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The small intestine
/content/chapter/10.22233/9781910443248.chap7
The small intestine
- Author: Alison Moores
- From: BSAVA Manual of Canine and Feline Abdominal Surgery
- Item: Chapter 7, pp 104 - 138
- DOI: 10.22233/9781910443248.7
- Copyright: © 2015 British Small Animal Veterinary Association
- Publication Date: November 2015
Abstract
Surgery of the small intestine is commonly performed in small animals. Both the oesophagus and stomach are larger and more distensible than the small intestine, so foreign bodies are more likely to become lodged in the small intestine, particularly the duodenum and jejunum. This chapter covers anatomy, diagnostic and surgical techniques, surgical conditions and postoperative care. Operative techniques: Approach to small intestinal surgery; Enterotomy for removal of a solid foreign body; Small intestinal biopsy; Combined gastrotomy and enterotomy for removal of a linear foreign body; Enterectomy and anastomosis (sutured anastomosis); Functional end-to-end anastomosis using surgical staples; Reduction of intussusception and enteroplication; Omentalization of the small intestine.
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Figures
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7.1
Blood supply to the small intestines. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2015 British Small Animal Veterinary Association
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7.1
Blood supply to the small intestines. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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Small intestinal obstruction. © 2015 British Small Animal Veterinary Association
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Small intestinal obstruction.
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Small intestinal strangulation. © 2015 British Small Animal Veterinary Association
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Small intestinal strangulation.
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Radiographic diagnosis of small intestinal obstruction. (Reproduced from
Graham et al. (1998)
with permission from the Journal of Small Animal Practice) © 2015 British Small Animal Veterinary Association
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Radiographic diagnosis of small intestinal obstruction. (Reproduced from
Graham et al. (1998)
with permission from the Journal of Small Animal Practice)
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Simple appositional suture pattern. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2015 British Small Animal Veterinary Association
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Simple appositional suture pattern. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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7.9
Modified Gambee suture. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2015 British Small Animal Veterinary Association
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Modified Gambee suture. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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Necrotic appearance of the intestines in a cat following an intussusception and strangulation. © 2015 British Small Animal Veterinary Association
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Necrotic appearance of the intestines in a cat following an intussusception and strangulation.
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Enterotomy with suspected necrotic areas later converted to enterectomy. © 2015 British Small Animal Veterinary Association
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Enterotomy with suspected necrotic areas later converted to enterectomy.
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Sutured enterotomy. © 2015 British Small Animal Veterinary Association
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Sutured enterotomy.
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Final positioning for a jejunostomy tube. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2015 British Small Animal Veterinary Association
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Final positioning for a jejunostomy tube. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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Plication of small intestines containing a linear foreign body. © 2015 British Small Animal Veterinary Association
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Plication of small intestines containing a linear foreign body.
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Intussusception. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2015 British Small Animal Veterinary Association
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Intussusception. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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Intussusception at the enterocolic junction in a cat (arrowed). © 2015 British Small Animal Veterinary Association
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Intussusception at the enterocolic junction in a cat (arrowed).
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Enteroplication. © 2015 British Small Animal Veterinary Association
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Enteroplication.
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Volvulus following intussusception and enteroplication in a dog. (Reproduced from
Jasani et al. (2005)
with permission from the Journal of Small Animal Practice)
© 2015 British Small Animal Veterinary Association
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Volvulus following intussusception and enteroplication in a dog. (Reproduced from
Jasani et al. (2005)
with permission from the Journal of Small Animal Practice)
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Severe mesenteric volvulus. The bowel is strangulated and necrotic. (Courtesy of B. Stanley) © 2015 British Small Animal Veterinary Association
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Severe mesenteric volvulus. The bowel is strangulated and necrotic. (Courtesy of B. Stanley)
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Mass resected with 4–8 cm margins. © 2015 British Small Animal Veterinary Association
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Mass resected with 4–8 cm margins.
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Use of a scalpel blade to take a full-thickness elliptical biopsy sample: 3–4 mm wide and 5–10 mm long. An assistant’s fingers are occluding the intestine orally and aborally.
Use of a scalpel blade to take a full-thickness elliptical biopsy sample: 3–4 mm wide and 5–10 mm long. An assistant’s fingers are occluding the intestine orally and aborally. © 2015 British Small Animal Veterinary Association
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Use of a scalpel blade to take a full-thickness elliptical biopsy sample: 3–4 mm wide and 5–10 mm long. An assistant’s fingers are occluding the intestine orally and aborally.
Use of a scalpel blade to take a full-thickness elliptical biopsy sample: 3–4 mm wide and 5–10 mm long. An assistant’s fingers are occluding the intestine orally and aborally.
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Use of a skin biopsy punch to take a full-thickness circular biopsy sample.
