Abdominal Exploratory Surgery


Key Points

Abdominal exploratory can be both a diagnostic and therapeutic procedure.  Vomiting is the primary sign of a variety of diseases affecting the GI tract.  After surgery has been completed, intensive care must be provided for the best chance for a successful outcome

Introduction

  • Surgery of the stomach or intestines is very common. Reasons for operating on the gastrointestinal tract include ingested foreign bodies, cancer, twisted intestines, intussusception, bloat, and to collect full-thickness biopsies of the intestines. A variety of diagnostic tests are done prior to the abdominal exploratory in order to pin point where the problem is and what the nature of it is.
  • As a starting point, blood work is done to determine if there are liver, kidney, pancreas, or electrolyte abnormalities. A complete blood cell count is used to look for signs of infection and anemia. Radiographs (x-rays) can be very helpful to indicate the presence of a problem in the gastrointestinal tract. Unfortunately, plain radiographs frequently are only suggestive of a problem and do not give us a definitive answer. As a result additional tests such as ultrasound or contrast radiographs (barium swallow) may be indicated.  Ultrasound is a very good test to identify foreign bodies and internal organ tumors, but gas within the intestine will block the view of ultrasound imaging and may result in a false negative test.  In order to reduce the risk for a negative exploratory (i.e. no surgical lesion found), a CT scan of the abdomen can be done prior to surgery.  It is very important to do the imaging study (ultrasound, radiographs or CT scan) just prior to surgery, as some foreign bodies will pass from the small intestine to the colon and then can be passed from the body without surgery.
  • Sometimes these tests also do not give us a final answer and exploratory surgery is needed. A negative exploratory may be the result; that is, all of the internal organs appear normal. If we do not find any obvious problem with the internal organs, biopsies still are done as microscopic disease may be causing the clinical signs. Even though it may seem disappointing to not find a problem that can be surgically corrected, it is better to explore the abdomen than ignore a surgical problem that the pet otherwise could die from. Fortunately, most abdominal exploratories yield a surgically correctable disease.

 

Signs of gastrointestinal disease

  • Vomiting is the primary sign seen with a variety of diseases affecting the GI tract. Generally, if an obstruction of the GI tract is present, diarrhea is not a symptom, but occasionally it is. If the problem is acute (due to ingestion of a foreign body), acute vomiting is almost always present. Chronic signs such as intermittent vomiting or diarrhea may be due to inflammatory bowel disease or cancer. Weight-loss can also be a clinical sign of chronic gastrointestinal diseases.
  • Age can give us an indication of the type of problem. Ingested foreign bodies are more common in young animals and cancer is more common in older pets. The underlying problem that a pet may be having, frequently requires abdominal exploratory and sometimes biopsy of various internal organs.

 

A foreign body is found in the intestine at the time of surgery and the bowel is healthy.

Abdominal exploratory and GI surgery

  • Frequently, the decision to do an abdominal exploratory is based on radiographs or ultrasonic evaluation. Many times these tests are suggestive of a specific problem involving the stomach or intestines. As a result surgery is done in order to confirm what is suspected.  Occasionally the abnormal gas pattern seen on the radiographs is not due to an obstruction of the intestine and no gross abnormality is found. In this situation the pet still may have a form of infiltrative cancer or viral infection (flu-like syndrome), or bacterial infection. If this is the situation, biopsies are taken to rule out any serious problem.  In our practice, we always recommend abdominal CT scan, if a foreign body is not clearly seen in the small intestines, as this will almost eliminate the risk a negative exploratory.
  • Even though it may seem disappointing to not find a problem that can be surgically corrected, it is better to explore the abdomen than ignore a surgical problem that the pet otherwise could die from. Fortunately, most abdominal exploratories yield a surgically treatable disease.

 

 

  • In this case, the bowel is healthy enough so that the surgeon is able to safely make an incision in the intestine to remove the foreign body.

    If a foreign body is found in the stomach or intestines, the object is removed by making an incision in the intestine or stomach. If a foreign body has caused a portion of the intestine to die off (necrotic), this part of the bowel may need to be removed.

  • In the event that a tumor of the intestine or stomach has been found, surgical removal will be performed if possible.
  • Feeding tubes may need to be placed, especially if the patient is very malnourished from chronic disease. This tube can be removed in approximately 10 days if the pet is doing well.

 

Aftercare and convalescence

  • After surgery has been completed, intensive care must be provided for the best chance for a successful outcome.
  • Pain control is managed after surgery to keep your pet comfortable.
  • Close observation is maintained to make sure that your pet is not developing a life-threatening infection of the abdominal cavity called peritonitis. Antibiotics are administered for 24 hours.
  • Fluids are administered intravenously to combat dehydration and maintain hydration.
  • Feeding of the patient is started within 24 hours after surgery. If your pet is still too nauseated, food and water are with held. If your pet has a lot of vomiting a tube may be placed down the nose to the stomach in order to remove excess fluid that may be in the stomach.
  • Exercise is restricted for a period of 3 weeks. During this time no rough-housing with other pets or people, jumping, or bounding up stairs is permitted.
  • Most pets will start to feel better 2 to 4 days after surgery. By 2 weeks after surgery they should have recovered completely. Healing of the internal tissues takes longer, therefore restricted activity on a leash should continue for a period of 3 weeks after surgery.
  • If your pet has cancer and chemotherapy is needed, this treatment is commonly delayed for 2 weeks after surgery. Chemotherapy is given every 2 to 3 weeks for a total of 5 treatments. The oncologist may elect to choose a protocol is different from the standard one if there is a need for this.

 

Potential complications

  • As with any surgery, complications may arise. Even though rare, anesthetic death can occur. With the use of modern anesthetic protocols and extensive monitoring devices (blood pressure, EKG, pulse oxymetry, inspiratory and expiratory carbon dioxide levels, and respiration rate), the risk of  anesthesia is minimized.
  • Infection is an uncommon complication as strict sterile technique is used during the surgery and antibiotics are administered.
  • Seroma formation or fluid accumulation under the skin incision can also occur. This problem in general will resolve with time. Occasionally the seroma or fluid that has build up may require draining.
  • Peritonitis is a very serious problem that fortunately does not occur very often. The most common cause of infection of the abdominal cavity is due to leakage of bowel contents through the enterotomy or anastomosis site. If this problem is to occur clinical signs become evident 2 to 5 days after surgery. Emergency surgery is needed if this occurs.
  • Intussusception can occur following intestinal surgery. This problem is where the small intestine telescopes on itself. In this situation another surgery is needed to correct the problem.
  • If a cancerous portion of intestine has been removed, recurrence to the tumor is possible especially if the tumor is malignant. Spread of cancer to another location (metastasis) may also occur.

FOR VETERINARIANS – HOW TO DO AN EXPLORATORY AND BIOPSY OF INTERNAL ORGANS:

 

 


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