This document discusses various gastrointestinal surgical procedures in veterinary medicine. It covers topics such as gastric and abomasal ulcers, gastric dilatation and torsion, gastric neoplasms, bloat, and rumen fistulation and rumenotomy. Diagnostic techniques including radiography, endoscopy, and ultrasound are mentioned. Surgical treatments including gastrectomy, pyloroplasty, and rumenostomy are summarized. The document provides an overview of common gastrointestinal surgical conditions and procedures in large animals.

1. • Veterinary Gastrointestinal surgery
• Presented by
• Dr. Rekha Pathak
• Senior scientist , IVRI
The photographs have been collected from
different sources i.e. Internet, text books
etc

2. Gastric ulcer / Abomasal ulcer:
• assoc. with chronic renal
/ hepatic
• mast cell neoplasia
• gastrin producing
neoplasia
• gastric neoplasia
• coagulation disorder
• FB / gun shot wound
• ICH

3. • Uremia
• Poison
• Snakebite
• Primary ulcers are
less common
• Ulcers secondary –
common
• Aspirin:
experimentally to
produce ulcers

4. • Pathophysiology:
• Gastric/ duodenal
mucosa/ covered
with mucus layer
(sulfated mucin
bound to epi. cells)

5. • Offers protection –
against – corrosive
/ digestive effects
of gastric acid and
pepsin (auto
digestion and
ulceration)

6. • Reduced mucosal
bl. Flow- local
ischemia – sepsis/
hemorrhagic shock
– sudden expulsion
of apical mucin –
circumscribed popn
of cells

7. • Reflux of bile salts
from duodenum to
stomach – bile salts –
more destructive than
pancreatic juices- act
as detergents that
solubilize lipid - cell
memb and inhibit the
ion transport sys.

8. • bile content – greatest – pyloric antrum –
ulcer region of stomach
• hyper secretion of HCL
– gastrinoma ie non beta islets cell tumour of
pancreas and hypergastinemia
– in renal failure (gastrin is removed by
kidneys)

9. – increased histamine: mastocytoma and Endotoxemia
and hemorrhagic shock
– NSAIDS- reduced secretion of mucus
• alters the biochemical composition of mucin
• ingestion of chemicals(arsenic ,cresote)
• Signs: vomiting (not immediately after
ingestion)
• eating – gastric pain- relieved by vomiting
• Hemet emesis and melena
• slow bleeding: coffee colored blood
• sudden - massive and semi clotted blood

10. • generalized peritonitis: gastric perforation
(mostly doesn’t occur due to effective sealing
with omentum)
• wt. loss – hepatic/ neoplastic
• additionally in calves : due to bleeding ulcers –
recumbent suddenly – cold extremity- subnormal
temp. tachycardia and dehydration- hypovolemic
shock and death 24 hrs

11. • Abomasal ulcers :
suckling calves and
adult cattle
(buffaloes)
• adult: 1st few wks of
partu.(stress and
lactation)
• Stress related
(summer months
independent of
partu.)

12. • Calves: dietary
transition from low
DM to high DM
• Trichobezoars
• Asso. With impaction
also

13. • Type I erosion and
ulcers with slight
hemorrhage
• Type II bleeding
ulcers
• Type III perforation
with acute
circumscribed
peritonitis
• Type IV perforation
with diffuse peritonitis

14. • Diagnosis:
• TRP ; pain on left
of xiphoid
• Abomasal ulcer:
pain on rt. side

15. • RG: double contrast:
create
pneumoperitoneum
and give barium
meal
• Barium: ulcers appear
as outpouchings from
lumen containing the
contrast material

16. • Fluoroscopy: helps in variable
positioning and pin point the site

17. • Endoscopy: not
in threatened
bleeding cases
(allows biopsies)
• Exploratory:
laparotomy if life
threatening
hemorrhage

18. Treatment
• Surgical excision
• Cranial midline incision
• Carefully palpate from fundus to pylorus
• If ulcers then – adhesion, serosal scarring
and irregular thickened areas on gastric
wall

19. • Inspect the
pancreas-
gastrinoma- p.
nodules
• If gastrinoma- en
block resection of a
lobe or complete
pancreas(90%
removal – no
endocrinal
insufficiency)

20. • If no ulcers found
• Open stomach- find the bleeding site- also
on pyloric antrum(equidistant from lesser /
greater curvature)
• Extend to duodenum if necessary

21. • Small ulcers :
elliptical incision-
mucosa closed –
simple continuous
– 3/0 or 4/0
absorbable chromic
and interrupted
Lambert on serosa
and muscularis
• Multiple ulcers on
pyloric part –
bilroth I
gastrectomy
technique

22. • Bilroth technique I :
ligate the rt. Gastric
artery near pylorus on
the lesser curvature
• Rt. Gastroepiploic
vessels ligated
• Take care not to injure
the pancreas
• Pyloric and gastric
branches supplying the
area to be resected are
ligated

