Intestinal surgery is commonly performed in dogs for a variety of diagnostic and therapeutic indications, although these procedures more commonly involve the small intestine than the large intestine.1–3 In 1 study3 of gastrointestinal surgeries performed in dogs at a single hospital, only 19 of 225 identified surgeries involved the large intestine. Although infrequently reported, large intestinal surgery is often considered for dogs with obstructive foreign bodies, neoplasia, and intussusception.3–6 In 1 study,6 foreign bodies found in the colon at the time of surgery accounted for 9 of 208 (4%) discrete foreign bodies detected throughout the gastrointestinal tract. The large intestine is a relatively common site for tumor development, accounting for 58 of 160 (36%) to 96 of 160 (60%) intestinal tumors in previous studies7–9 of dogs, with adenocarcinoma being the most common nonhematopoietic neoplasm diagnosed. Intussusceptions can occur in dogs of various ages, and sometimes occur secondary to other processes such as neoplasia and foreign bodies. Intussusception is often found at the ileocolic junction, and surgical treatment is indicated to remove abnormal tissue and restore intestinal motility.4,10–12 Large intestinal surgery may also be performed as treatment for colonic torsion; strictures; colonic duplication; colonic, cecal, and rectal perforations; and cecal inversion.13–17 These disorders often require surgical intervention to allow resection of diseased or devitalized tissue and alleviation of clinical signs, and these procedures often result in enterocolic, colocolic, or colorectal anastomoses.7,18,19
Full-thickness small and large intestinal incisions in dogs have reported dehiscence rates of 28 of 225 (12%) to 42 of 295 (14%).1,3,20 Reported risk factors for intestinal dehiscence, in general, include preexisting septic peritonitis, hypoalbuminemia, intraoperative hypotension, and presence of an intestinal foreign body.1–3,21 In addition, administration of corticosteroids in dogs undergoing surgery of the large intestine was associated with failure to survive in 1 report.3 The consequences of intestinal dehiscence can be devastating, with mortality rates after intestinal dehiscence in dogs and subsequent septic peritonitis found to be as high as 22 of 29 (76%) to 11 of 13 (85%).1,2,20,21 It has been theorized that dehiscence is more likely to develop in small animal patients after surgery of the large intestine than after surgery of the small intestine because of the poor collateral blood supply, high intraluminal pressure during passage of fecal boluses, and high bacterial load in the large intestine.22 Dehiscence rates following surgery of the large intestine are infrequently reported in the veterinary literature. In 1 retrospective study3 performed to evaluate risk factors for peritonitis and death after gastrointestinal surgery, 19 of 197 dogs had surgery involving the large intestine, and of those 19, 6 developed septic peritonitis.
In people, results of large investigations and meta-analyses indicate that rates for development of intestinal leakage following anastomoses involving the colon and rectum range from 3.8% to 23%; this factor is associated with a mortality rate of approximately 12.9%,23–26 and the proportion of human patients with subclinical leakage detected with diagnostic imaging may be as high as 50%.27,28 The incidence of subclinical anastomotic leakage in dogs has not been reported to the authors’ knowledge.
There is a paucity of information available in the veterinary literature on colon surgery requiring full-thickness incisions and the risk factors associated with dehiscence and death in patients undergoing these procedures. The objectives of the study reported here were to determine the overall complication rate after full-thickness large intestine incisions in dogs at 4 veterinary referral facilities, to assess potential risk factors for death during initial hospitalization and intestinal dehiscence following these surgeries, and to report short-term mortality rates (up to 7 days after surgery) for these patients. We hypothesized that the dehiscence and mortality rates following full-thickness incisions of the large intestine would be similar to those reported elsewhere1–3,21 for small intestinal surgery.
The authors thank Dr. Sarah Roberts for assistance in data accumulation; Dr. Roberts’ participation was supported by the University of Tennessee Center of Excellence Summer Research Experience.
The authors declare that there were no conflicts of interest.
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