal began in the
immediate postoperative period post anesthesia recov-
ery and were satisfactory in all pigs. Color of the edges,
appearance of periostomal skin and its function were satis-
factory in all animals during the follow-up period as well.
Mucocutaneous separation of the colostomy with preser-
vation of the stoma function occurred in one animal, with
no sinking or stenosis (Table I).
Complications
During the pilot protocol stage, ileal interposition with
perforation occurred in one animal. It was successfully
repaired by laparotomy conversion. The bladder was per-
forated in the third pig. This perforation was successfully
closed through the same incision in which the colosto-
my was made afterwards. The procedure was simple and
fixation of the colostomy to the aponeurosis fascia was
performed, without difficulty and with minimal bleeding.
Control colonoscopy on the seventh day confirmed the
presence of normal mucosa around colostomy and effec-
DISCUSSION
The jury is still out for establishing the most effective
surgical strategy for patients with partial obstructive left
colon cancer. Colostomy has been described as a first step
of a two-stage surgery on these patients (1,9,10). More-
over, neoadjuvant chemotherapy for locally advanced
rectal and anal cancer has expanded the indications of a
minimally invasive approach for fecal diversion, as it may
avoid an additional surgery and the need of general anes-
thesia, serving as a bridge to oncologic surgical resection
(11). Self-expandable metallic stents (SEMS) have been
introduced as part of the management of complete or par-
tial obstructive colorectal cancer, in order to avoid a two-
step emergent surgical procedure that includes a colostomy
(12). A recent meta-analysis demonstrated that colorectal
SEMS as a bridge to elective surgery compared to emer-
gency surgery in left-sided colorectal cancer obstruction
showed a better prognosis in terms of lower postoperative
morbidity, higher primary anastomosis rate and lower sto-
ma rate. Despite these favorable immediate postoperative
outcomes, a similar overall postoperative mortality of
SEMS insertion as a bridge to surgery compared to emer-
gency surgery was shown (10.7% vs 12.4%) (13). Further-
more, the long-term oncological outcome, such as disease
recurrence, was worse in the group with SEMS as a bridge
to surgery than in the emergency surgery group. Based
on these unfavorable long-term oncological outcomes,
the recent SEMS guidelines by the European Society of
Gastrointestinal Endoscopy (ESGE) do not recommend
routine SEMS insertion as a bridge to surgery in potential-
ly curable left-sided obstructive colorectal cancer (CRC)
obstruction (14). Additionally, a higher risk of perforation
in patients treated with SEMS that were receiving antian-
giogenic agents such as bevacizumab has been reported
(15). Therefore, endoscopic colostomy can emerge as a
minimally invasive alternative that can serve as a bridge

Table I. Post operative variables

Presence Colostomy mucosal Procedure weight Post procedure
Pigs Feeding Animal movements Complications
of Feces color (kg) weight (kg)
1 Good Yes Yes Red No 37.3 37.1
2 Good Yes Yes Red No 31.4 31
3 Good Yes Yes Red Bladder perforation 40.8 40.3
4 Good Yes Yes Red No 32.4 32.5
5 Good Yes Yes Red Retraction 33.3 33.1