Use of a skin biopsy punch to take a full-thickness circular biopsy sample. © 2015 British Small Animal Veterinary Association
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Use of a skin biopsy punch to take a full-thickness circular biopsy sample.
Use of a skin biopsy punch to take a full-thickness circular biopsy sample.
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Linear foreign body in the stomach (left) and pylorus of a dog. The intestines are plicated.
Linear foreign body in the stomach (left) and pylorus of a dog. The intestines are plicated. © 2015 British Small Animal Veterinary Association
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Linear foreign body in the stomach (left) and pylorus of a dog. The intestines are plicated.
Linear foreign body in the stomach (left) and pylorus of a dog. The intestines are plicated.
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The stomach has been isolated with laparotomy swabs and stay sutures. A gastrotomy has been performed and the gastric portion of the foreign body is being removed.
The stomach has been isolated with laparotomy swabs and stay sutures. A gastrotomy has been performed and the gastric portion of the foreign body is being removed. © 2015 British Small Animal Veterinary Association
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The stomach has been isolated with laparotomy swabs and stay sutures. A gastrotomy has been performed and the gastric portion of the foreign body is being removed.
The stomach has been isolated with laparotomy swabs and stay sutures. A gastrotomy has been performed and the gastric portion of the foreign body is being removed.
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Enterotomy of the small intestine to remove the residual linear foreign body. Note the intestine has been isolated from the abdomen and swabs have been placed in a layered fashion to contain the spillage of intestinal contents.
Enterotomy of the small intestine to remove the residual linear foreign body. Note the intestine has been isolated from the abdomen and swabs have been placed in a layered fashion to contain the spillage of intestinal contents. © 2015 British Small Animal Veterinary Association
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Enterotomy of the small intestine to remove the residual linear foreign body. Note the intestine has been isolated from the abdomen and swabs have been placed in a layered fashion to contain the spillage of intestinal contents.
Enterotomy of the small intestine to remove the residual linear foreign body. Note the intestine has been isolated from the abdomen and swabs have been placed in a layered fashion to contain the spillage of intestinal contents.
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The intestine is being examined following removal of a linear foreign body. Note the bruising and change in intestinal colour along the mesenteric border. The presence of necrosis or any large perforations would necessitate enterectomy.
The intestine is being examined following removal of a linear foreign body. Note the bruising and change in intestinal colour along the mesenteric border. The presence of necrosis or any large perforations would necessitate enterectomy. © 2015 British Small Animal Veterinary Association
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The intestine is being examined following removal of a linear foreign body. Note the bruising and change in intestinal colour along the mesenteric border. The presence of necrosis or any large perforations would necessitate enterectomy.
The intestine is being examined following removal of a linear foreign body. Note the bruising and change in intestinal colour along the mesenteric border. The presence of necrosis or any large perforations would necessitate enterectomy.
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Intestine of different diameters. Note that the Doyen forceps on the larger diameter intestine could be moved further from the cut edge to aid suturing.
Intestine of different diameters. Note that the Doyen forceps on the larger diameter intestine could be moved further from the cut edge to aid suturing. © 2015 British Small Animal Veterinary Association
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Intestine of different diameters. Note that the Doyen forceps on the larger diameter intestine could be moved further from the cut edge to aid suturing.
Intestine of different diameters. Note that the Doyen forceps on the larger diameter intestine could be moved further from the cut edge to aid suturing.
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The mesenteric border of the smaller diameter intestine has been incised to increase the circumference and aid in suturing to the larger diameter intestine.
The mesenteric border of the smaller diameter intestine has been incised to increase the circumference and aid in suturing to the larger diameter intestine. © 2015 British Small Animal Veterinary Association
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The mesenteric border of the smaller diameter intestine has been incised to increase the circumference and aid in suturing to the larger diameter intestine.
The mesenteric border of the smaller diameter intestine has been incised to increase the circumference and aid in suturing to the larger diameter intestine.
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Enterectomy completed with simple interrupted sutures.
Enterectomy completed with simple interrupted sutures. © 2015 British Small Animal Veterinary Association
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Enterectomy completed with simple interrupted sutures.
Enterectomy completed with simple interrupted sutures.
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Perforation of the caecum due to sharp foreign bodies in the small and large intestine. Vessels to the distal small intestine, caecum and proximal large intestine have been ligated and transected.
Perforation of the caecum due to sharp foreign bodies in the small and large intestine. Vessels to the distal small intestine, caecum and proximal large intestine have been ligated and transected. © 2015 British Small Animal Veterinary Association
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Perforation of the caecum due to sharp foreign bodies in the small and large intestine. Vessels to the distal small intestine, caecum and proximal large intestine have been ligated and transected.
Perforation of the caecum due to sharp foreign bodies in the small and large intestine. Vessels to the distal small intestine, caecum and proximal large intestine have been ligated and transected.
