Surgical Management of Certain Surgical Management of Certain Ano-rectal Affections in Farm Ano-rectal Affections in Farm

AnimalsAnimalsByBy

Prof.Dr.Prof.Dr.Gamal I .A .KarroufGamal I .A .Karrouf

Dept. of Surgery, Anesthesiology & Dept. of Surgery, Anesthesiology & Radiology. Faculty of Vet. Medicine, Radiology. Faculty of Vet. Medicine,

Mansoura UniversityMansoura University

Aim of the workAim of the work

• The present study aimed to declare The present study aimed to declare the commonly and rarely occurred the commonly and rarely occurred anorectal affections in farm animals anorectal affections in farm animals as well as the description of their as well as the description of their surgical management.surgical management.

Materials and MethodsMaterials and Methods• The present study was carried out on a total The present study was carried out on a total

number of 65 cases suffered of different anorectal number of 65 cases suffered of different anorectal

affectionsaffections These animals either presented to These animals either presented to

Surgery Clinic of the Mansoura teaching hospital Surgery Clinic of the Mansoura teaching hospital

or managed during field training trips in Dakahlia or managed during field training trips in Dakahlia

villages during the period between April 2003 to villages during the period between April 2003 to

March 2006March 2006

Diagnosis of these affections were based on Diagnosis of these affections were based on history of the case and presenting clinical findings history of the case and presenting clinical findings and it was clear in cases of anorectal and it was clear in cases of anorectal malformation; however abdominal pressure was malformation; however abdominal pressure was needed to differentiate between atresia ani and needed to differentiate between atresia ani and atresia ani et recti. In cases of anus vaginalis, the atresia ani et recti. In cases of anus vaginalis, the presence of fistula was ascertained through the presence of fistula was ascertained through the history and vaginal examination digitally to detect history and vaginal examination digitally to detect the unnatural opening in the roof of the vagina the unnatural opening in the roof of the vagina while the faces were expelled through while the faces were expelled through vulvavulva . .Exploratory laparotomy was used in Exploratory laparotomy was used in extensively atretic rectum. Confirmative extensively atretic rectum. Confirmative histopathological examination was performed for histopathological examination was performed for neoplastic massesneoplastic masses

Surgical proceduresSurgical procedures• AnesthesiaAnesthesia: : caudal epidural analgesia caudal epidural analgesia

using Lidocaine 2%(Xylocaine) for all cases in using Lidocaine 2%(Xylocaine) for all cases in calves while local analgesia using lidocaine calves while local analgesia using lidocaine was used in some cases of atresia ani in was used in some cases of atresia ani in lambs. In mares with rectovestibular fistula, lambs. In mares with rectovestibular fistula, the regional analgesia for surgery was the regional analgesia for surgery was achieved by caudal epidural analgesia using achieved by caudal epidural analgesia using a 0.17mg/kg B.W. xylazine diluted with 4ml of a 0.17mg/kg B.W. xylazine diluted with 4ml of 2%2% Lidocaine (0.22 mg/kg B.W. )and sterile Lidocaine (0.22 mg/kg B.W. )and sterile saline to 10 ml saline to 10 ml

The congenital anorectal affections The congenital anorectal affections recorded in the present work were atresia recorded in the present work were atresia ani (24 cases) , atresia ani et recti (4 cases) ani (24 cases) , atresia ani et recti (4 cases) , atresi ani et vulvi (3 cases), atresia ani , atresi ani et vulvi (3 cases), atresia ani with taillessness (1 case) atresia ani with with taillessness (1 case) atresia ani with rectovaginal fistula (11 casesrectovaginal fistula (11 cases ( (while the while the acquired oneacquired one includesincludes rectal prolapse (15 rectal prolapse (15 cases), anorectal tears (2 cases) , cases), anorectal tears (2 cases) , perirectal abscess (1caseperirectal abscess (1case ( (rectovaginal rectovaginal fistula (2 cases), rectal polyp (1casefistula (2 cases), rectal polyp (1case(( and and rectal leiomyoma (1case).rectal leiomyoma (1case).

A precise case history, physical and A precise case history, physical and

clinical examinations as well as clinical examinations as well as

surgical exploration in some instances surgical exploration in some instances

were sufficient for diagnosis of many were sufficient for diagnosis of many

of these cases while confirmative of these cases while confirmative

histopathological examination was histopathological examination was

carried out for neoplastic massescarried out for neoplastic masses . .