Rev Esp Enferm Dig 2017;109(4):273-278

2017, Vol. 109, N.º 4 ENDOSCOPIC COLOSTOMY WITH PERCUTANEOUS COLOPEXY: AN ANIMAL FEASIBILITY STUDY 277
to oncologic treatment, potentially overcoming present
limitations of SEMS without the additional morbidity of
general anesthesia and surgery for fecal diversion.
Technical advantages and limitations of different
approaches to perform colostomy have been described.
Laparotomy allows a thorough evaluation of the abdo-
men, but causes more pain, longer recovery time, and a
larger scar. In addition, there is a higher chance of wound
infection and incisional hernia (1,16). Minimally invasive
techniques like laparoscopy, gasless or trephine technique
avoid large abdominal incisions and therefore reduce
postoperative pain, ileus, and wound complications (3-6).
Other advantages may include shorter hospital stay, and
earlier initiation of other treatment such as chemotherapy
or radiation therapy in patients with locally advanced rectal
or anal cancer.
In the laparoscopic approach visualization is improved
but costs are increased. Laparoscopy has been described as
the best way to proceed for the formation of an intestinal
stoma (17,18). In the gasless technique, there are no inci-
sions other than the one that is done to create the stoma.
Visualization is reasonable, recovery is faster, and pain is
minimal. In addition, the procedure can be performed safe-
ly, with minimum morbidity. However, general anesthesia
may be a drawback for critically ill patients (6,19).
The trephine colostomy technique does not allow easy
identification of the colon segment, and differentiation
between the proximal and distal ends of the sigmoid loop
can be technically difficult (7,20,21).
Mattingly and Mukerjee first reported endoscopic-as-
sisted colostomy without general anesthesia or laparotomy
(3). Fifteen patients were involved in this study. Four cases
were performed under local or regional anesthesia. Fecal
stream was successfully diverted using this minimally
invasive technique in all patients. No immediate periopera-
tive complications related to this technique were described.
However, a retrospective review of those patients reported
retraction of the colostomy in 13% of cases (4).
Although endoscopic-assisted colostomy is not a new
technique (22,23), percutaneous colopexy adds important
technical advantages: strong and permanent attachment of
the colon to the abdominal wall facilitates safe colostomy
performance. Besides that, a pexy stitch on the colonic
mucosa serves as a reference to the point that must be over-
come for the creation of a colostomy proximal to the pexy.
This approach does not require the creation of a pneumo-
peritoneum and allows the creation of a colostomy under
conscious sedation, with regional or local anesthesia. This
probably could account for a lower risk of anesthesia com-
plications, a shorter recovery time and, thus, lower costs
of hospital care. In addition, procedural time is reduced.
We reported an average procedure time of 25 minutes,
compared to longer times reported with others techniques
(6,17,22).
Some of the patients who can benefit from this tech-
nique are those with important systemic comorbidities,
Rev Esp Enferm Dig 2017;109(4):273-278
ASA III or IV, as it would prevent the use of general anes-
thesia. Moreover, neoadjuvant chemotherapy for locally
advanced rectal and anal cancer has expanded the indi-
cations of a minimally invasive approach for fecal diver-
sion, as it may avoid an additional surgery and the need
of general anesthesia, serving as a bridge to treatment for
oncologic resection (11,24).
Bowel preparation was done with a rectal enema.
That is because anterograde preparation is not feasible
in most cases of partially obstructive tumors in humans.
In some cases, the enema effect was not good enough
and it was necessary to work with formed stool in the
colon lumen. The endoscopist had no major problem to
advance the scope over the feces. Considering that it is
not a diagnostic procedure, we believe that working on
a completely cleaned colon is not needed, favoring the
use of the method in patients with partial colon or rectal
obstruction. An important technical consideration regard-
ing care for diminishing infectious risk is that the stoma
is performed outside of the abdominal cavity, after having
scope confirmation of the correct bowel segment to make
the incision. Additionally, it is worth mentioning that a
gastroscope was used instead of a colonoscope in order
to reproduce the clinical scenario of having to overpass a
stenosed rectal or colonic segment. Moreover the use of
a slim gastroscope could be a reasonable option for this
procedure in selected cases.
Potential limitations of this technique are the small
exposure of the incision with lack of intra-abdominal
exploration and technical difficulty for aponeurosis fixa-
tion. The orientation of the endoscopist to reach the ante-
rior abdominal wall is an obstacle that can be overcome by
gentle palpation of the abdomen at the maximum trans-il-
lumination point. This maneuver can be an obstacle in
obese patients, but does not preclude the procedure.
Besides, one of the major drawbacks of colostomy is
shrinkage, and it is thought to be caused by mesenteric
tension. Because of that we recommend that colostomy
should be done between 20 and 30 cm from the anal verge,
with the colonic wall directly against the abdominal wall
and avoiding excess torque maneuvers of the scope. Of
note, adequate patient selection should be considered, as
multiple previous surgeries could preclude a successful
mobilization and trans-illumination of the colon into the
abdominal wall.
With regard to possible causes for complications,
important differences of pig anatomy compared to humans
should be mentioned. The bladder can reach the umbilical
scar in pigs. We think this anatomic variation could have
influenced the bladder perforation on the third animal. On
the other hand, the descending colon of the pig is found on
the right side of the abdominal cavity, which could predis-
pose the ileal interposition that we experienced during the
pilot protocol stage. The different location of the descend-
ing colon also explains why colostomies in animals were
performed on the right iliac fossa.
278 L. A. BUSTAMANTE-LOPEZ ET AL. Rev Esp Enferm Dig
Based on the need for alternatives to laparotomy and
laparoscopy for the creation of ostomies, we made a tech-
nical breakthrough, and showed that endoscopic colostomy
with percutaneous colopexy proves to be a simple, feasible
and effective method with low morbidity for performing
colostomy in experimental animals. Further studies will
be needed to prove its successful clinical application in
humans.
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Rev Esp Enferm Dig 2017;109(4):273-278
PAPER

Long-term results of subtotal

colectomy for acquired hypertrophic
megacolon in eight dogs
OBJECTIVES: To evaluate the long-term results of subtotal colectomy distal colon are unable to relax, causing
functional colonic obstruction (Ehrenpreis
for acquired hypertrophic megacolon in the dog.
1970).
METHODS: Eight dogs with acquired hypertrophic megacolon Acquired megacolon may result from
long-standing mechanical or functional
underwent subtotal colectomy with preservation of the ileocolic bowel obstruction and may be classified
junction. Long-term follow-up was obtained by clinical records and as either primary or secondary. In cats,
the causes and treatment of primary idio-
telephone interviews with the owners.
pathic megacolon have received consider-
RESULTS: Eight large-breed dogs (age range: 6 to 12 years; mean able attention (Bright and others 1986,
Rosin and others 1988, Bertoy and
age: 10 75 years) were enrolled. The use of bone meal, low levels

