The use of a vascularized pedicle jejunal graft to treat the dehiscence suture of trans anal pull trought trough a combined approach, in two dog
Collivignarelli F.1,2 Tamburro R. Vignoli M.2
1,CVRS Policlinico Veterinario Roma Sud Rome, Italy, 2,Faculty of Veterinary Medicine – University of Teramo, Teramo, Italy.
Jejunal grafting was used to repair a large defect for dehiscence suture after a trans anal pulltrought for colon
and rectal carcinoma through a combined approach .
Material and methods
The animal was positioned in dorsal recumbency, and both the ventral
abdomen and the perineal area prepared for surgery. A ventral midline
abdominal approach was performed first, from xiphoid to pubis.
Findings included a moderate amount of peritoneal effusion.The colon
was evident with suture dehiscence. Initially, primary closure of the
colon with recto was attempted using 4-0 PDS in a simple interrupted
pattern. This resulted in a tension on the closure that resulted in sutures
tearing through the tissues. To decrease tension, a jejunal grafting
technique was utilized. A 5-cm segment of healthy jejunum, including
jejunal artery and vein, was isolated and mobilized from the middle of
the jejunum. The graft harvest site was anastomosed using 4-0 PDS in
simple continuous appositional patterns. The jejunal segment was
transposed, and sutured in place with 4-0 PDS in a simple interrupted
pattern in the cranial colon portion. The rectal portion was hard to
scarify by this approach even if bilateral ischiopubic osteotomy was
performed. A doyenne clamp was push inside abdomen by anus, and
the caudal aspect of jejunal graft was push out the perineal. The
abdomen was lavaged with 5 L of sterile saline and a Jackson Pratt
drain was placed in the peritoneal cavity prior to closure. The abdomen
is closed routinely. The dog is then positioned in sternal recumbency. A
trans anal rectal jejunal anastomosis was done. using 4-0 PDS in
simple continuous appositional patterns. The dog received intensive unit care for three days.
The dog was hospitalized with a Jackson-Pratt drain for the following 4 d. The drain was removed based on
decreased production and cytologic evaluation of the abdominal fluid. The dog was discharged 5 d following
the surgery. Medications prescribed included amoxicillin/clavulanate potas- sium (14 mg/kg BW, PO, q12h)
and enrofloxacin (6.8 mg/kg BW, PO, q24h)
results There were no major intraoperative complications. Surgical times were 125 and 110 minutes,
respectively. Diarrea was seen for three days. No fecal incontinence was seen both in the short and long-term
The suture deischence after pull trought is a severe
complication can to die or euthanasia for severe peritonite.
the strategy to treat this condition are a surgery revision
with colostomy temporary or permanent. The use of a
vascularised pedicle jejunal is a good alternativee to treat a
suture dehiscence. This case represents the novel use of a
jejunal graft for successful repair of a severe deiscente after
trans anal pulltrought to treat a rectal colon
adenocarcinoma. It is clear the septic peritonitis that
developed after the initial procedure was due to suture
leakage The leakage was seen in the revision surger too.
The results support the use of this technique as a
potential method to maintain treat a suture deiscente.