Atresia ani was the most Atresia ani was the most common congenital common congenital malformation recorded in malformation recorded in the present work. It was the present work. It was more prevalent in lambs more prevalent in lambs followed by calves and followed by calves and kids kids

• clinical signs includes mild to severe clinical signs includes mild to severe abdominal distension, tenesmus and abdominal distension, tenesmus and bulge beneath the tail. These animals bulge beneath the tail. These animals were seen to nurse well after birth were seen to nurse well after birth but with time usually they became but with time usually they became dull and depressed. dull and depressed. These signs were These signs were not observed in cases of atresia ani not observed in cases of atresia ani accompanied with rectovaginal fistula accompanied with rectovaginal fistula where the affected female animals where the affected female animals were up to 3-6 months without were up to 3-6 months without showing clear signs of illness and showing clear signs of illness and surviving several months without surviving several months without diagnosis or treatment. diagnosis or treatment.

• Surgical correction of a patent Surgical correction of a patent anal opening must be done as anal opening must be done as early as possible to save the early as possible to save the animal life especially in male animal life especially in male animals .Reconstruction of the animals .Reconstruction of the anal opening was successfully anal opening was successfully performed, defecation performed, defecation appeared to be normal without appeared to be normal without complications in the treated complications in the treated animals, despite the absence of animals, despite the absence of an anal sphincter. an anal sphincter.

Fig.(1):Atresia ani in a male kid (A) and Fig.(1):Atresia ani in a male kid (A) and after reconstruction of the anal opening after reconstruction of the anal opening (B).(B).

Fig.(11) : Atresia ani in a Fig.(11) : Atresia ani in a buffalo calf (A), after buffalo calf (A), after making a circular incision making a circular incision and exposure of the and exposure of the rectum (B), complete rectum (B), complete reconstruction of the anal reconstruction of the anal orifice (C) and after orifice (C) and after removal of skin stitches removal of skin stitches (D).(D).

Atresia ani with hypoplasia of the penile body was recorded in a calf. The affected animal was presented with a small ill developed penile body with a stricture of the external orifice of the penile urethra. The calf was treated beside reconstruction of the anal opening a urethrostomy was performed (Fig.12).

Fig.(12): Atresia ani Fig.(12): Atresia ani with hypoplasia of the with hypoplasia of the penile body in mixed penile body in mixed breed calf (A) after breed calf (A) after reconstruction of the reconstruction of the anal opening (B) and anal opening (B) and urethrostomy (C&D).urethrostomy (C&D).

When atresia was more extensive When atresia was more extensive where the majority of the rectum is where the majority of the rectum is atretic and a natural channel to the atretic and a natural channel to the anus was impossible, the blind end anus was impossible, the blind end of the colon was found via a of the colon was found via a paramedian suprapubic exploratory paramedian suprapubic exploratory laparotomy and translocation of the laparotomy and translocation of the colon to the body wall exiting as a colon to the body wall exiting as a colostomy (Fig.4).colostomy (Fig.4).

Fig.(4):Fig.(4):Atresia ani with severely atretic rectum in a mixed Atresia ani with severely atretic rectum in a mixed breed calf . Mal-interfered opening at the proposed site of breed calf . Mal-interfered opening at the proposed site of anal opening (A), an exploratory laparotomy and anal opening (A), an exploratory laparotomy and exposure of the blind end of the colon exposure of the blind end of the colon (B) and opening and fixation of the colon to the (B) and opening and fixation of the colon to the laparotomy wound (C).laparotomy wound (C).

• In case where the entire In case where the entire rectum was atretic, the rectum was atretic, the prognosis was grave. prognosis was grave.

• if the end of the colon can if the end of the colon can not be located in the pelvic not be located in the pelvic cavity, euthanasia is cavity, euthanasia is indicatedindicated

• Several congenital Several congenital abnormalities including abnormalities including atresia recti, atresia vulvi, atresia recti, atresia vulvi, rectovaginal fistula and rectovaginal fistula and anury has been recorded in anury has been recorded in the present study the present study accompanied the atresia ani accompanied the atresia ani

In case of anus vaginalis, the atretic In case of anus vaginalis, the atretic anus was firstly patent then the fistula was anus was firstly patent then the fistula was repaired through either direct approach of repaired through either direct approach of the fistula through the vulva or through a the fistula through the vulva or through a cutaneous transverse incision between the cutaneous transverse incision between the anus and vulva. The incision was further anus and vulva. The incision was further extended cranially and the adhesions extended cranially and the adhesions around the fistula were dissected free. The around the fistula were dissected free. The rectal defect was closed transversely while rectal defect was closed transversely while the vaginal defect was closed the vaginal defect was closed longitudinallylongitudinally (Figs.7&8). (Figs.7&8).

