Читать книгу Complications in Equine Surgery - Группа авторов - Страница 52

Definition

Insufflation is the directed administration of air through the endoscope to provide distension and visualization of collapsible hollow organs and can result in small intestinal volvulus or rupture of a hollow viscus.

Risk factors

 None identified

 Inattention during procedure

Pathogenesis

These complications are likely the result of the effective creation of a one‐way valve when performing endoscopy in long, narrow, tubular organs, whereby there is no means for the insufflated air to escape and depressurize the system.

Segmental jejunal volvulus has been described as a complication after gastroscopy [2]. The incidence of jejunal volvulus is low, with only 1–2 cases per year per institution included in their study (0.3–3.2%/year) [2]. All of the horses had gas distension of the affected small intestine, which was presumed to be related to the gas insufflation associated with gastroscopy. In the report of jejunal volvulus, there was no apparent association with duration of gastroscopy, duration of feed withholding, or use of duodenoscopy.

Although bladder rupture has not been directly described as a complication of cystoscopy in the literature, this author has observed a case in which prolonged urethroscopy and insufflation was used in an attempt to endoscopically remove a urethrolith [3]. The procedure resulted in retropulsion of the urethrolith into the bladder. Subsequently, a perineal urethrotomy was performed to ensure patency of the urinary tract, but bladder rupture and uroperitoneum was diagnosed 12 hours later. It cannot be proven that the urethroscopy caused the bladder rupture, but this was seen as a potential cause for the complication.

Gastric rupture has not been described in the equine literature as a sequella of gastroscopy; however, gastric rupture has been described in a human patient during diagnostic upper gastrointestinal endoscopy [4]. While this complication would be unlikely in most normal‐sized horses, it may be a potential complication in small patients.

Prevention

The authors of the jejunal volvulus case series concluded that it is advisable to minimize the duration and amount of air insufflated into the duodenum, reduce the amount of sedatives administered, and to use suction to decompress the stomach after gastroscopy is completed [2]. Bladder rupture and hypothetical gastric rupture are presumed to be exceptionally rare occurrences. Therefore, it is difficult to identify preventative measures. It may be prudent to avoid prolonged cystoscopy, especially if the urethra is partially obstructed.

Diagnosis

Jejunal volvulus was diagnosed as the presence of severe colic signs requiring colic surgery within a few hours of the gastroscopy procedure. Gastric rupture (hypothetical) or bladder rupture could be identified as the loss of distension at the time of the endoscopic examination. In the proposed clinical case, bladder rupture was identified as signs of uroperitoneum several hours later.

Treatment

All of these complications require emergency exploratory celiotomy to diagnose and correct the problem. Non‐surgical methods to manage bladder rupture have been described and may be a consideration in certain cases.

Expected outcome

If treated promptly, the outcome following jejunal volvulus and bladder rupture would be expected to be good. If intestinal ischemia or peritonitis occurs, the prognosis is much more guarded. Gastric rupture is a hypothetical risk, but if it occurred, the outcome would be poor due to difficulty in accessing the stomach for repair of the rupture and the spillage of gastric contents and subsequent peritonitis.