& Management / Disease
Investigation & Management / Techniques:
- Anaesthetise and intubate the rabbit.
- Place the rabbit in right lateral recumbency.
- Surgically prepare the left paracostal area.
- Use strips of gauze to cover the rabbit's teeth and gently pull the
Placing the tube
- Make a 3 mm incision 7.5 mm caudoventral to the greater curvature of
the 12th rib to identify the site of cannula placement.
- Lubricate the bronchoscope with 2% lidocaine hydrochloride gel.
- This prevents activation of the hypersensitive pharyngeal
- Insert the bronchoscope through the mouth and advance it through the
oesophagus into the stomach.
- Connect a hose to the biopsy port of the endoscope and, using a pump
(aquarium air pump), distend the stomach with air.
- Distending the stomach brings the stomach wall into contact with
the left abdominal wall and displaces the liver, spleen and caecum
away from the intended gastrotomy site.
- Pass a 16-gauge Medicut tapered intravenous cannula through the skin
incision and push it through the abdominal wall and gastric wall.
- Remove the stylet.
- Pass a polyester suture through the cannula into the stomach.
- Visualise the suture in the stomach using the bronchoscope.
- Grasp the suture with the snare of the bronchoscope.
- Bring the end of the snare and suture to just inside the
- Bring the bronchoscope, with snare and suture, back out of the
- Remove the Medicut cannula from the abdominal wall and pass it over
the end of the polyester suture.
- Produce a 60 degree taper on the gastrostomy tube.
- Suture the gastrostomy tube to the suture material.
- Pull on the gastrostomy tube using the suture material, to stretch
it, so that the funnel end of the Medicut cannula can fit over the
tapered end of the tube..
- Lubricate the cannula and gastrostomy tube.
- Place tension on the suture from outside the body wall and pull the
suture, cannula and attached gastrostomy tube through the mouth,
oesophagus, stomach, gastric wall and abdominal wall.
- Reintroduce the bronchoscope into the stomach and confirm the
placement of the gastrostomy tube.
- Apply traction on the gastrostomy tube to ensure the gastric wall
and abdominal wall are in contact.
- Fix the tube externally by passing a flange (made from the wide
connecting end of the catheter) over the tube and in close contact
with the abdominal wall.
- This prevents inward movement of the tube.
- Place tape around the gastrotomy tube next to the flange to keep it
- Close the tube with a three-way stopcock.
Protecting the tube
- Place a stockinette jacket (4 inch stockinette, doubled and with
holes cut for the forelimbs and the tube) onto the rabbit.
- Or It may be possible to shorten the tube, fit an
intermittent injection port and not use a stockinette jacket.
- Consider fitting a collar (Elizabethan or soft collar). See: Treatment and Care
- Wound Management
- Elizabethan collars appear to depress rabbits.
- A collar may not be needed; experimentally, most rabbits did not
remove bother the tube.
- Monitor the PEG incision site and clean the skin around the site
- Keep the rabbit in a smooth-sided cage lacking sites on which the
tube could catch.
- Consider giving appropriate systemic broad-spectrum
- Feed through the tube.
- Food must be well-blended and warmed to at least room
temperature before feeding.
- N.B. consider the maximum stomach capacity of the rabbit when
considering how much to give at one time.
- Offer food as well.
Removal of the tube
- Sedation is not required.
- Remove the tube by pulling with steady traction while placing firm
counter-pressure on the adjacent skin.
- This may require more pressure than expected.
- Rabbits did not show signs of discomfort during this procedure.
- Leave the tube for sufficiently long (14 days) that fibrous
adhesions will have formed between the stomach and abdominal wall,
preventing peritonitis when the tube is withdrawn.
|Appropriate Use (?)
- To allow enteral nutritional support of anorectic rabbits, e.g. in
the medical management of gastric stasis. (J521.33.w1)
- For long-term, large-volume or frequent gastric dosing of
|Complications/ Limitations / Risk
||In experimental use of a
percutaneously placed gastrotomy tube in five rabbits:
- The skin around the tube was warm and reddened for about 5-6 days
after tube insertion.
- The flange tended to become adherent to the skin; daily cleaning was
- In two rabbits, superficial necrosis developed on the skin under the
flange; the affected area was cleaned with hydrogen peroxide and the
flange slightly loosened.
- In all rabbits, a rim of granulation tissue formed around the tube
by one week, with increased superficial scaling of the surrounding
- In two rabbits, a small amount of purulent exudate developed around
the tube at day 10; culture revealed Staphylococcus aureus and,
in one rabbit, Escherichia coli.
- Cleaning with hydrogen peroxide resolved the infections.
- Rabbits started eating pellets voluntarily within three days of tube
- Rabbits showed a slight weight loss initially, then regained weight
to pre-operative values by three to eight days post operation.
- After the tubes were removed, wound closure was immediate but with
serum leakage and, in two cases purulent exudate for one day.
- Cleaning with hydrogen peroxide was effective.
- At necropsy, fibrous adhesions were confirmed, connecting the
stomach wall to the abdominal wall.
|Equipment / Chemicals required and Suppliers
16-French de Pezzer (mushroom) catheter, modified by
cutting the small, bulb end off to improve passage of food
through the catheter, and by cutting off the wide connecting end. (J521.33.w1)
16-gauge tapered intravenous catheter. (J521.33.w1)
Bronchofibrescope with biopsy forceps. (J521.33.w1)
1 m of 0 polyamide. (J521.33.w1)
|Expertise level / Ease of Use
- This procedure should only be
carried out by an individual with appropriate clinical training and practical
|Legal and Ethical Considerations
In some countries there may be
legislation restricting the use of this type of technique to licensed veterinarians. For
example in the UK: "The Veterinary Surgeons Act 1966 (Section 19) provides,
subject to a number of exceptions, that only registered members of the Royal College of
Veterinary Surgeons may practice veterinary surgery." (See: LCofC1
- RCVS Guide to Professional Conduct 2000 - Treatment of
Animals by Non-Veterinary Surgeons).
||Debra Bourne MA VetMB PhD
Frances Harcourt-Brown BVSc