- Stabilise the rabbit's condition if possible: (B601.17.w17)
- Give intravenous fluids. (B601.17.w17)
- Provide analgesia. (B601.17.w17)
- Use abdominal radiography and ultrasonography to confirm the
presence of an intestinal foreign body. (B601.17.w17)
- Anaesthetise the rabbit.
- Place the rabbit in dorsal recumbency.
- On a circulating water blanket. (B602.22.w22)
- Clip and scrub the rabbit's abdomen from the inguinal to midthoracic
area for laparotomy. (B602.22.w22)
- Place an intravenous catheter into a cephalic or lateral saphenous
- Make a midline incision through the skin from just caudal to the
xiphoid down to the pubis (or from the umbilicus to the pubis). (B601.17.w17)
- Incise the thin subcutaneous tissue to expose the linea alba. (B601.17.w17)
- Isolate the linea alba and use fine toothed thumb forceps to tent it
away from the abdominal viscera. (B601.17.w17)
- Using an inverted number 10 or number 15 scalpel blade (cutting edge
of the blade directed upwards), make a stab incision through the linea
alba, parallel to the linea alba. (B601.17.w17)
- Care is required to avoid damaging the caecum, which has a thin
wall, is usually distended with ingesta, and lies directly under
the abdominal wall. (B601.17.w17,
- Place a small thumb forceps into the abdomen and directed parallel
to the linea alba; use this to lift the linea alba away from the
underlying viscera. (B601.17.w17)
- Using a scalpel, cut cranially and caudally along the linea alba
between the jaws of the forceps.(B601.17.w17)
- Or use blunt-topped fine tissue cutting scissors, with
one blade inserted into the abdomen parallel to the linea alba and
used to lift the abdominal wall away from the viscera while
cutting cranially and caudally. (B601.17.w17)
- Note: the incision should be long enough to allow exploration of the whole
- Place laparotomy pads, moistened with saline, along the incision
on both sides and use a retractor (e.g. a Lonestar Veterinary Retractor
or Balfour retractor) to give
better exposure of the abdomen. (B601.17.w17,
- Palpate the entire gastrointestinal tract from the distal oesophagus
to the descending colon.
- Note: handle the bowel gently to avoid development of
postoperative ileus and shock. (B602.22.w22)
- Identify the intestinal area of interest. (B600.10.w10,
- With an intestinal obstruction, follow along the small intestine
until the point where it changes from distended and fluid-filled to
flat and empty. (J29.16.w3)
- Check the intestinal tissue for signs of devitalization, or
abnormalities which may have increased the risk of obstruction. (J29.16.w3)
- Isolate the bowel section - exteriorise the section and use sterile absorbent material to protect the surrounding
tissues - surround the exteriorised section with moistened laparotomy sponges. (B600.10.w10)
- "Milk" the intestinal contents away from the
- Place atraumatic forceps or bowel clamps, or have an assistant place their fingers
to prevent ingesta contaminating the surgical field.
- Make an incision longitudinally in the intestine, along the opposite edge from the
- Ideally, incise healthy bowel caudal to the foreign body (i.e. not in
possibly devitalised tissue).
- Or incise at the junction of the foreign body and normal
- Manoeuvre the foreign body to the incision and remove it.
- Note: on occasion, with a linear foreign body (which may
be accompanied by plication of the bowel or intussusception),
several enterotomy sites may be needed. (B602.22.w22)
- Trim off any everted mucosa. (B600.10.w10)
- For foreign bodies at the fusi coli:
- If possible, avoid enterotomy by massaging the offending
material (usually hard faeces or caecoliths) past this point and
into the descending colon. (B602.22.w22)
- Closing small intestine
- Use a simple interrupted pattern and synthetic absorbable
monofilament suture material.
- Use a fine, strong, inert,
material (e.g. 4/0 or 5/0 (1.5 or 1 metric) poliglecaprone (Monocryl) or polydioxanone
(PDS II, Ethicon). (B600.10.w10,
- Use a single layer of appositional sutures,
ensuring they include the submucosa and minimising reduction in
intestinal diameter. (B600.10.w10,
- Place sutures in the submucosa if identifiable, otherwise
- Either close the longitudinal incision longitudinally.
- Or close the longitudinal incision transversely to avoid
reducing the intestinal luminal diameter. (B601.17.w17,
- Wrap omentum around the incision site; if necessary, tack this
to the serosa to ensure it stays in place. (B601.17.w17)
- Closing descending colon
- Close the longitudinal incision transversely to avoid reducing
the intestinal luminal diameter. (B602.22.w22)
- Use interrupted sutures and an appositional or crushing
- Closing the caecum
- Use a double-layer inverting technique.
