Читать книгу Small Animal Surgical Emergencies - Группа авторов - Страница 182

Even though many discrete small intestinal foreign bodies are easily removed, the nature of the foreign body and the location of the obstruction can present a surgical challenge. Removal of foreign bodies within the duodenum demands knowledge of the regional anatomy including the entrance of normal anatomic structures, such as the bile and pancreatic ducts, into the proximal duodenum (Figure 5.6). The intimate association of the duodenal and pancreatic blood supply is also important to consider when incising the duodenum. In addition, the distal duodenum turns at a sharp angle at the caudal duodenal flexure. This bend is created by the duodenocolic ligament, which tethers the distal duodenum to the colon. Careful excision of this ligament allows this area of the small intestine to be exteriorized and more adequately visualized during foreign body removal.

Figure 5.5 A string foreign body under the tongue of a cat.

Minimally invasive options for exploratory laparoscopy in patients with GI obstruction recently have been evaluated. One study performed laparoscopy followed by open laparotomy in dogs to assess if laparoscopy was feasible in cases of suspected GI obstruction. The results indicated that laparoscopy was equivalent to open laparotomy in regard to ability to diagnose an obstruction, with laparoscopy having a significantly smaller incision length; however, the time for laparoscopic explore was longer than for open abdominal explore. Additionally, complete laparoscopic explore was not possible in 3 of 16 cases, and conversion to a much longer incision length would have been needed to treat the obstruction in 4 of 13 cases where laparoscopic explore was feasible [58]. In another study, dogs undergoing single incision laparoscopic‐assisted intestinal surgery (SILAIS) were retrospectively compared with dogs undergoing open laparotomy for simple intestinal foreign body removal. Three of thirteen dogs in the SILAIS group required conversion to open laparotomy, but no postoperative complications occurred in either group. No significant differences were found in recovery time, surgical time, or duration of hospitalization between the two groups [59]. The results of these studies show promise for minimally invasive options for use in simple GI obstructions; however, more research is needed to determine if these options provide a benefit to the patient over traditional open procedures for intestinal foreign body cases.

Figure 5.6 Anatomy of the stomach and duodenum including the entrance of normal anatomic structures, such as the bile and pancreatic ducts, into the proximal duodenum.