Fig.(7): Malinterfered in a case of atresia ani and Fig.(7): Malinterfered in a case of atresia ani and rectovaginal fistula with stenotic anal opening . rectovaginal fistula with stenotic anal opening . Note the fecal matter voided through the vulva (A) Note the fecal matter voided through the vulva (A) and a catheter passed through the fistula (B).and a catheter passed through the fistula (B).

Fig.(8):Fig.(8): The same case in fig. 6B after The same case in fig. 6B after reconstruction of the anal opening (A) and reconstruction of the anal opening (A) and closure of the fistula through the vulva (B) .closure of the fistula through the vulva (B) .

Fig.(15) : (A) Atresia ani with rectovaginal Fig.(15) : (A) Atresia ani with rectovaginal fistula in 4 months old sheep (A), fistula in 4 months old sheep (A), reconstruction of the anal opening (B) and reconstruction of the anal opening (B) and after removal of skin stitches (C).after removal of skin stitches (C).

•Atresia ani either alone or associated with atresia recti or rectovaginal fistula was one of most rare ano-rectal affection recorded in foal, donkey foal and mare-donkey. These affections have not been well documented in these animals.

Fig.(2): Atresia ani with hypospadias in Fig.(2): Atresia ani with hypospadias in one day old donkey (A) and after one day old donkey (A) and after reconstruction of the anal opening (B).reconstruction of the anal opening (B).

In cases of atresia recti, the In cases of atresia recti, the blind end of the rectum was freed blind end of the rectum was freed and moved caudally and fixed to and moved caudally and fixed to the subcutaneously perianal the subcutaneously perianal tissues with four non penetrating tissues with four non penetrating catgut No.I sutures. The rectum catgut No.I sutures. The rectum opened and the edges sutured to opened and the edges sutured to the skin with interrupted the skin with interrupted suturessutures ))Fig.3Fig.3((

Fig.(3): Foal with atresia ani et recti (A). Note no bulging Fig.(3): Foal with atresia ani et recti (A). Note no bulging was noticed at the anal scar .B) After deeper dissection was noticed at the anal scar .B) After deeper dissection and grasping of the rectum towards the anal orifice .C) and grasping of the rectum towards the anal orifice .C) Complete reconstruction of the anal opening and fixation Complete reconstruction of the anal opening and fixation of the rectum with passage of the meconium .of the rectum with passage of the meconium .

A rare case of anus vaginalis that A rare case of anus vaginalis that was recorded in 6 months old mare-was recorded in 6 months old mare-donkey showed that the rectum was donkey showed that the rectum was atretic and represented by vulvar like atretic and represented by vulvar like opening into the vagina which was opening into the vagina which was fixed into the reconstructed anal fixed into the reconstructed anal opening (Figs.16, 17&18).opening (Figs.16, 17&18).

Fig.(16) : Atresia ani with rectovaginal Fig.(16) : Atresia ani with rectovaginal fistula in 6 monthes old she-donkey (A) and fistula in 6 monthes old she-donkey (A) and expelling of fecal matter through the vulva expelling of fecal matter through the vulva (arrow B).(arrow B).

Fig.(17): Fig.(17): The same case in fig .16 after surgical The same case in fig .16 after surgical site preparation (A). Note a perineal bulge and site preparation (A). Note a perineal bulge and absence of a patent anus. The rectum separated absence of a patent anus. The rectum separated from the atretic anus and open directly into the from the atretic anus and open directly into the lumen of the vagina through a vulval like lumen of the vagina through a vulval like opening (B) .opening (B) .

Fig.(18): The same case in fig 16 where the Fig.(18): The same case in fig 16 where the the vulval like rectum fixed into the anal the vulval like rectum fixed into the anal wound (A) and after complete fixation of the wound (A) and after complete fixation of the rectum to the reconstructed anal opening rectum to the reconstructed anal opening (B).(B).