MacCoy 1989, Barreau 1994, Washabau
of exercise, chronic constipation with dyschesia and tenesmus and Hasler 1997, Washabau and Holt
1999). Specifically, it has been proposed
refractory to medical management were factors predisposing that secondary megacolon can develop as
dogs to acquired hypertrophic megacolon. The diagnosis was a result of chronic obstructive lesions (for
example pelvic canal stenosis) affecting
confirmed in all animals by abdominal palpation, plain radiography the colon (Holt and Brockman 2003).
and postoperative histopathological findings. There were no Alternatively, this condition may be caused
by neurological abnormalities resulting
intraoperative complications. One dog died as a result of septic from sacral nerve injury or sacral spinal
peritonitis. The clinical conditions (that is, resolution of obstipation cord deformity (MacPhail 2002). Al-
though canine-acquired megacolon has
and stool consistency) of the remaining seven dogs were improved been described previously (Sahay and
at discharge; all animals returned to normal defecation in five to others 1983, Bright and others 1986,
Barreau 1994, Petrus and others 2001),
10 weeks (mean: 7 3 weeks) and were alive 11 to 48 months

data concerning the long-term clinical out-
(mean: 40 5 months) after surgery.
 come of this condition remain scanty.
Nonetheless, medical (Hall and Washabau
CLINICAL SIGNIFICANCE: Predominantly bony diet and/or low levels of 1997, Hasler and Washabau 1997) and
physical activity may predispose dogs to acquired hypertrophic surgical strategies for the treatment of
feline and canine megacolon have been de-
megacolon. Our results emphasise the long-term effectiveness of scribed. Specifically, subtotal or total colec-
subtotal colectomy with preservation of the ileocolic junction in this tomy has been advocated as the treatment
of choice in cases non-responsive to med-
condition. ical therapy (Fellenbaum 1978, Bright and
others 1986, Bertoy and MacCoy 1989,
De Haan and others 1992, Barreau 1994).
T. NEMETH, N. SOLYMOSI AND INTRODUCTION In this case series, we sought to evaluate
G. BALKA* the long-term results of subtotal colectomy
Megacolon is characterised by the presence for acquired hypertrophic megacolon in
Journal of Small Animal Practice (2008)
49, 618–624 of an enlarged, hypomotile colon. This the dog. We therefore reviewed the clinical
DOI: 10.1111/j.1748-5827.2008.00624.x condition has been reported to occur in data of eight dogs treated by this technique
human beings (Swenson and Bill 1948), during a 5-year period.
cats (Dietzmann 1968), dogs (Bright and
others 1986) and pigs (Bassett and others
1999). MATERIALS AND METHODS
Department and Clinic of Surgery and In human beings, congenital megacolon
Ophthalmology, *Department of Pathology and (Hirschsprung’s disease) is caused by the A total of eight dogs were included in
Forensic Veterinary Medicine, Faculty of
Veterinary Science, Szent István University, failed migration of colonic ganglion cells the study. All animals had a history of
Budapest, Hungary during gestation. Varying lengths of the bony diet, low levels of exercise, chronic

618 Journal of Small Animal Practice
Vol 49
December 2008
Ó 2008 British Small Animal Veterinary Association
 Colectomy for acquired hypertrophic megacolon in dogs

