Nigerian Veterinary JournalVol 35 (3) 1022-1025

'- __ A Case ReportColostomy for the Relief of a Rectovaginal Fistula

and Atresia Recti in a Sow: A Case Report

JEREMIAH, K.T., OMAMEGBE, J.O., UKAHA, R.O., NJOKU, U.N., OGBU, E.O., NTUEN, U.G. and UZUEGBU, O.M.*

Department of Veterinary Surgery and Theriogenolgy, and * Veterinary Teaching Hospital, Michael Okpara University of Agriculture,Umudike, Nigeria. Correspondence: E-mail:jeremiahkelechi@gmail.com, Tel: +2348037575024

INTRODUCTIONA congenital rectovaginal fistula resultsfrom the failure of the urorectal septum toseparate the cloaca into urethrovesical andrectal segments during embryonicdevelopment such that a fistula persistbetween the epithelial surfaces of thedorsal wall of the vagina and the ventralwall of the rectum(Steiner, 200 4). In suchcases, the vulva functions as a commonopening to the urogenital andgastrointestinal tracts. (Aronson, 2003,Wykes and Olson, 2003). Wide fistulasallow the passage of flatulence and faecesinto and through the vagina to exit thevulva. The consistency of the faeces voidedthrough the vulva depends on the portionof the lower gastrointestinal tract fistulatedto the vagina. Generally however, thegenital area of such animals may get soreand infected. Affected animals suffervulvular irritation, tenesmus, cystitis, andmegacolon, among others. (Mahler andWilliams zoog.Aronson, 2003)

In some cases RVF coexist with atresia aniof varying degrees (Types I-IV), Wykes andOlson 2003, Burrows and Sherding,1992).Mfected animal may live and thriveas long as the faeces remain semi fluid andis voided via the vagina. The diagnosis ofthe condition is often made when theaffected neonate have been weaned.(Aronson, 2003, Wykes and Olson, 2003).

The prevalence of a n o- rectalabnormalities in animals has not beenconclusively determined, Aronson (2003),reported a higher prevalence in dogs andcats, Remi-Adewunmi (2007), reported ahigh prevalence in calves while Roberts(1986) reported a higher prevalence inswine than other species.In humans, most recto-vaginal fistulasarise from obstetrical trauma at parturitionespecially in immature females and as aresult of some primitive cultural practicesin some communities, inflammatory boweldisease (IBD), radiation, proctitis, andpelvic infection (Bradley et al., 2010).

Congenital RVFs in animals have beentreated surgically using a variety oftechniques including the use of plasticadhesives provided there is an anal opening(Mahler and Williams, 2005, Vianna andTobias, 2005, Aronson, 2003, Wykes andOlson, 2003, Prassinos et al., 2003)The reported post operative complicationsof RVFs in animals are feacal incontinence,constipation, obstipation, tenesmus, peri-anal oedema, urinary incontinence, analstenosis and wound dehiscence. (Mahlerand Williams 2005, Vianna and Tobias,2005, Aronson, 2003, Wykes and Olson,2003).

Case reportA nine month old sow presented at the

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surgery unit of the College of VeterinaryMedicine, Michael Okpara University ofAgriculture, Umudike, Abia state with ahistory of defecating and urinating throughthe same orifice was diagnosed as a case ofRVF and AAI AR and imperforate ani (IA)(Figl)

Figure 1. The sow onexamination table showingthe presence of faeces in thevulva and absence of ana)orifice.

position ofthe anus in a

normal animal

The sow was sedated with Xylazine (2-(2-6-dimethylphenylamino) - 4-H-5, 5-dihydro-l, 3-thiazide. Kepro, Holland) atthe dose of r.rmiligram/kilogram bodyweight (mg/kg bwt) intramuscularly (i/rn)and anaesthetized with Ketamine (dl- 2-(0-chlorophenyl) - 2-methylamino)-cyclohexaxnone hydrochloride, (RotexMedica, Germany) at 15mg/kg bwt i 1m.Following aseptic preparation of theventral abdomen for surgery and with thesow on dorsal recumbency, the fistula wasapproached through a caudal midlineceliotomy. The descending colon waslocated and traced caudally until thefistulous connection to the vagina waslocated. The fistula was within

Figure 2 : Arrow Points to the connectionbetween the colon and the vagina.

the pelvic cavity, and was between therectal region of the gastroinestinal tractand the vagina, caudal, to the cervix (Fig 2).The rectal and anal canals were atrectic andthere was no anal orifice (imperforateanus). The colon was double clampedabout 2.0 centimeters (em) cranial to thefistula and severed between the clamps.The colonic stumps were closed withParker- Kerr suture pattern using size 0chromic catgut, (Fig 3).

The Proximaland distalstumps of the

Figure 3: The proximal and distal colon.stumps of the colon closed withParker Kerr suture pattern.

Efforts to pull the cranial colonic stumpthrough the pelvic canal to the normalposition of the anus for a pull-throughprocedure were unsuccessful resulting in adecision to manage the condition b y flankcolostomy.