•Atresia ani et vulvi was Atresia ani et vulvi was one of the most rare one of the most rare affection recorded in the affection recorded in the present work. It was present work. It was demonstrated in 3 calves demonstrated in 3 calves where reconstruction was where reconstruction was simply performed simply performed

The anal opening was firstly The anal opening was firstly reconstructed via a circular incision reconstructed via a circular incision against the seat of the anus while the against the seat of the anus while the vulvar lips was reconstructed through a vulvar lips was reconstructed through a midline incision against the seat of the midline incision against the seat of the vulva clearing the vaginal mucosa. The vulva clearing the vaginal mucosa. The mucosal membrane on each side was mucosal membrane on each side was sutured to the skin with simple sutured to the skin with simple interrupted suture pattern using silk No.1interrupted suture pattern using silk No.1

Fig.(6Fig.(6((: : AtresiaAtresia ani et vulvi with the presence of a ani et vulvi with the presence of a very fine opening (probe) discharging urine in very fine opening (probe) discharging urine in newly born native breed calf (A) and after newly born native breed calf (A) and after reconstruction of both anal opening and vulvar reconstruction of both anal opening and vulvar lips(B) lips(B)

Fig.(13) : Atresia ani et vulvi Fig.(13) : Atresia ani et vulvi and the urine passed from and the urine passed from pin point opening in the pin point opening in the distal end of the vulva (A) distal end of the vulva (A) and after reconstruction of and after reconstruction of vulvar lips and anal opening vulvar lips and anal opening (B&C).(B&C).

Fig.(14): Atresia ani et vulvi in one day old calf with Fig.(14): Atresia ani et vulvi in one day old calf with the presence of pin point orifice discharging fluidy the presence of pin point orifice discharging fluidy meconium (A&B) and after reconstruction of the anal meconium (A&B) and after reconstruction of the anal opening and vulval lips ( C ).opening and vulval lips ( C ).

• Rectal stricture due to either mal-Rectal stricture due to either mal-interference or following repair of interference or following repair of atresia ani accompanied by atresia ani accompanied by progressive fibrosis of created progressive fibrosis of created anal opening was recorded in 4 anal opening was recorded in 4 calves. Surgical interference was calves. Surgical interference was carried out to relieve the stricture carried out to relieve the stricture by retraction and resection of the by retraction and resection of the strictured portion with suturing of strictured portion with suturing of the viable rectum to the skin at the viable rectum to the skin at the anus the anus

Fig.(5): Stricture of the Fig.(5): Stricture of the anal opening in a female anal opening in a female buffalo calf due to mal-buffalo calf due to mal-interference after patent interference after patent anal orifice (A) and after anal orifice (A) and after its reconstruction (B).its reconstruction (B).

Acquired anorectal affection as rectal Acquired anorectal affection as rectal

prolapse, anorectal tears, rectovestibular prolapse, anorectal tears, rectovestibular

fistulas, perirectal abscess ,rectal polyp and fistulas, perirectal abscess ,rectal polyp and

rectal leiomyoma were recorded in the rectal leiomyoma were recorded in the

present studypresent study

• Mucosal and complete rectal Mucosal and complete rectal prolapse was diagnosed in the prolapse was diagnosed in the present study .The higher present study .The higher number was recorded in donkeys. number was recorded in donkeys. Higher successful rates were Higher successful rates were obtained following early obtained following early management of rectal prolapse management of rectal prolapse by replacement and retention by replacement and retention with a purse-string suture.with a purse-string suture.

Fig.(10):Fig.(10): Recent mucosal prolapse in a Recent mucosal prolapse in a donkey (A) and after reduction and donkey (A) and after reduction and retention by purse-string suture (B).retention by purse-string suture (B).

Fig.(19): Complete rectal Fig.(19): Complete rectal and vaginal prolapse in and vaginal prolapse in a she-donkey (A) and a she-donkey (A) and following reduction and following reduction and retention using silk for retention using silk for the anal orifice and the anal orifice and umbilical tape for vulval umbilical tape for vulval lips .lips .

• Rectovestibular fistula was Rectovestibular fistula was

recorded in two mares, the recorded in two mares, the

condition followed repair of condition followed repair of

third degree rectovestibular third degree rectovestibular

laceration .laceration .