23. • 2 st. intestinal
clamps are placed
across the pyloric
antrum
• another 2 are
placed distal to the
pylorus and avoid
the common bile
duct.
• Excise the pyloric
sphincter and canal

24. • Gastric mucosa is
apposed with 3-0
synthetic
absorbable suture
in an Cushing
pattern starting
from the lesser
curvature and
continuing towards
the greater
curvature

25. • Equal in size to the
duodenal dia
• Apposed – 3-0 –
synthetic absorbable,
polypropylene, or
nylon – lamberts
pattern
• Duodenum is then
anastamosed with
stomach

26. Gastric acute dilatation and
torsion
• Gastric dilatation-
volvulus (GDV)
• Only dilation common
in puppies
• Overeating/
parasitism
• Larger and giant
breeds – deep
chested

27. • Overeating –
relieved by induced
vomiting or passing
stomach tube
• Parasitism
• Pica
• Postprandial
activity
• Delayed gastric
emptying-
pyloromyotomy

28. • Pathophysiology
• Rotation after dilation
• Aerophagia – source
of intragastric gas
• Distended stomach
(gas + fluid) – more
prone to rotation
• Prevents eructation –
esophagus and
emptying from
duodenum
• Distension increases

29. •Presses the caudal vena/ portal vein –
reduced venous return – red. CO. –
red. Tissue perfusion and shock
•Ischemic bowel – release toxins-
endotoxemia-shock and hypotension
•Red. Ventilation- pressure on
diaphragm

30. • Acid base and electrolyte disturbance
• Myocardial ischemia
• Rotation of stomach – strangulation
of gastric vessels- edema and anoxia
–gastric wall ulceration and necrosis

31. • Clinical signs
• Acute onset of cranial abd. Distention
• Vomiting
• Profuse salivation-pain
• Prolonged CRT, Pallor, weak pulse
• Shock (pooling of blood in spleen due to rotation
of splenic vessels, hypovolemia and
hypotension)
• Dyspnea

32. • RG signs: differentiate simple gastric
distension from GDV
• Gas filled stomach- 50-75% - splenic
position is normal if no volvulus
• In GDV –pylorus is located cranial/dorsal –
fundus
• Position of spleen may not be normal

33. • A tissue density line
dividing the gas filled
stomach into
compartments
• VD - pylorus is near
or near to the left of
the midline
• Gastric perforation-
pneumoperitoneum
• Clockwise 270
• Anticlockwise 90

34. • Preoperative care
• Gastric
decompression
• Needle
trocarization 18 G
needle
• Thrust on rt. Or
left wall – point of
greatest distension

35. • 2-3 needles – relieves
gas component of
distension
• Alternatively – if not
effectively reduced –
stomach
• Pass the s.tube
through mouth gag-
resistance is
encountered in gastro
esophageal junction –
rotate and advance

36. • Removal of
intragastric gas –
trocarization- corrects
the gastro esophageal
angle-allows passage
of S. tube
• Passage of st doesn’t
mean absence of g.
rotation
• Withdraw the tube
after decompression

37. • Sometimes for
decompression –
temporary Gastrotomy is
constructed
• Close the Gastrotomy
wound and proceed for
surgical correction of
rotation (Decompression
doesn’t always result in
normal gastric position)
• Shock therapy

38. • Surgical correction of volvulus
• If surgery is delayed – gastric necrosis worsens
• Reposition the stomach by derotating it
• Avoid injury to splenic v. (digital palpation of
esophagus reveals the direction of rotation
• Pylorus is a good / useful landmark – firm
consistency)
• See the viability of gastric tissue – necrosed
and non-viable – esp. the greater curvature is
damaged

39. • Serosal color,
thickness of wall and
vascular patency
• Partial gastrectomy
• Hemoperitoneum -
centesis of abdominal
cavity- splenic torsion
and gastric torsion
• Blue-black
areas/diffuse
petechial /ecchymotic
stomach- gastrectomy
not indicated –
becomes normal after
decompression

40. • Spleenectomy – damaged
• Gastropexy- red. Rate of
GDV
• Pyloric antral region is
fixed to the adjacent rt.
abdominal wall
• Gastropexy is always
performed on the rt. Side
of the stomach – some
rotation – still occur-
bet.left gastric wall and
left abd.wall

41. G. neoplasm
• Avg. age 8 y
• Alimentary tract: oral
cavity – rarely in
stomach
• Persistent vomiting
unrelated to eating

42. •Within the antrum on the lesser
curvature
•Metastasis: liver, lungs, spleen
•Leiomyoma/
rhabdomyosarcoma/polyps
(solitary or multiple)