constipation with dyschesia and tenesmus
refractory to medical management per-
formed by practitioners or veterinary
internists before surgery. Medical manage-
ment of constipation was attempted in all
cases with oral stool softeners (paraffin oil
or lactulose), prokinetics (sennoside and/or
cisapride) and regular enemas (with warm
water and oil). Despite thorough medical
management, inability to defecate per-
sisted in all dogs. Clinical examination
revealed anorexia, significant weight loss,
regular vomiting and a markedly distended
abdomen with a palpable dilated intestine.
Enlargement of the diameter of the colon
beyond 1.5 times the length of the body
of the seventh lumbar vertebra was shown
by plain radiography in all dogs. Dogs suf-
fering from other clinical conditions that
could have lead to megacolon (for example,
neurological disorders, stenosis of the
pelvic canal, prostatic diseases and perineal
hernia) were excluded from this study.
Age, breed, sex, clinical signs (for exam-
ple, general impression, circulatory and
respiratory parameters, abdominal signs,
tenesmus and constipation), duration of
clinical signs, laboratory data (haemato-
logical and biochemical assessment), peri-
operative events and clinicopathological
findings were recorded. Long-term fol-
low-up was based (1) on the review of
the clinical records and (2) on telephone
interviews with the owners.
All animals were parenterally treated
with 10 mg/kg amoxicillin/clavulanic acid
(Augmentin; Glaxo-SmithKline) plus 30
mg/kg enrofloxacin (Ganadexil Enrofloxa-
cina; Invesa) for two days before surgery.
Preoperative enemas were unsuccessful in
all dogs. Premedication was achieved with
0
01 mg/kg iv acepromazine (Vetranquil;
Ceva) and 0
05 mg/kg iv fentanyl (Fen-
tanyl; Gedeon Richter) as a loading bolus
followed by a constant-rate infusion of
fentanyl. Intravenous 4 mg/kg propofol
(Fresenius Propofol; Fresenius Kabi) was
used for induction. Maintenance was
achieved with a mixture of oxygen and iso-
flurane (Isoflurane USP; Phoenix Pharma-
ceutical) administered by inhalation.
Following a lower ventral midline lapa-
rotomy, the intraoperative diagnosis of
megacolon was established based on the
presence of massive distension of the large
bowel, which was filled with hard faecal
masses. Manual removal of the faeces
was attempted unsuccessfully in all cases.
All dogs underwent subtotal colectomy
with preservation of the ileocolic junction
and caudal mesenteric arteries and veins.
Intestinal transit was re-established with
an end-to-end colocolic anastomosis using
two layers (penetrating and Lembert) of
simple interrupted sutures. A 3/0 USP
absorbable monofilament suture material
(polydioxanone, PDS) was used in all dogs.
A passive abdominal Penrose drain was
placed for three to four days. Postoperative
analgesia was achieved by the continuation
of constant-rate infusion with 0
05 mg/kg
iv fentanyl (Fentanyl; Gedeon Richter) fol-
lowed by a single injection of 0
2 mg/kg
meloxicam (Metacam; Boehringer) once
per day. Oral administration of a concen-
tration diet (Concentration Diet, Waltham)
was started on the first day after surgery, fol-
lowed by canned soft food for three days.
The drain was removed three to four days
postoperatively. All dogs were successfully
discharged five to seven days after surgery
in improved clinical conditions. Owners
were educated to feed animals with a mois-
turised soft diet and to enhance oppor-
tunities for physical activity. Antibiotic
medications were discontinued one week
after surgery.
At the time of follow-up, owners were
telephonically interviewed on the current
clinical conditions of operated dogs, the
features of defecation, the quality and
quantity of stools. They were also asked
their general opinion on the clinical
management.
The study variables (duration of tenes-
mus and constipation, time to normal
defecation after surgery and survival rate)
were statistically analysed in the R environ-
ment. Correlations between two variables
were assessed with the Pearson’s correlation
coefficient.
RESULTS
All dogs (age range: six to 12 years; mean
age: 10
2562
2 years, median: 11 years)
with megacolon belonged to large breeds
(for example Hungarian Kuvasz, Cauca-
sian shepherd dog and German shepherd
dog) (Table 1). The male to female ratio

Table 1. General characteristics of dogs included in this study

No. Signallment (breed, sex, age) History of Predominant clinical finding Time to Survival at Age at
tenesmus and normal follow-up study
constipation faeces (months) (years)
(weeks) (weeks)

1 Hungarian Kuvasz, male, 12 years 22 Anorexia, irregular vomiting, distended colon 7 40 15.3
filled with hard faeces, obstipation
2 Caucasian shepherd dog, male, 9 years 24 Anorexia, abdomen painful and stiff on palpation, 6 44 12
6
distended colon filled with bony faeces, obstipation,
mild bloody peritoneal effusion
3 Sarplaninac, male, 12 years 11 Distended colon filled with hard faeces, obstipation 6 11 13
4 English mastiff, male, 10 years 20 Remarkable cachexia, anorexia and apathy, 9 45 13
7
stiff and painful abdomen, distended colon filled
with hard faeces, obstipation
5 Mongrel, male, 9 years 26 Anorexia, distended colon filled with hard faeces, 5 48 13
obstipation, irregular bloody discharge from the anus
6 German shepherd dog, male, 12 years 16 Distended colon filled with hard faeces, obstipation — — —
7 Mongrel, female, 12 years 24 Anorexia, distended colon and rectum filled with 10 47
5 16
hard faeces, obstipation
8 Caucasian shepherd dog, male, 6 years 5 Distended colon filled with hard faeces, obstipation 8 46 9
8

Journal of Small Animal Practice
Vol 49
December 2008
Ó 2008 British Small Animal Veterinary Association 619

