DISEASE SUMMARY PAGE

Acute Gastro-Intestinal Obstruction in Rabbits

Rabbit in pain. Click here for full page view with caption Rabbit in pain. Click here for full page view with caption Lateral radiograph acute gastrointestinal obstruction. Click here for full page view with caption Dorsoventral radiograph acute gastrointestinal obstruction. Click here for full page view with caption Lateral radiograph; obstructing object moved through intestines. Click here for full page view with caption Decompressing the stomach. Click here for full page view with caption Fluid from the stomach of a rabbit with gastric dilatation. Click here for full page view with caption

Summary Information
Diseases / List of Physical / Traumatic Diseases / Disease summary
Alternative Names
  • Gastric dilatation
  • Gastric dilation
Disease Agents
  • Often ingestion of a felted mat of the rabbits own fur, sometimes carpet fibres, plastic, whole pulses, whole locust beans, corn-cob litter, clay-based cat litter (clumping) or other small objects. (B600.10.w10, B601.8.w8, B602.16.w16, J29.16.w3)
    • Obstructing fur mats are often the size of a large faecal pellet. (J3.161.w1)
  • Usually obstruction occurs in the small intestine, less commonly at the pylorus. (B600.10.w10, J29.16.w3)
    • In a study of 76 cases of gastric dilation, obstruction was usually in the small intestine; no obstructions were identified at the pylorus, but several occurred just distal to this, where the gut diameter narrows. (J3.161.w1)
  • Rabbit secrete saliva continuously, and are unable to vomit, therefore the stomach rapidly distends with fluid if this cannot pass through the digestive tract; gas is also produced. The stomach and intestine proximal to the obstruction become dilated. (B600.10.w10, B601.8.w8)
  • Other reported causes of intestinal obstruction include neoplasia, post-surgical adhesions, intussusception (Intussusception in Lagomorphs), tapeworm cysts (Tapeworm Cyst Infection in Lagomorphs), strangulated hernia following castration, and diverticulosis. (B600.10.w10, J3.161.w1)
  • Obstruction can occur due to masses outside the GIT: in one case, signs of intestinal obstruction occurred due to a 12 mm diameter calculus (Urolithiasis in Lagomorphs) wedged in the pelvic inlet. (J3.96.w4)
Infectious Agent(s) --
Non-infectious Agent(s) --
Physical Agent(s) --
General Description
Clinical signs
  • Acute onset abdominal pain, gastric dilatation. (B602.16.w16)
  • Severe gastric dilatation. (B600.10.w10)
  • Depression, complete inappetance, collapse. (B600.10.w10, J29.16.w3)
  • Signs of pain: immobility and lack of response to external stimuli; other sighs may include tooth grinding and hunching up. (B601.8.w8, J3.161.w1, J29.16.w3)
  • Rabbits may stretch out their body to get more comfortable. (V.w129)
  • Dehydration. (B600.10.w10)
  • Death if the rabbit is not treated; this may occur within eight hours of the initial signs. (J29.16.w3)
  • Note: rupture of the stomach or intestine may occur as a complication.