Askin incision about 2.0 ern long was madeto the left of the original laparotomyincision. The underlying abdominalmuscles were bluntly dissected to accessthe abdomen. The proximal end of thecolon was passed through the slit in theperitoneum and muscle layers andexteriorized through the skin incision, (Fig4). About 1.0 em of the terminal end of thecolon and the Parker Kerr stitch on it wasamputated and the rim of the colon wassutured to the rim of the abdominal skinincision using simple interrupted stitchesof size 110 monofilament nylon.

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Skin incision

Figure 4: The colon being pulled through theabdominal muscles.

ostium

Figure 5: Metal ring attached to keep theostium patent.

The laparotomy incision was closed in aroutine manner and the sow was treatedwith a single dose (ro.omg/bwt) ofoxytetracycline long acting (Kepro,Holland) i/m and piroxicam (Laborate,India) at dose of o.gmg/kg for three days.The recovery of the animal fromanaesthesia and surgery was uneventfuland skin stitches were removed iadavspost surgery.

Post operative complicationsTwo months post surgery; the sow becamebloated, anorexic, very tender around thecolostomy site and unable to pass faecesdue to a severe constriction of thecolostomy orifice. A metal ring wastherefore fixed at the colostomy orifice tokeep it patent (figure 5). The sow recovereduneventfully thereafter, mated andfarrowed piglets.

DISCUSSIONThis was a case of congenital high RVF andtype III congenital AA cum IA in a sowwhere the fistula originated proximal to theanorectal sphincter complex deep insidethe pelvic canal which is in agreement withprevious reports (Aronson 2003, Wykesand Olson, 2003).In such cases, a diagnosis of RVF andatresia of the caudal digestive tract may bemade based on case history, clinical signsand physical findings. A retrogradevaginogram or sonographic examinationmay be required for the determination ofthe exact position of the fistula, thetermination of the caudal digestive tractand which of types I-IV AAI AR is present insuch cases (Vianna and Tobias, 2005,Aronson, 2003, Wykes and Olson, 2003).There were no signs of vulvular irritations,cystitis, urinary and vaginal infections.

Farmers are always advised to fatten andcull such animal to prevent theperpetration of the hereditary geneticproblem. Where treatment is desiredespecially in valuable animals, a case ofRVF cum AR with IA may be treatedsurgically by creating a neo-rectum andperforming a colonic pull-throughprocedure (Vianna and Tobias, 2005).Inthis case a left flank colostomy wasperformed about 3cm from the pelvic brimsuch that the mammary gland areas willnot be soiled with feacal materials whichwould not be healthy for the piglets. Theabdominal muscles were bluntly separatedin an oblique manner in a caudo-cranialdirection into the abdominal cavity suchthat the abdominal muscles simulated asphincter.The post surgical complication of strictureof the colostomy orifice agrees with whatwas reported by Remi-Adewunmi et al.(2007)·In this case the sow was served solely todemonstrate to students that such cases inpriced animals can be salvaged or managed

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by performing a colostomy.

REFERENCESARONSON, L. (2003): Rectum and anus.

In: Slatter DH, editor. Textbook ofSmall Animal Surgery. 3.Philadelphia: WB Saunders, pp.682-708.

BRADLEY, J. CHMPAGNE, M.D.,MICHAEL, F. and MCGEE, M.D.(2010): Rectovaginal Fistula. Surg.CUnN Am. 90: 68-82.

HANAVADI, S., DURHAM-HALL, A. andOKE, T. (2004): Forgotten vaginalpessary eroding into rectum. Ann RCollSurgEngl. 86:W18-9.

KANKAM, O.K. and GERAGHTY, Y.R.(2002): An erosive pessary. J R SocMed.95:507·

MAHLER, S. and WILLIAMS, G. (2005):Preservation of the fistula forreconstruction of the anal canal andthe anus in atresia andrectovestibular fistula in 2 dogs. VetSurg·34:148-152.

PRASSINOS, N.N., PAPAZOGLOU, L.G.,ADAMAMA-MORAITOU, K.K.,GALATOS, A.D., GOULETSOU, P.and RALLIS, T.S. (2003): Congenitalanorectal abnormalities in six dogs.Vet Rec.153:81-85.

REMI-ADEWUNMI, B.D., FALE, M.S.,USMAN, B. and LAWAL, M. (2007):A retrospective study of atresia anicases at tha Ahmadu Bello UniversityVeterinary Teaching Hospital Zaria,Nigeria. Nigeriaa Veterinary Journal28(1): 48-53.

SANDBORN, W.J., FAZIO, V.W. andFEAGAN, B.G. (2003): AGAtechnical review on perianal Crohn'sdisease. Gastroenterology.125:1508-30.

SINGHAL, S.R., NANDA, S. andSINGHAL, S.K. (2007) Sexualintercourse: an unusual cause ofrectovaginal fistula. Eur J ObstetGynecol Reprod.131:243-4.

STEINER, A. Surgery of the colon. In:FUBINI, S; DUCHARME, N. Farmanimal surgery.r.Ed. St. Louis:Elsevier Saunders, 2004,PA 72-4 77.

VIANNA, M.L. and TOBIAS, K.M. (2005):Atresia ani in the dog: A retrospectivestudy. J Am Anim Hosp Assoc.41:317-322.

WYKES, P.M. and OLSON, P.N. (2003)Vagina, vestibule, and vulva. In:Textbook of Small Animal Surgery.Slatter DH, editor. WB Saunders:Philadelphia: PP.1502-1510

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