was 7:1. The use of bone meal, low levels of
exercise, chronic constipation (duration
range: five to 26 weeks, mean 18
567
3
weeks, median: 21 weeks) with dyschesia
and tenesmus refractory to medical man-
agement were factors predisposing dogs
to acquired hypertrophic megacolon. All
animals underwent unsuccessful medical
treatment for at least two months. No con-
current disease had been previously
reported by the owners or the referring
practitioners. The predominant clinical
features were weight loss, anorexia and
vomiting. A markedly distended abdomen
with a palpable dilated intestine extending
up to the epigastrium was present in all
cases. Clinical laboratory abnormalities
included mild anaemia, slightly elevated
packed cell volume, and a mild leucocytosis
with lymphopenia. Colonic distension
with stool retention was evident on plain
radiography (Fig 1). The spillage of bowel
FIG 1. Left lateral (A) and ventrodorsal (B)
plain abdominal radiographs of the large
intestine of dog 5. Distended colon filled with
hard faecal material. Radiographic
confirmation of megacolon was based on the
comparison between the increase in colonic
diameter (arrow marked with Dc) and the length
of the seventh lumbar vertebra (arrow marked
with L7LV) according to the O’Brien (1978)
formula: Dc $ 1
5x L7LV
620
T. Nemeth and others
contents during surgery occurred in two
cases (1 and 3) and dissection of the grossly
distended colon was challenging (Fig 2).
Moreover, requirements for sterility were
not easily achieved during resection and
anastomosis. Nonetheless, no intraopera-
tive surgical complications occurred. Sur-
gical suturing was easy to achieve by
means of penetrating sutures placed into
the thickened colonic wall.
The excised colonic segments were sub-
mitted for histopathological evaluation.
Several different stains (haematoxylin-
eosin, Azan, Mallory trichrome and Van
Gieson) were used. Histopathology re-
vealed thickening of bowel wall because
of the hypertrophy of smooth muscle cells,
especially within the tunica muscularis and
the lamina muscularis mucosae. Both the
inner circular and outer longitudinal layers
of smooth muscle were hypertrophic at his-
tology. The muscle layers of the affected
dogs’ colon were approximately twice as
thick as the corresponding layers of the
same colonic section from a healthy dog
of the same size and bodyweight (Fig 3).
FIG 2. Intraoperative picture of megacolon
during sceletisation (A). End-to-end
colocolonic anastomosis with simple
interrupted sutures (B)
Journal of Small Animal Practice
Vol 49
December 2008
Ó 2008 British Small Animal Veterinary Association
The mucosa and lamina propria were intact
in all cases, the only exception being dog 5.
Specifically, in this case, there was inflam-
mation and ulceration of the mucous mem-
brane with infiltration of histiocytes and
plasma cells.
Dog 6 died on the fifth postoperative
day, although microbiological examina-
tion in this dog revealed an Escherichia coli
strain susceptible to amoxicillin/clavulanic
acid and enrofloxacin used perioperatively.
Necroscopy disclosed septic peritonitis
without disruption of the anastomoses.
The remaining seven dogs were discharged
in improved clinical conditions. These
dogs were all alive 11 to 48 months (mean:
40
5 months) after surgery according to the
telephone interviews conducted with the
owners. The return of normal defecation
(two to three times a day, faeces of normal
consistency) without tenesmus occurred
between five and 10 weeks (mean: 7
361
8
weeks, median: seven weeks) postopera-
tively. This process occurred with a gradual
decrease in the frequency of daily defeca-
tion (from 10 to 12 daily episodes of mod-
erate diarrhoea) alongside an increasing
consistence of the faecal material (with
two to three evacuations per day). Clinical
management was judged to be satisfactory
by all owners. A weak negative correlation
was seen between age at time of surgery and
survival at time of follow-up. No other sig-
nificant correlations were detected.
DISCUSSION
Congenital megacolon (also known as
Hirschsprung’s disease in human beings)
is caused by the absence of inhibitory neu-
rons in Auerbach’s and Meissner’s plexuses
(Garrett and others 1969) leading to spastic
contraction of the affected segment with
subsequent dilation of the proximal bowel
section (Ehrenpreis 1970). Although the
exact causes of megacolon in small animals
have not been clearly identified yet, the
absence of myenteric ganglia in the distal
colon has been described in two cats (Yoder
and others 1968, Ly 1977) and the occur-
rence of colon aganglionosis has been
reported in two other cats (Rosin and
others 1988).
Acquired megacolon is generally
idiopathic or secondary to neurogenic,
 Colectomy for acquired hypertrophic megacolon in dogs
FIG 3. Histology findings (40-fold magnification) in normal colon (upper row) and hypertrophic
megacolon (lower row). Several different stains (haematoxylin-eosin, Azan, Mallory trichrome and
Van Gieson) were used
alimentary or orthopaedic causes. Most