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Two pairs of Doyen (bowel) clamps have been placed at the planned sites of transection. Note that the current position of the clamps will need to be adjusted to allow placement of the arms of the stapler. Stay sutures have been placed for manipulation of the intestine into the stapler.
Two pairs of Doyen (bowel) clamps have been placed at the planned sites of transection. Note that the current position of the clamps will need to be adjusted to allow placement of the arms of the stapler. Stay sutures have been placed for manipulation of the intestine into the stapler. © 2015 British Small Animal Veterinary Association
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Two pairs of Doyen (bowel) clamps have been placed at the planned sites of transection. Note that the current position of the clamps will need to be adjusted to allow placement of the arms of the stapler. Stay sutures have been placed for manipulation of the intestine into the stapler.
Two pairs of Doyen (bowel) clamps have been placed at the planned sites of transection. Note that the current position of the clamps will need to be adjusted to allow placement of the arms of the stapler. Stay sutures have been placed for manipulation of the intestine into the stapler.
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The small and large intestine have been transected between the bowel clamps. Note the swab under the intestine to prevent abdominal contamination.
The small and large intestine have been transected between the bowel clamps. Note the swab under the intestine to prevent abdominal contamination. © 2015 British Small Animal Veterinary Association
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The small and large intestine have been transected between the bowel clamps. Note the swab under the intestine to prevent abdominal contamination.
The small and large intestine have been transected between the bowel clamps. Note the swab under the intestine to prevent abdominal contamination.
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The two cut ends of intestine have been placed with the anti-mesenteric borders adjacent to each other. Each fork of a linear cutting stapler has been placed into each lumen of intestine.
The two cut ends of intestine have been placed with the anti-mesenteric borders adjacent to each other. Each fork of a linear cutting stapler has been placed into each lumen of intestine. © 2015 British Small Animal Veterinary Association
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The two cut ends of intestine have been placed with the anti-mesenteric borders adjacent to each other. Each fork of a linear cutting stapler has been placed into each lumen of intestine.
The two cut ends of intestine have been placed with the anti-mesenteric borders adjacent to each other. Each fork of a linear cutting stapler has been placed into each lumen of intestine.
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After firing the stapler, an anastomosis has been formed between the two segments of intestine. The staple lines will be offset from each other when the next stapler is placed to avoid them healing together and closing or narrowing the anastomosis.
After firing the stapler, an anastomosis has been formed between the two segments of intestine. The staple lines will be offset from each other when the next stapler is placed to avoid them healing together and closing or narrowing the anastomosis. © 2015 British Small Animal Veterinary Association
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After firing the stapler, an anastomosis has been formed between the two segments of intestine. The staple lines will be offset from each other when the next stapler is placed to avoid them healing together and closing or narrowing the anastomosis.
After firing the stapler, an anastomosis has been formed between the two segments of intestine. The staple lines will be offset from each other when the next stapler is placed to avoid them healing together and closing or narrowing the anastomosis.
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A linear stapler has been placed across the open ends of the intestine. The stay sutures have been used for manipulation to ensure the intestinal wall is fully incorporated in the stapler. A linear cutting stapler could be used, but the first line of staples may impede cutting by the blade.
A linear stapler has been placed across the open ends of the intestine. The stay sutures have been used for manipulation to ensure the intestinal wall is fully incorporated in the stapler. A linear cutting stapler could be used, but the first line of staples may impede cutting by the blade. © 2015 British Small Animal Veterinary Association
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A linear stapler has been placed across the open ends of the intestine. The stay sutures have been used for manipulation to ensure the intestinal wall is fully incorporated in the stapler. A linear cutting stapler could be used, but the first line of staples may impede cutting by the blade.
A linear stapler has been placed across the open ends of the intestine. The stay sutures have been used for manipulation to ensure the intestinal wall is fully incorporated in the stapler. A linear cutting stapler could be used, but the first line of staples may impede cutting by the blade.
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After firing the stapler, residual tissue has been resected by cutting along the stapler.
After firing the stapler, residual tissue has been resected by cutting along the stapler. © 2015 British Small Animal Veterinary Association
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After firing the stapler, residual tissue has been resected by cutting along the stapler.
After firing the stapler, residual tissue has been resected by cutting along the stapler.
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Complete staple line closing the intestinal lumen.
Complete staple line closing the intestinal lumen. © 2015 British Small Animal Veterinary Association
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Complete staple line closing the intestinal lumen.
Complete staple line closing the intestinal lumen.
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A stay suture has been placed at the opposite end of the completed anastomosis for additional security, although this is not necessary.
A stay suture has been placed at the opposite end of the completed anastomosis for additional security, although this is not necessary. © 2015 British Small Animal Veterinary Association
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A stay suture has been placed at the opposite end of the completed anastomosis for additional security, although this is not necessary.
A stay suture has been placed at the opposite end of the completed anastomosis for additional security, although this is not necessary.