1887

The small intestine

image of The small intestine
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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. 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.
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7.3 Small intestinal obstruction.
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7.4 Small intestinal strangulation.
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7.7 Radiographic diagnosis of small intestinal obstruction. (Reproduced from with permission from the )
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7.8 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.
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7.11 Necrotic appearance of the intestines in a cat following an intussusception and strangulation.
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7.12 Enterotomy with suspected necrotic areas later converted to enterectomy.
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7.13 Sutured enterotomy.
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7.14 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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7.15 Plication of small intestines containing a linear foreign body.
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7.16 Intussusception. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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7.17 Intussusception at the enterocolic junction in a cat (arrowed).
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7.18 Enteroplication.
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7.19 Volvulus following intussusception and enteroplication in a dog. (Reproduced from with permission from the
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7.20 Severe mesenteric volvulus. The bowel is strangulated and necrotic. (Courtesy of B. Stanley)
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7.21 Mass resected with 4–8 cm margins.
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Image of 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. 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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Image of 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. Use of a skin biopsy punch to take a full-thickness circular biopsy sample.
Image of 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. Linear foreign body in the stomach (left) and pylorus of a dog. The intestines are plicated.
Image of 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. 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.
Image of 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. 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.
Image of 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. 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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Image of 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. 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.
Image of 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. 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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Image of Enterectomy completed with simple interrupted sutures.
Enterectomy completed with simple interrupted sutures. Enterectomy completed with simple interrupted sutures.
Image of 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. 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.
Image of 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. 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.
Image of 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. The small and large intestine have been transected between the bowel clamps. Note the swab under the intestine to prevent abdominal contamination.
Image of 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. 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.
Image of 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. 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.
Image of 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. 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.
Image of 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. After firing the stapler, residual tissue has been resected by cutting along the stapler.
Image of Complete staple line closing the intestinal lumen.
Complete staple line closing the intestinal lumen. Complete staple line closing the intestinal lumen.
Image of 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. A stay suture has been placed at the opposite end of the completed anastomosis for additional security, although this is not necessary.

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