cases of feline megacolon are idiopathic,
and the most common clinical symptoms
include chronic anorexia, vomiting, weight
loss, constipation and tenesmus (Bright
and others 1986, Bertoy and MacCoy 1989,
Barreau 1994, Washabau and Holt 1999,
Holt and Brockman 2003). Although the
exact aetiology of this condition remains
to be elucidated, a primary neurological
or degenerative neuromuscular cause has
been suggested to play a role (Washabau
and Stalis 1996).
Although canine megacolon has been
previously described in the literature, data
regarding the clinical course and outcome
in this condition are scarce. An 8-year-old
entire male German shepherd dog with
focal ulcerative colitis and megacolon has
been described (Bright and others 1986).
After unsuccessful attempts to evacuate
the colon with multiple enemas, subtotal
colectomy with removal of the ileocolic
junction and end-to-side ileocolostomy
was performed. The dog continued to show
tenesmus despite excellent health and
appetite five years after surgery. A 6
5-
year-old Lhasa Apso suffering from obsti-
pation and megacolon because of bony diet
has been also reported. Enterotomy and
surgical removal of obstructing hard faeces
were performed. Surgery was followed by
laxative diet and proved to be successful
Journal of Small Animal Practice
Vol 49
December 2008
Ó 2008 British Small Animal Veterinary Association
(Sahay and others 1983). Moreover, a re-
view paper has described three dogs with
megacolon secondary to different primary
conditions such as imperforate anus (in a
one-month-old entire male boxer), post-
ovariohysterectomy pelvic canal stenosis (in
an eight-year-old neutered female Pincher)
and cauda equina compression (in a 10-
year-old entire male German shepherd
dog). The paper did not report the clinical
course and outcomes of all dogs (Barreau
1994). A dog suffering from acquired
dilated megacolon secondary to autono-
mic ganglioneuritis has also been reported
(Petrus and others 2001). In this case, a
four-year-old entire female Labrador re-
triever was treated unsuccessfully with
enemas, lactulose and cisapride. The dog
was then treated by surgical evacuation
of the impacted colon through an incision.
Unfortunately, constipation recurred after
temporary improvement of constipation,
and the owner refused subtotal colectomy.
Thus the dog was euthanased.
In the present case series, all dogs had
a history of long-lasting constipation
refractory to appropriate medical treat-
ment with dietary interventions, laxatives
(emollient oil and lactulose), prokinetics
(sennoside or cisapride), and enemas. Cal-
cium sennosides (designated A and B)
are hydroxyanthracene glycosides derived
from senna leaves. They have been used
as natural, safe, time-tested laxatives in
both traditional and modern medicine.
Although oral or intracolonic sennosides
may inhibit myoelectric activity in the
colon for 12 to 18 hours after a three to
six hour delay, three to 10 contractions
with a high amplitude (giant contractions)
appear during the inhibition, thereby elim-
inating faecal matter and causing diarrhoea
(Fioramonti and others 1988, Staumont
and others 1988). Cisapride has been
shown to stimulate smooth muscle con-
traction along the entire length of the colon
(Hasler and Washabau 1997). Ranitidine
and nizatidine, two H2-receptor antago-
nists, have also been shown to stimulate
colonic peristalsis (Hall and Washabau
1997). The effect of mitemcinal (GM-
611), a novel orally active motilin agonist,
on defecation has been investigated in rab-
bits and dogs. This compound has been
shown to increase stool weight in a dose-
dependent fashion, without causing loose
stools (Sudo and others 2007).
Owners reported a predominantly bony
diet in all dogs described in the present
study. In this regard, the mechanical
obstruction by firm ingesta may play a role
in the weakening of bowel contractions.
Nonetheless, in an experimental study in
the dog, artificial distension of the ileum
inhibited ileal motility and relaxed the
colon as detected by barostat, thereby
resulting in short-term dilation of the large
bowel in the absence of mechanical
obstruction. The resting tone of the colon
was shown to be under adrenergic, cholin-
ergic-nicotinic and nitric oxide-like-medi-
ated inhibitory control; however, these
agents cannot mediate solely the inhibition
of the colonic tone elicited by ileal disten-
sion (Basilisco and Phillips 1994). Not-
ably, all animals were kept in gardens on
chains or in kennels without possibility
of walks or exercise. The influence of re-
gular physical activity on colonic transit
time and defecation has been previously
studied in middle-aged sedentary human
patients suffering from chronic idiopathic
constipation. Exercise resulted in a signi-
ficant reduction in the percentage of in-
complete defecation, the percentage of
defecation requiring straining and the per-
centage of hard stools. The rectosigmoid
and total colonic transit time similarly
decreased, thereby suggesting that a lack
621