• . Several techniques have been recommended for repair of rectovestibular fistula. Direct repair of the fistula through the vulva in anaesthetized mare has been reported (Hilbert, 1981). Most surgeons prefer to convert them to third degree perineal laceration and repaired them by one of the standard method (Aanes, 1988 and Belknap&Nickels, 1992). For deep (cranial) fistula, a perineal body transection has been utilized through a transverse skin incision equidistant between the anus and dorsal commissure of the vulva with dissection cranially through the perineal body to the fistula (Aanes,1988 and Trotter, 1993).

In the present study repair of rectovestibular In the present study repair of rectovestibular fistula in mares was done by direct approach fistula in mares was done by direct approach through the rectum in standing mares leaving through the rectum in standing mares leaving the anal sphincter and perineal body intact the anal sphincter and perineal body intact (Adams et al.,1996).(Adams et al.,1996).The edge of the fistula The edge of the fistula where rectal and vestibular mucosa have healed where rectal and vestibular mucosa have healed together was completely incised intogether was completely incised in a a circumferential manner . The margins of the circumferential manner . The margins of the fistula along the incision were removed edges fistula along the incision were removed edges for the entire circumference of the for the entire circumference of the fistulafistula ))Figs.9a&b).Figs.9a&b).

Closure was done in three layers of Closure was done in three layers of sutures using polygalactin 910 (Vicryle) No.1 sutures using polygalactin 910 (Vicryle) No.1 in an interrupted pattern. The first line for in an interrupted pattern. The first line for closure of the defect by incorporating three closure of the defect by incorporating three distinct layers, in each suture, the rectal distinct layers, in each suture, the rectal submucosa through perineal fascia and submucosa through perineal fascia and vestibular submucosa on the cranial side of vestibular submucosa on the cranial side of the fistula and then through the vaginal the fistula and then through the vaginal submucosa , perineal fascia and rectal submucosa , perineal fascia and rectal submucosa on the caudal side. submucosa on the caudal side.

All sutures are preplaced, the end were left All sutures are preplaced, the end were left long and tagged with hemostats (Fig.10c) long and tagged with hemostats (Fig.10c) after all sutures were placed, they were tied after all sutures were placed, they were tied singly to close the fistula. Any gaps were singly to close the fistula. Any gaps were closed with additional sutures .The second closed with additional sutures .The second line of sutures closes the rectal mucosa line of sutures closes the rectal mucosa transversely with a continuous horizontal transversely with a continuous horizontal mattress suture while the third closes the mattress suture while the third closes the mucosa of the vestibule with a continuous mucosa of the vestibule with a continuous horizontal mattress suture pattern using the horizontal mattress suture pattern using the same suture material. same suture material.

Fig.(9): (A) Rectovestibular fistula in a mare.Fig.(9): (A) Rectovestibular fistula in a mare.(B) The entire margin of the fistula has freshly (B) The entire margin of the fistula has freshly incised edge of rectal and vestibular mucosa.incised edge of rectal and vestibular mucosa.(C) Interrupted sutures of size 1 polygalactin 910 (C) Interrupted sutures of size 1 polygalactin 910 used to approximate the tissues in a transverse used to approximate the tissues in a transverse direction.direction.

• Regional anesthesia for repair of Regional anesthesia for repair of

rectovestibular fistula was achieved by rectovestibular fistula was achieved by

caudal epidural analgesia using xylazine-caudal epidural analgesia using xylazine-

lidocaine combination provided a rapid lidocaine combination provided a rapid

onset of analgesia and duration of action onset of analgesia and duration of action

up to 5 hours without interference in the up to 5 hours without interference in the

motor control of the limbs motor control of the limbs

Fig.20: The same Fig.20: The same case in Fig.8 showing case in Fig.8 showing complete healing of complete healing of the rectovestibular the rectovestibular fistula.fistula.

Rectal tear was diagnosed in mixed Rectal tear was diagnosed in mixed breed cow following a rough rectal breed cow following a rough rectal palpation. The lesion involved the dorsal palpation. The lesion involved the dorsal aspect of the rectum. Proctorrhaphy aspect of the rectum. Proctorrhaphy through the anus under the effect of through the anus under the effect of caudal epidural analgesia was done using caudal epidural analgesia was done using continuous chromic catgut sutures and continuous chromic catgut sutures and interrupted silk sutures for complete interrupted silk sutures for complete appositionapposition (Fig.21).(Fig.21).

Fig. (21):Fig. (21): Dorsal rectal tears in a mixed breed Dorsal rectal tears in a mixed breed cattle following rough rectal palpation (A) cattle following rough rectal palpation (A) and after its reconstruction (B).and after its reconstruction (B).