  • The rabbit may be dead or moribund when found. (J3.161.w1)
Diagnosis
  • Clinical signs. (B602.16.w16)
  • Abdominal palpation: distended stomach palpable cranially on the left, or a tympanic, distended abdomen, or a doughy feel (following intestinal rupture). (B600.10.w10, J29.16.w3)
  • Radiography: preferably two orthogonal views; serial radiographs may be useful to indicate passage of the obstruction. (B600.10.w10, B601.8.w8, B602.16.w16, J3.161.w1, J29.16.w3)
    • Stomach grossly distended with fluid and gas, filling the anterior abdomen. Gas shadows in the intestine proximal to the obstruction. (B600.10.w10, B602.16.w16)
    • Lateral radiography provides a definite diagnosis of gastric dilatation. (J3.161.w1)
    • Free gas in the abdomen suggests gut rupture has already occurred and euthanasia is the appropriate treatment. (J29.16.w3)
    • Gas/fluid in the stomach and no or minimal gas in the small intestine suggests a proximal small intestinal obstruction; prompt gastric decompression and surgery, or euthanasia, is needed. (J29.16.w3)
    • Gas/fluid in the stomach and lots of gassy loops in the small intestine suggests that the obstruction has reached the distal small intestine and may pass through the gut. Decompressive surgery or repeated radiography after 30-60 minutes is suggested. If the gas shadows have not moved, the obstruction is not moving and surgery is required, while an increase in gas loops or gas moving into the caecum suggests movement of the obstruction and medical management may be used. (J3.161.w1, J29.16.w3)
    • Gas in the caecum suggests that the obstructing object has moved through the gut. (J29.16.w3)
  • Clinical pathology: marked hyperglycaemia (20 - 25 mmol/L) may be seen (returning to normal after successful treatment). (B600.6.w6)
  • Exploratory laparotomy will confirm the situation (e.g. whether or not the gut has ruptured), and the cause of the obstruction. (J3.96.w4, J29.16.w3)
Further Information
  • Sometimes the obstructing object moves through the small intestine and signs resolve. (J29.16.w3)
  • Common sites for impaction of foreign bodies (Gastro-intestinal Foreign Bodies in Rabbits) are the proximal duodenum, sacculus rotundus and ileocaecal junction. (B601.17.w17, B602.13.w13)
  • Death is due to shock or peritonitis. (J29.16.w3)
  • The prognosis is guarded. (B601.8.w8)
    • In a study of 84 cases of acute gastric dilatation, 29 died or were euthanased without treatment; 15 were treated medically because radiography indicated the obstruction had moved out of the small intestine and 13 of these recovered while two died; 40 were treated surgically of which 10 died during surgery, eight died after surgery, three had intestinal neoplasia and were therefore euthanised, and 19 recovered. (J3.161.w1)
    • The prognosis may be affected by the site of the obstruction; in a study of 84 cases, rabbits with a more proximal site of obstruction (duodenum, and particularly the proximal duodenum were less likely to survive than rabbits with an obstruction of the ileum. (J3.161.w1)
Susceptibility
  • Long-haired and moulting rabbits may be more likely to develop this condition, but it also occurs in short-haired rabbits. (J29.16.w3)
Treatment
  • Rapid, aggressive treatment is essential to save the rabbit. (B602.16.w16)
  • Medical
    • Analgesia: 
      • Buprenorphine 0.01 - 0.05 mg/kg subcutaneously or intramuscularly every 12 hours, or an NSAID e.g. Flunixin meglumine 0.3 - 2.0 mg/kg subcutaneously or intramuscularly every 12 hours for up to three days. (B602.16.w16)
        • Note: caution with the use of Flunixin meglumine; this is not generally used now in rabbits in the UK due to side effects. (V.w129)
      • Buprenorphine, 0.01 - 0.05 mg/kg, subcutaneously, intramuscularly or intravenously, every 6 - 12 hours, plus a NSAID (e.g. meloxicam 0.1 - 0.2 mg/kg subcutaneously or intramuscularly every 24 hours, or carprofen 1.0 - 2.4 mg/kg subcutaneously or intramuscularly every 24 hours). (J29.16.w3)
      • Hypnorm (fentanyl/fluanisone can be used as a single dose, 0.2 - 0.3 mg/kg subcutaneously to provide both analgesia and sedation. (J29.16.w3)