of physical activity can lead to constipation
in humans (De Schryver and others 2005).
In keeping with these findings, the absence
of physical activity may have contributed to
bowel hypomotility and the development
of constipation in our case series.
The diagnosis of megacolon in our study
was supported by typical physical findings
including an extremely distended colon
filled with hard faeces and extending up
to the epigastrium. Notably, rectal digital
palpation did not disclose any anomaly
(for example pelvic canal stenosis) (Bertoy
2002). Radiographic examination showed
pathognomonic signs of megacolon (that is
dilated colonic sections filled with hard fae-
ces). In our study, the radiological diag-
nosis of megacolon was confirmed when
the enlargement of the diameter of the
colon was beyond 1
5 times the length of
the body of the seventh lumbar vertebra
(O’Brien 1978). Alternatively, megacolon
can be confirmed if the diameter of the
colon exceeds the length of the body of
the second lumbar vertebra (Lee and
Leowijuk 1982). However, megacolon is
a functional disease. Thus, the diagnosis
is chiefly based on history, physical exam-
ination and confirmation of extremely dis-
tended bowel filled with hard faecal matter.
In this regard, radiology findings may sup-
port the diagnosis.
Several antibiotic regimens have been
tested in colorectal surgery. A large review
of randomised controlled trials of human
antimicrobial prophylaxis did not show
a clear superiority of one specific regi-
men; however, some inadequate regimens
were identified (Song and Glenny 1998).
Broad-spectrum activity against both
Gram-positive and Gram-negative aerobic
and anaerobic isolates is essential in this
setting (Holt and Brockman 2003, Niles
and Williams 2005). This could be ac-
hieved by amoxicillin and clavulanic acid,
but this combination is ineffective against
Enterobacter and Pseudomonas (Graber
1998). Because of its activity against these
bacteria, enrofloxacin may offer a valuable
option (Plumb 1999). Antibiotics were
administered during the attempts to evac-
uate the colon. As the rich bacterial popu-
lation, the high intraluminal pressure and
the prolonged lag phase of colon healing
may increase the risk of dehiscence for at
least four days postoperatively (Niles and
622
T. Nemeth and others
Williams 2005), the continuation of the
perioperative antibiotic administration
may have exerted beneficial effects.
In the present study, preoperative ene-
mas were not attempted because several
previous conservative efforts had failed.
Furthermore, routine use of enemas before
colotomy or colectomy remains controver-
sial. Indeed, there is evidence to suggest
that it could be associated with an increased
risk of leakage and gross abdominal
contamination (Bertoy 2002, Niles and
Williams 2005). This could be ascribed
to the change of dry, hard and easily manip-
ulated faeces into an infectious liquid
milieu (Holt and Brockman 2003). How-
ever, mechanical cleaning remains the
standard practice before elective colonic
resection in human beings (Nichols and
others 1997). Although manual removal
of faeces from the colonic segment to be re-
sected is recommended (Holt and Brockman
2003), the removal of solid faeces from the
resection sites was difficult in our study.
Thus far, several surgical techniques for
the management of megacolon have been
described, mainly in cats. In this regard,
previous techniques such as coloplasty
with the reduction of the diameter of the
affected bowel (Bruce 1959), and partial
colectomy with removal of a segment of
the affected colon alongside with the ileo-
colic junction and the caecum (Yoder and
others 1968) are no longer performed. In
the present study, we performed a subtotal
colectomy with preservation of the ileo-
colic junction and the caudal mesenteric
artery and vein, followed by the creation
of an end-to-end colocolic anastomosis.
The ileocolic junction was preserved, inas-
much as it minimises the development of
postoperative diarrhoea because of bacte-
rial overgrowth (Bright and others 1986,
Holt and Johnston, 1991). Preservation
of the caudal mesenteric artery and vein
is beneficial because it maximises blood
supply to the remaining distal colonic seg-
ment (Washabau and Holt 1999). How-
ever, there is little evidence that surgical
closure of the caudal mesenteric vessels
would significantly impair the blood sup-
ply of the caudal colonic segment and
the rectum. A number of techniques have
been reported as for the restoration of
bowel continuity after subtotal colectomy,
including end-to-end, end-to-side and side-
Journal of Small Animal Practice
Vol 49
December 2008
Ó 2008 British Small Animal Veterinary Association
to-side colocolostomies (Barreau 1994,
White 2002). In a study the recovery from
diarrhoea after subtotal colectomy occurred
at eight postoperative weeks. The recovery
was confirmed by the return of a normal
bowel transit time, decreased moisture vol-
ume, and reconstruction of cholinergic
fibres in the anastomotic section (Jimba
and others 2002).
Several experimental studies aiming to
evaluate the clinical outcomes of total
colectomy followed by ileoproctostomy
or ileoanal anastomosis in the dog have
shown that persistent diarrhoea, skin exco-
riation and nocturnal incontinence occur
in the majority of cases (Mibu and others
1987, Ferrara and others 1992). This is
in contrast to the cases reported in this
manuscript. It is possible that the resolu-
tion of diarrhoea and return of normal con-
sistency stools in this case series reflects
the less radical surgery performed with pre-
servation of both the ileocolic junction,
colorectal junction and rectum. This com-
plication may be overcome via different
interventions. Specifically, the use of an
antiperistaltic ileal segment can maintain
solid stools, normal weight and electrolyte
and water balance (Tuley and others 1976).
Interposition of a jejunal segment into the
anorectal area may increase absorption of
water, sodium and chloride from the oper-
ated intestinal section (Mibu and others
1987). Preservation of faecal continence
may be achieved by application of an ileal
(J-) pouch as a functionally passive reser-
voir after proctocolectomy (Sarmiento
and others 1997, Willis and others 2004,
2007). The potential utility of total/com-
plete colectomy with resection of the ileo-
colic junction has been also suggested,
producing an ileocolic or ileorectal anasto-
mosis (Fellenbaum 1978, Bright and
others 1986, Bertoy and MacCoy 1989).
In our study, a double layer (penetrating
and seromuscular) simple interrupted pat-
tern with 3/0 USP absorbable monofila-
ment suture material (polydioxanone,
PDS) was used for anastomosis in all dogs