Lacerated wound of the anus Lacerated wound of the anus was recorded in a male donkey was recorded in a male donkey Surgical reconstruction was Surgical reconstruction was performed. First intention healing performed. First intention healing was obtained after removal of thewas obtained after removal of thesuturessutures

Fig. (22): Old lacerated wound of the anal orifice in Fig. (22): Old lacerated wound of the anal orifice in a donkey (A) after its debridement and a donkey (A) after its debridement and reconstruction (B&C) and complete healing (D).reconstruction (B&C) and complete healing (D).

Perirectal abscess rarely Perirectal abscess rarely have been reported in have been reported in adult horses. Abscesses in adult horses. Abscesses in this area may develop this area may develop secondary to rectal tears secondary to rectal tears or other mucosal trauma or other mucosal trauma or from gravitation of an or from gravitation of an abscess in the gluteal abscess in the gluteal muscles into perirectal muscles into perirectal tissues tissues

Perirectal abscess was diagnosed in a Perirectal abscess was diagnosed in a mare .The abscess was drained lateral mare .The abscess was drained lateral to the anus under the effect of caudal to the anus under the effect of caudal epidural analgesia beside a laxative epidural analgesia beside a laxative diet was fed. Second intention healing diet was fed. Second intention healing was obtained 20 days after treatment was obtained 20 days after treatment (Fig.23) .(Fig.23) .

Fig. (23): Perirectal abscess in 5 years old Fig. (23): Perirectal abscess in 5 years old mare (A) and after complete healing (B) .mare (A) and after complete healing (B) .

•Rectal Neoplasms •

•--------------------------------------------------------------------------------•Malignant rectal neoplasms are usually

adenocarcinomas in dogs and lymphosarcomas in cats. Adenocarcinomas are slow growing and infiltrative. Local or systemic metastasis may

develop before tenesmus, dyschezia, hematochezia, or diarrhea is seen. Surgery is the treatment of

choice for adenocarcinomas, but it may be unrewarding because metastasis has usually

occurred before the diagnosis. Cats with rectal lymphosarcoma are treated medically with

antineoplastic drugs.

•Rectal Polyps • •--------------------------------------------------------------------------------•Rectal adenomatous polyps are an infrequent,

usually benign disease, primarily of small animals. The larger the polyp, the greater the potential for

malignancy. Signs include tenesmus, hematochezia, and diarrhea. The polyp is usually palpable per

rectum and bleeds easily with surface ulceration. Periodically, the polyp may prolapse through the

anal orifice. Surgical excision is usually followed by rapid clinical recovery and lengthy survival time. New polyps may develop after surgery. A biopsy should always be submitted for histopathologic

diagnosis

The term polyp is used as a growth The term polyp is used as a growth description for any lesion that projects description for any lesion that projects into the bowel lumen. Polyps are non into the bowel lumen. Polyps are non neoplastic masses that resemble neoplastic masses that resemble tumor, may be formed as the result of tumor, may be formed as the result of abnormal mucosal maturation or abnormal mucosal maturation or chronic inflammation. Grossly they are chronic inflammation. Grossly they are firm nodule or masses of various size firm nodule or masses of various size that may be ulcerated ,infected and that may be ulcerated ,infected and hemorrhagic. Histologically ,they are hemorrhagic. Histologically ,they are similar to fibroma but well vasularized similar to fibroma but well vasularized

A rectal polyp was diagnosed in a stallion. A rectal polyp was diagnosed in a stallion. The lesions were pedunculated hanged The lesions were pedunculated hanged through the anus, traction of the tumor created through the anus, traction of the tumor created a stalked polyp. The mass was easily excised a stalked polyp. The mass was easily excised after after ligation and division of the attachment to ligation and division of the attachment to the rectal mucosa under the effect of manual the rectal mucosa under the effect of manual restraint and caudal epidural analgesia. restraint and caudal epidural analgesia. Histopathological examination represented by Histopathological examination represented by fibrous connective tissue infiltrated with fibrous connective tissue infiltrated with rounded inflammatory cells (Fig.24).rounded inflammatory cells (Fig.24).

Fig.(24)Non-neoplastic rectal polyps in a stallion (A) Fig.(24)Non-neoplastic rectal polyps in a stallion (A) and its microscopic picture represented by fibrous and its microscopic picture represented by fibrous connective tissues infiltrated with round inflammatory connective tissues infiltrated with round inflammatory cells ( H&E,x20) .cells ( H&E,x20) .

