A Review of Normal Intestinal Healing, Intestinal Anastomosis, and the Pathophysiology and Treatment of Intestinal Dehiscence in Foreign Body Obstructions in Dogs

• Published in: Topics in companion animal medicine Vol. 41; p. 100457
• Main Authors: Mullen, Kaitlyn M., Regier, Penny J., Ellison, Gary W., Londoño, Leonel
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2020; Elsevier Limited
• Subjects: Anastomosis; Anastomosis, Surgical - adverse effects; Anastomosis, Surgical - methods; Anastomosis, Surgical - veterinary; Animals; Antibiotics; Biomechanics; canine intestine; Collagen; Decision making; Dehiscence; Digestive System Surgical Procedures - veterinary; Dogs - surgery; Enteral nutrition; enterotomy; Foreign bodies; Foreign Bodies - surgery; Foreign Bodies - veterinary; foreign body obstruction; Healing; Inflammation; Intestinal obstruction; intestinal tissue; Intestine; Morbidity; Nutrition; Obstructions; Parenteral nutrition; Pathophysiology; Patients; Peritonitis; Peritonitis - veterinary; Postoperative Complications - etiology; Postoperative Complications - veterinary; resection and anastomosis; septic peritonitis; Small intestine; Surgery; Surgical anastomosis; Surgical Stapling - veterinary; Surgical Wound Dehiscence - physiopathology; Surgical Wound Dehiscence - therapy; Surgical Wound Dehiscence - veterinary; Suture Techniques - veterinary; Sutures; Tensile strength; Veterinary medicine; Wound Healing; EEA; intestinal obstruction; IL; enterotomy; canine intestine; foreign body obstruction; R&A; TA; TNF; FEESA; endoGIA; septic peritonitis; resection and anastomosis; PT/PTT; MAP; GIA; PDS; intestinal tissue
• ISSN: 1938-9736; 1946-9837; 1876-7613
• DOI: 10.1016/j.tcam.2020.100457

Small intestinal anastomoses are commonly performed in veterinary medicine following resection of diseased or devitalized intestinal tissue. Traditionally, suture has been employed to anastomose intestinal ends. However, use of intestinal staplers has become increasingly popular due to the ability to produce a rapid anastomosis with purported superior healing properties. Under normal conditions, intestinal healing occurs in three phases: inflammatory, proliferative, and maturation. Dehiscence, a devastating consequence of intestinal anastomosis surgery, most often occurs during the inflammatory phase of healing where the biomechanical strength of the anastomosis is almost entirely dependent on the anastomotic technique (suture or staple line). The resulting septic peritonitis is associated with a staggering morbidity rate upwards of 85% secondary to the severe systemic aberrations and financial burden induced by septic peritonitis and requirement of a second surgery, respectively. Intraoperative and postoperative consideration of the multifactorial nature of dehiscence is required for successful patient management to mitigate recurrence. Moreover, intensive postoperative critical care management is necessitated and includes antibiotic and fluid therapy, vasopressor or colloidal support, and monitoring of the patient's fluid balance and cardiovascular status. An understanding of anastomotic techniques and their relation to intestinal healing will facilitate intraoperative decision-making and may minimize the occurrence of postoperative dehiscence.