according to papers reporting that appro-
priate anastomosis can be achieved by
a two-layer closure (Bright and others
1986, Barreau 1994, White 2002). How-
ever, a single-layer simple interrupted pat-
tern with polydioxanone suture material
has mostly been recommended for large
 Colectomy for acquired hypertrophic megacolon in dogs
intestinal anastomoses in cats (De Haan
and others 1992, Sweet and others 1994,
Bertoy 2002, MacPhail 2002, Holt and
Brockman 2003). The use of a simple con-
tinuous suture pattern after subtotal colec-
tomy has also been reported (Bright and
others 1986) and may not have significant
disadvantages compared with the simple
interrupted technique (Pavletic and Berg
1996). In our study, no clinical evidence
of stenosis or disruption was seen when
a handsawn double layer (penetrating and
Lembert) of simple interrupted sutures
was used. In this context, the extremely
increased diameter of the colon may pre-
vent the two-layer technique from causing
a remarkable stricture. Although one dog
(no. 6) died of diffuse septic peritonitis
on the fifth postoperative day, suture insuf-
ficiency was not seen at necropsy. The sur-
gical stapling technique to create a circular
two-layer inverting end-to-end anastomo-
sis (EEA device) has also been described
(Kudisch and Pavletic 1993, Kudisch
1994, MacPhail 2002, Holt and Brockman
2003). Alternatively, a biofragmentable
intestinal anastomosis ring may also be
used for large intestinal anastomoses, by
placing a specific ring (87
5 per cent poly-
glyconic acid plus 12
5 per cent barium sul-
phate) between the two cut ends (Barreau
1994, Huss and others 1994).
In our study, histopathological evalua-
tion revealed prominent smooth muscle
hypertrophy in the affected colon, as con-
firmed by the presence of massively thick-
ened muscle layers. Histological data in
acquired megacolon affecting small ani-
mals – especially in the dog – are scarce.
The main histopathological features of
idiopathic megacolon in cats are minor
abnormalities in smooth muscle cells or
in myenteric and submucosal neurons
(Washabau and Stalis 1996). The presence
of mucosal alterations (ulceration and
inflammatory cell infiltration) chiefly de-
pends on the duration of the process and
is affected by the type and amount of in-
gesta and the bacterial population. In a
previous study, colonic biopsies of four
cats undergoing subtotal colectomy be-
cause of idiopathic megacolon revealed
mucosal fibrosis with diffuse, chronic mild
colitis, severe submucosal congestion and
focal chronic ulcerative colitis with com-
pensatory muscle hyperplasia (Bright and
Journal of Small Animal Practice
Vol 49
December 2008
Ó 2008 British Small Animal Veterinary Association
others 1986). A human study reviewing
894 cases of megacolon disclosed the pres-
ence of mucosal ulcers, mucosal hyperpla-
sia and chronic inflammation (Garcia and
others 2003). Altered contractile proteins
and neural innervation in idiopathic mega-
rectum and megacolon were reported in
another human study (Gattuso and others
1998). Aberrant innervation because of
traumas or autonomic ganglioneuritis
may result in megacolon in the dog (Petrus
and others 2001). In such cases, the tunica
muscularis of the affected area is either nor-
mal or thinner, respectively. In the present
study, smooth muscle hypertrophy is likely
to act as a compensatory mechanism eli-
cited by an increased resistance to hard
ingesta (fecalith) in the absence of underly-
ing neurogenic or orthopaedic diseases.
Nevertheless, the contribution of low-
grade chronic obstructive disease to the
development of megacolon cannot entirely
be ruled out.
Although the major causes of acute post-
operative complications such as infection,
haemorrhage, ischaemia or obstruction
(Barreau 1994) did not occur in our study,
one dog died of septic peritonitis. Notably,
the microbiological examination revealed
E. coli contamination. The strain was sen-
sitive to amoxicillin and clavulanic acid. As
during surgery for megacolon a massive
bacterial invasion of the operating site
may occur, postoperative drainage can be
considered (Holt and Brockman 2003).
No definite data on time, indication and
methods for abdominal drainage are cur-
rently available even in colorectal surgery
in human beings. Human surgeons gener-
ally use abdominal lavage and drains as
a second stage procedure when anastomosis
leakage or peritonitis occur (Faranda and
others 2000, Chouillard and others
2007). It should be noted, however, that
the effectiveness of intraoperative drainage
have been questioned (Merad and others
1998, Yeh and others 2005). The therapeu-
tic efficacy and complications of abdomi-
nal drainage in canine colorectal surgery
has not been adequately addressed. In
any case, we have no clear evidence that
the drain may exert beneficial effects by
preventing septic complications. Never-
theless, the possibility of ascending con-
tamination through the abdominal drain
cannot be ruled out.
The remaining seven dogs were dis-
charged in improved clinical conditions
and defecating liquid stools six to eight
times a day. According to the results of
telephone interviews with the owners, the
long-term effectiveness of subtotal colec-
tomy with preservation of the ileocolic
junction in canine megacolon seems prom-
ising. Normal or nearly normal defecation
(passage of faeces of normal consistency
two to three times a day) was achieved
within five to 10 weeks. No complications
similar to those reported in cats – recur-
rence of constipation, weight loss, constant
diarrhoea, tenesmus or rectal bleeding
(White 2002) – were seen in this study.
In a previous study, the enteric function
of four cats undergoing subtotal colectomy
for megacolon was compared with that of
four normal cats. Cats treated surgically
were healthy and thriving and, in general,
enteric function was similar to that of con-
trols. Bowel movements occurred only
slightly more frequently, with no signifi-
cant differences in faecal volume or water
content. The results of this study did not
provide evidence of an abnormal subclini-
cal bowel function occurring in cats after
subtotal colectomy (Gregory and others
1990). These data are in keeping with
our present findings. Accordingly, in our
study all dogs regained good physical con-
ditions, and all are still alive at a mean of
40
5 months after surgery.
In conclusion, this study suggests that an
exclusively bony diet in combination with
low levels of physical activity may pre-
dispose dogs to acquired hypertrophic
megacolon. Our results emphasise the
long-term effectiveness of subtotal colec-
tomy with preservation of the ileocolic
junction in this condition.
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