Rectal lieomyoma was seen in a Rectal lieomyoma was seen in a buffalo. The tumor was firm lobulated, buffalo. The tumor was firm lobulated, grayish in color and not encapsulated grayish in color and not encapsulated projected outside the rectal projected outside the rectal lumen .Microscopically the tumor consists lumen .Microscopically the tumor consists of muscle bundles arranged in all of muscle bundles arranged in all direction and planes. The muscles fibers direction and planes. The muscles fibers were spindle shaped ,arranged parallel to were spindle shaped ,arranged parallel to each other .They had a ribbon-shaped each other .They had a ribbon-shaped nucleus with rounded ends (cigar shapednucleus with rounded ends (cigar shaped) ) ((Fig.25)Fig.25) . .

Fig.(25): Rectal leiomyoma in a buffalo (A), during Fig.(25): Rectal leiomyoma in a buffalo (A), during its surgical removal ( B ) and the microscopic its surgical removal ( B ) and the microscopic examination (C) revealed the presence of bundles examination (C) revealed the presence of bundles of neoplastie smooth muscle cells with cigar of neoplastie smooth muscle cells with cigar shaped nucleus ( H&E, x 300 ).shaped nucleus ( H&E, x 300 ).

ConclusionConclusion

The higher incidence of congenital The higher incidence of congenital anomalies was recorded in lamb followed anomalies was recorded in lamb followed by calves while the higher incidence of by calves while the higher incidence of acquired anorectal affections was recorded acquired anorectal affections was recorded in donkeys. Uncommon anorectal in donkeys. Uncommon anorectal affections such as atresia ani in donkey affections such as atresia ani in donkey foal andfoal and rectovaginal fistula in she-donkey, rectovaginal fistula in she-donkey, atresia ani et recti in a foal, atresia ani et atresia ani et recti in a foal, atresia ani et vulvi in calves, rectal polyp and rectal vulvi in calves, rectal polyp and rectal leiomyoma were recorded in the present leiomyoma were recorded in the present work.work.

Rectovestibular fistula was recorded in 2 Rectovestibular fistula was recorded in 2 mares. It occurs as a complication of the third mares. It occurs as a complication of the third degree rectovestibular lacerations repair. degree rectovestibular lacerations repair. Clinical examinations revealed the presence of Clinical examinations revealed the presence of common opening between the rectum and common opening between the rectum and vagina, fecal matter expelled through the vulva vagina, fecal matter expelled through the vulva with signs of pneumovagina. The two cases with signs of pneumovagina. The two cases were treated by a transrectal approach where were treated by a transrectal approach where the fistula was debrided and closed in three the fistula was debrided and closed in three layers and without conversation into a third layers and without conversation into a third degree peineal laceration. Follow up of the two degree peineal laceration. Follow up of the two cases revealed complete healing cases revealed complete healing (Fig. 20)(Fig. 20). .

Atresia ani with rectovaginal fistula (anus vaginalis) was recorded in 11 animals (6 sheep , 4 calves and a she-donkey). The atretic anus was circumvented via an unnatural opening into the roof of the vagina. The faeces was voided through the vulva which showed faecal soiling, palpation of the fistula digitally from the vulva revealed that the fistula was approximately 2-3 cm from the external commisure of the vulva and about 1-2 cm. in diameter. The affected animals were up to 3-6 months old without showing any clear signs of illness; however there was a steady increase in their abdominal circumference and a slower growth rate than the littermate (Fig15).

Atresia ani et vulvi was diagnosed in 3 Atresia ani et vulvi was diagnosed in 3 native breed calves. These animals were native breed calves. These animals were presented 1-2 days after calving . One calf presented 1-2 days after calving . One calf having passed neither meconium nor urine having passed neither meconium nor urine since birth , while the second calf passed thin since birth , while the second calf passed thin stream of fluidy meconum through a pin point stream of fluidy meconum through a pin point orifice of the vulva and the last one passed thin orifice of the vulva and the last one passed thin stream of urine during straining from a narrow stream of urine during straining from a narrow orifice .Careful examination revealed the orifice .Careful examination revealed the absence of both anal opening and vulva. absence of both anal opening and vulva. Complete recovery was obtained following Complete recovery was obtained following reconstruction of both anus and vulva. (reconstruction of both anus and vulva. (Figs. Figs. 13&14)13&14). .