        • This also makes it easier to position the rabbit for radiography and to pass a stomach tube. (J29.16.w3)
    • Shock dose of crystalloids, intravenously or intraosseously. (B602.16.w16) See: Treatment and Care - Fluid Therapy
    • Short-acting corticosteroid e.g. 11 - 25 mg/kg prednisolone sodium succinate. (B602.16.w16)
    • Anti-ulcer medication - ranitidine, 2 mg/kg intravenously every 24 hours as a gastroprotectant. (J29.16.w3)
  • Surgical
    • Decompression: Pass a stomach tube to decompress by releasing gas and liquid. (B600.10.w10, B602.16.w16, J3.161.w1, J29.16.w3)
      • Make sure the rabbit is intubated. Keep the rabbit's head up to prevent aspiration of stomach contents. (V.w129)
      • The tube may block with hair/stomach contents, in which case it must be removed, emptied, and replaced. (B600.10.w10, J3.161.w1)
      • Keep the stomach tube in place throughout surgery. (B600.10.w10)
      • Decompression has multiple benefits, reducing pain, improving venous return to the heart and decreasing the likelihood of stomach or gut rupture. (J29.16.w3)
      • It may be possible to pass a stomach tube in a depressed rabbit without any sedation. More usually, sedation or anaesthesia (isoflurane) is needed. (B600.10.w10, B602.16.w16, J29.16.w3)
    • Surgically remove the obstruction (after decompression). (B600.10.w10, B602.16.w16, J3.161.w1, J29.16.w3) See: Laparotomy in Rabbits
      • Anaesthetise: following sedation with fentanyl/fluanisone (which will also provide analgesia), mask down with isoflurane, then intubate (B600.10.w10)
        • Give butorphanol or buprenorphine as an analgesic if another induction combination was used not including an analgesic. (B600.10.w10)
        • Give fluids: Hartmann's solution 10-20 mL/kg/hr intravenously during surgery. (J3.161.w1)
      • Locate the obstruction. (B600.10.w10, J29.16.w3)
      • If possible, gently "milk" the obstruction from the small intestine along to the ileocaecal valve and through into the large intestine or move it back into the stomach and remove by gastrotomy. (B601.8.w8, J3.161.w1, J29.16.w3)
        • Note: it is preferable to manipulate an obstructing object to the large intestines, if possible, or back to the stomach for gastrotomy, rather than carrying out an enterotomy or enterectomy. (J29.16.w3)
      • If the obstructing object cannot be moved along the intestinal tract, or there is devitalised tissue, enterotomy is required. (J3.161.w1, J29.16.w3)
      • If an area of duodenum/intestine is necrotic, this must be resected. (B600.10.w10, B602.16.w16)
        • 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)
        • See: Enterotomy in Rabbits (Techniques) - Intestinal resection and anastomosis
      • Consider giving some liquid food by stomach tube at the end of surgery, before removing the stomach tube, to encourage gut motility. (J29.16.w3)
      • Postoperatively, keep the rabbit in a warm, quiet place. (J29.16.w3)
      • Give postoperative analgesia, motility stimulants and antibiotic cover. (B600.10.w10, J3.161.w1)
      • See: Treatment and Care - Surgery (Post-operative care)
    • Note: prognosis is guarded. (B600.10.w10, B601.8.w8, B602.16.w16, J3.161.w1, J29.16.w3)
      • Death may occur during surgery. (J3.161.w1)
      • Death may occur following surgery, due to peritonitis, shock, post-operative ileus, acute renal failure or probable electrolyte imbalances. (J3.161.w1)
  • Euthanasia is an appropriate treatment unless the owner accepts the risks as well as the expense of surgery. (B600.10.w10)
    • Euthanasia is appropriate in cases where the gut has already ruptured. (J29.16.w3)
Prevention
  • Watch for and manually remove mats (felts) of fur which may build upon the rabbit (especially on the underside of the hind feet). (B600.10.w10)
    • These are more likely to develop in long-coated rabbits and those with reduced ability to groom properly due to e.g. dental disease. (B600.10.w10)
  • Ensure whole pulses are not included in the feed. (B600.10.w10)
Associated Techniques
Host taxa groups /species
Disease Author Debra Bourne MA VetMB PhD MRCVS (V.w5)
Referees William Lewis BVSc CertZooMed MRCVS (V.w129)

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