- Use fine synthetic absorbable suture material (0.3 - 0.7 metric,
6/0 - 7/0 USP) on a small atraumatic needle. (B601.17.w17)
Use 4-0 to 6-0 (1.5 - 0.7 metric) absorbable synthetic monofilament. (B602.22.w22)
- If the needle is too large, caecal contents will leak
through the needle holes.
- Use a simple continuous suture in the first layer. (B601.17.w17)
- Oversew with an inverting suture. (B601.17.w17)
- Place sutures every 2 - 3 mm. (B602.22.w22)
- Omentum can be included in the incision line. (B602.22.w22)
- Or Wrap omentum around the incision site; if necessary,
tack this to the serosa to ensure it stays in place. (B601.17.w17)
Intestinal resection and anastomosis
- If an area of duodenum/intestine is necrotic, this
must be resected. (B600.10.w10,
- Section at an angle to preserve vascularity. (B600.10.w10)
- Anastomose end-to-end, ensuring a good seal to minimise
the risk of leakage of intestinal contents. (B600.10.w10)
- Examine the bowel and confirm the area to be removed. This includes
the diseased area plus a few cm to either side. (B601.17.w17)
- Double-ligate and transect mesenteric vessels to the selected area
- Massage the intestine to move ingesta cranially and caudally away
from the incision site.
- Use atraumatic clamps or an assistant's fingers to keep ingesta from
the surgical site.
- Place straight haemostats on the intestine at an acute angle so that
the mesenteric side of the remaining bowel is longer than the
anti-mesenteric side (i.e. the mesenteric side of the removed piece of
bowel is shorter than the antimesenteric side).
- This increases the luminal diameter and assists in ensuring an
adequate blood supply to the antimesenteric aspect.
- Incise the intestine at an acute angle so that the mesenteric side
is longer than the anti-mesenteric side. (B602.22.w22)
- Anastomose the intestine
- Use a fine 4-0 to 6-0 synthetic monofilament suture material. (B602.22.w22)
0.3 - 0.7 metric, i.e. 6/0 to 7/0 USP with a small needle. (B601.17.w17)
- Use an appositional closure. (B602.22.w22)
- Place sutures through the submucosa (holding layer) if this is
identifiable, otherwise place the sutures full-thickness. (B601.17.w17)
- Either: Initially pre-place three sutures on the
mesenteric side. Tie these three sutures, then place simple
interrupted sutures around the anastomosis site. (B601.17.w17)
- Or: Initially place one suture at the mesenteric border
and a second at the antimesenteric border. Then approximate the
circumference of the intestinal wall on one side and place sutures
on that side, 3-4 mm apart, equally spaced to ensure gentle
apposition, then turn the intestine over and repeat on the other
- Close the defect in the omentum using a fine monofilament
absorbable suture material in a continuous suture pattern. (B601.17.w17)
- or simple interrupted sutures. (J495.32.w4)
- If the abdomen has been contaminated with intestinal contents
irrigate the abdomen with warm saline and apply suction; repeat
several times. (B602.22.w22)
- Take samples for aerobic and anaerobic culture and sensitivity.
- Close the linea alba in a simple continuous or interrupted pattern.
- Use a synthetic monofilament absorbable suture material. (B601.17.w17)
- If there is enough subcutaneous tissue available, close this in a
simple continuous suture pattern. (B601.17.w17)
- Use a synthetic absorbable suture material, monofilament or
- Braided material is easier to handle but has more drag, so
causes more tissue damage, and may allow bacterial growth. (B601.17.w17)
- Close the skin using a simple continuous subcuticular suture. (B601.17.w17)
- Use a synthetic monofilament absorbable suture material. (B601.17.w17)
- Supportive care is important. (B601.17.w17)
- Intravenous fluids. (B601.17.w17)
- Analgesia. (B601.17.w17)
- Nutritional support. (B601.17.w17)
- Aggressive antibiotic treatment if the abdomen has been contaminated
by gut contents during the procedure. (B602.22.w22)
- Note: there is a relatively high perioperative mortality rate
in rabbits following gastrointestinal foreign body obstruction.
|Cost / Availability
The costs of a surgical operation include those associated with: (J15.30.w1)
- Pre-operative diagnostics (e.g. radiography, ultrasonography, blood
- Perioperative medication (e.g. analgesics, antibiotics, fluids).
- Surgical preparation (of the operating theatre and the patient,
including staff time).
- Consumables and equipment.
- Time of the surgeon and assistant(s).
- Post-operative hospitalisation.