Rectal And Anal Surgery

Question 1

Rectal prolapse is secondary to ________ which an indicate rectal, anal, or urogenital disease

Answer 1

Tenesmus

Question 2

DDX for rectal prolapse

Answer 2

Prolapsed intussusception

Question 3

How can you test for rectal prolapse vs intussusception ?

Answer 3

Probe test
- passed between the border of the anus and protruding mass

• if probe can be passed = intussusception (Surgical emergency)

Question 4

Treatment for rectal prolapse?

Answer 4

Identify underlying cause

Reduce and place purse-string suture if viable — maintain for 3 days

Amputate if non viable

Colopexy if recurrent

Question 5

What complications can result after a rectal prolapse amputation?

Answer 5

Infection
Dehiscence
Stricture
Recurrence

Question 6

What are the indications and techniques used for colopexy?

Answer 6

Recurrent rectal prolapse
Perineal hernia

Suture technique - absorbable/nonabsorbable suture material

Incisional colopexy - absorbable suture material

Question 7

How is an incisional colopexy preformed?

Answer 7

Descending colon - apply traction
Incision through seromuscular layer of colon and transversus abdominus of body wall

Can perform in more than one spot on descending colon

Question 8

What are the benign colorectal tumors ?

Answer 8

Adenomatous polyp
Leiomyoma
Fibroma

Question 9

What are the malignant colorectal tumors?

Answer 9

Adenocarcinoma
Leiomyosarcoma
Lymphosarcoma

Question 10

Clinical signs of rectal adenoma?

Answer 10

Hematochezia
Tenesmus/dyschezia
Visible mass —> Polyploid/sessile/ multiple

Question 11

How can you diagnose rectal neoplasia?

Answer 11

Observe/palpate mass
Proctoscopy/colonoscopy
Biopsy - incisional vs excisional

Question 12

What are the possible approaches for surgical excision of colorectal neoplasia?

Answer 12

Transanal —> lesions involving caudal rectum or anal canal

Dorsal —> lesions involving midrectal but NOT anal canal

Rectal pull through —> distal colonic or midrectal leions not approachable through abdomen

Mucosal resection

Question 13

T/F: about 50% of colorectal adenocarcinomas are abdominal

Answer 13

True

Mets to regional lymph node and liver

Question 14

The transanal approach is limited to the caudal ______cm of the rectum. What type of analgesic can you do

Answer 14

4-6

Question 15

Complications from rectal surgery?

Answer 15

Dehiscence
Infection
Stricture
Incontinence — sphincteric or sensory

Question 16

What are disease of the anal sacs?

Answer 16

Anal sac impaction
Anal sacculitis
Anal sac abscess

Question 17

How are infected/accessed anal sacs managed ?

Answer 17

Anal sacculectomy (open or closed technique)

Question 18

How is a closed anal sacculectomy done? When would you use this technique ?

Answer 18

Blunt probe or instrument
Paraffin injection
Catheter

Use for tumors, infected glands

Question 19

How is an open anal sacculectomy done? When is this indicated?

Answer 19

Insert one blade of scissors into sac

Apply upward pressure to tops to miniseries tissue cut
OR
Insert groove director/probe through duct into anal sac

Incise over instrument with caudal tension on instrument to minimize damage to sphincter
Dissect anal sac from anal sphincter

Question 20

Complications to anal sacculectomy?

Answer 20

Infection

Draining tracts
- incomplete removal of anal sac (must excise to resolve)

Fecal incontinence

Question 21

What are the perineal tumors?

Answer 21

Persian a gland tumor —>adenoma/adenocarcinoma

Question 22

Adenoma are common in male intact dogs.. how would you treat and what is the prognosis?

Answer 22

Castration and resection

Good prognosis

Guarded to poor for malignant

Question 23

What is the tumor of the anal sac and what paraneoplasic syndromes are associated?

Answer 23

Apocrine gland adenocarcinoma

Paraneoplasic hyperCa
PU/PD
Renal failure

Question 24

Perianal fistulas are most common in what breed and what is the most likely EDX?

Answer 24

GSD

Immune mediated

Question 25

How are perianal fistulas managed?

Answer 25

Diet: IBD can predisposed
Cyclosporine
+/- ketoconazole, glucocorticoids, tacrolimus, azathioprine, metronidazole

Surgical interventions ONLY if un responsive to medical management