43. • Polyps – due to
sharp fragment of
bones- resting for
long in antrum -
injure mucosa –
herniation of sub
mucosa
• Clinical signs;
anorexia

44. • Loss of wt.
Obstructing
gastric out flow
• Normal
peristalsis is
interfered
• Anemia
• Abd. Pain

45. • Emesis unrelated to
ingestion of food /water
• Melena
• palpation
• Exploratory laparotomy

46. • RG: contrast – filling
defect

47. • Endoscope
• Ultrasonography
• Adenocarcinoma:
most common
• Sex predilection for
males
• Treatment
• Chemotherapy: not
successful

48. • Surgical
• Gastrectomy: Partial
gastrectomy is done
• Removal of any portion of
the stomach and up to (30-
40%) in antrectomy
• Partial gastrectomy – 40-
70%
• Subtotal gastrectomy : 70-
90%
• Antrectomy: reconstruction-
gastroduodenostomy
(bilroth I ) or
gastrojejunostomy(II)

49. • Two variations of partial
gastrectomy
• A-C : stay sutures are
placed to elevate the
stomach and to minimize
leakage
• Necrotic tissue is excised
with a rim of viable tissue
• A two layer inverting
closure is used
• D-I : atraumatic forceps
are placed across viable
tissue and necrotic tissue
is excised

50. • The stomach body is
subsequently closed with
a parker- Kerr line
• The first inverting layer
suture is placed over the
clamps
• Remove clamps, pull and
invert the suture line
• Second inverting suture
row

51. • End to end
anastomosis of
stomach

52. • Bilroth II –
performed if more
radical gastrectomy
is required, if there
is excessive
duodenal
involvement or
both

53. Bloat
• Bloat : Major problems- GIT – cattle and
buffaloes
• Higher in buffaloes
• Acute/chronic
• Gaseous bloat – free gas - dorsal part of
rumen
• Frothy bloat – gas trapped with ingesta-
dispersed throughout the rumen content

54. • Acute: rapid feeding and sudden diet
change – large ruminants
• s. ruminants – large quantities of grain
ingestion/cereals
• More pressure on diaphragm –
hypoventilation and red. Venous return to
the heart

55. • signs: bulge on Para lumbar fossa
• Abdominal distension
• Cyanotic mm
• v. serious – lying down – asphyxiated –
open mouth- protruded tongue and
tachycardia

56. • Treatment: puncture wall – left side with
trocar and canula
• if frothy – antifoaming agents – turpentine
oil (80ml) + mustard oil (500-1000 ml)
• antifroth prepn. – bloatosil
• gives immediate relief to ailing animal
• avoid conc. – 2-3 days and leguminous
fodder

57. • Resort to rumenotomy / rumenostomy
• S. animal: IV- RL or oral soda bicarb
• Chronic bloat: TRP (FBS) – reticuloperitonitis/
fibrinous pneumonia – pleuritis involving the
vagus nerve
• Liver abscess, splenic cyst and abscess, enlarged
mediastinal lymph nodes, pyloric stenosis
• Rumen fistulation / rumenotomy can be done

58. • Rumen fistulation:
• Anesthesia and
surgical prepn.:
standing position
• Sternal recumb. –
Camel
• Left Para lumbar
fossa
• Circular area – ventral
to transverse process
of lumbar vertebrae-
approx 10 cm dia.-
infiltrated

59. • A circular piece of
skin (4cm) –
removed to expose
the underlying
abdominal mus.
• Bluntly dissect and
expose rumen –
grasp – pulled in a
cone fashion to the
skin surface

60. • Anchor with 4
horizontal
mattress suture
through rumen
and skin

61. • Remove central
portion of rumen
• Incised edge of
rumen is sutured to
the skin with simple
interrupted and non-
absorbable
• Alternately – all the
layers – apply
interrupted mattress
sutures in circular rim

62. • Rumenotomy:
• Indications: FB,
ruminal impaction,
bloat, atony of
omasum or
abomasum
• Inverted L – block
• Local infiltration
along line of
incision

63. • Para vertebral
block
• Surgical technique:
20 cm incision-
middle of tuber
coxae and last rib
5 cm ventral to
lumbar process

64. • Caudal to last rib
(close to reticulum)
• Esp. in deep
bodied animals

65. • Anchor rumen to
the incision to
avoid
contamination of
abdominal m. and
peritoneum

66. • Continuous inverting
pattern – non-
absorbable

67. • Alternatively use
weingarts ring
(quicker)
• Incise rumen with
scalpel

68. • Evacuate and
explore for FB in
reticulum and
remove
• Try to feel for
abscess in reticular
area
• Reticulum is swept
with a magnet to
retrieve the iron FB
• Rumen cud + soda
bicarb= mineral oil

69. • Scrub and discard the
soiled instruments
• Close with double row
of lamberts or
inversion sutures
• Antibiotic and fluid
therapy