Atresia ani et recti was recorded in four animal(2 Atresia ani et recti was recorded in four animal(2 lambs-a calf and a foal). The blind end does not bulged lambs-a calf and a foal). The blind end does not bulged out on applying abdominal pressure but the end of the out on applying abdominal pressure but the end of the rectum was easily moved caudally and fixed to the rectum was easily moved caudally and fixed to the subcutaneously perianal tissues in all cases except one subcutaneously perianal tissues in all cases except one calf had atresia ani with extensively atretic rectum calf had atresia ani with extensively atretic rectum which receive an early interference in a private practice which receive an early interference in a private practice for creation of an anal opening. Deep pelvic dissection for creation of an anal opening. Deep pelvic dissection was attempted however the distended end of the rectum was attempted however the distended end of the rectum could not located and natural channel to the anus was could not located and natural channel to the anus was impossible. The blind end of the colon was found via impossible. The blind end of the colon was found via paramedian suprapubic exploratory laparotomy which paramedian suprapubic exploratory laparotomy which was sutured to the skin of the laparotomy wound. Follow was sutured to the skin of the laparotomy wound. Follow up of the case revealed that the calf was died 7 days after up of the case revealed that the calf was died 7 days after operation.operation.

ResultsResults

Atresia ani was the common recorded anorectal Atresia ani was the common recorded anorectal malformation in the present work and more prevalent in malformation in the present work and more prevalent in lamb than other domestic animals(Table1). It was lamb than other domestic animals(Table1). It was recorded in 24 male animals (15lambs, 5calves, 3 kids recorded in 24 male animals (15lambs, 5calves, 3 kids and a donkey foal). These animals were presented and a donkey foal). These animals were presented usually on the same day or the first day following usually on the same day or the first day following parturition. The affected animals had a history of normal parturition. The affected animals had a history of normal suckling after birth, but with time usually become dull. suckling after birth, but with time usually become dull. The presented signs include tenesmus along with mild to The presented signs include tenesmus along with mild to severe abdominal distension, bulge beneath the tail severe abdominal distension, bulge beneath the tail during straining or abdominal palpation indicating during straining or abdominal palpation indicating imperforated anus.. All cases were treated by creation of imperforated anus.. All cases were treated by creation of anus and reconstruction of the rectumanus and reconstruction of the rectum )) Fig.11). Fig.11).

Follow up of these cases indicate complete Follow up of these cases indicate complete recovery and the animals doing well passing recovery and the animals doing well passing meconium during the first 24 hours following meconium during the first 24 hours following surgery .Despite the absence of the anal surgery .Despite the absence of the anal sphincter, the operating animals were seen to sphincter, the operating animals were seen to defecate normally and growing well without a defecate normally and growing well without a history of complications . Two calves and a history of complications . Two calves and a donkey foal developed a stricture of the rectum donkey foal developed a stricture of the rectum which were re-operated with good results. Two which were re-operated with good results. Two lambs died 2 days after surgical interference lambs died 2 days after surgical interference where the animals showed signs of depression where the animals showed signs of depression preoperatively in which the operations was preoperatively in which the operations was performed in the second day after parturition .performed in the second day after parturition .

Atresia ani was corrected Atresia ani was corrected by making circular incision by making circular incision of 2-3cm diameter through of 2-3cm diameter through the skin covering the site of the skin covering the site of the anus(the anus(Figs.1&2)Figs.1&2)

Animals were kept on a laxative Animals were kept on a laxative diet beside a systemic course of diet beside a systemic course of antibiotics for 3-5 days together antibiotics for 3-5 days together with a prophylactic doses of with a prophylactic doses of antitetanic serum for equine, antitetanic serum for equine, sheep and goats.sheep and goats.

Postoperative caresPostoperative cares

Recent mucosal and complete Recent mucosal and complete rectal prolapse was reduced after rectal prolapse was reduced after lavage with a warm astringent lavage with a warm astringent solution and topical application of solution and topical application of glycerine and lidocaine glycerine and lidocaine cream .After complete repelling cream .After complete repelling the mass, the purse-string suture the mass, the purse-string suture in anus was used to maintain in anus was used to maintain retention retention (Fig.9)(Fig.9) . .

Rectal polyp in a stallion Rectal polyp in a stallion and rectal lieomyoma in and rectal lieomyoma in buffalobuffalo