Surgical treatment of intestinal Necrosis caused by Porcine umbilical hernia

If porcine umbilical hernia is treated in time, it is generally easy to cure and there will be no intestinal necrosis; if it is not treated in time, the intestines that fall into the hernia sac will die. Most of the cases with necrosis were small hernia ring, and the falling intestine was necrosed due to insufficient blood supply caused by the clamp of the hernia ring; although the hernia ring was large in a few cases, but the falling intestine was stimulated by the contents (even corrupt contents) for a long time and necrosis occurred. According to the situation, we use surgery to treat many cases of intestinal necrosis caused by porcine umbilical hernia, the effect is good, the following is introduced for reference.

1 clinical symptoms

It can be seen that there is a capsule in the navel, the size of a fist, or even larger. In general, it is normal to eat at the beginning of the disease, but because it is normal to eat, farmers generally do not receive treatment at this time. After 2 to 3 months (as long as half a year), the sac is enlarged, and the pig stops eating or eats a small amount of food. At this time, the body temperature is generally slightly higher than the normal body temperature. Agricultural products generally seek treatment at this time, because farmers generally judge whether pigs are sick by the amount of food they eat, and pigs are sick if they eat little or not.

2Surgical treatment

2.1 before operation, fasting for one day before operation, lie on your back in Baoding; thoroughly cut the hair off the hernia sac and its surroundings with shears, rinse with 0.1% bromogeramine solution, disinfect with 5% iodine tincture twice, wipe with 75% alcohol cotton balls to remove shyness. 0.5% procaine hydrochloride injection 10~30ml (10ml for piglets and 30ml for medium pigs) was used for stratified infiltration anesthesia at the bottom and base of the hernia sac respectively, and the operation began 5 minutes later.

2.2 Surgical procedure

2.2.1 ① cuts the skin longitudinally from the anterior and posterior base of the hernia sac with a scalpel to separate the skin and connective tissue to the base of the hernia sac; ② cuts open the subcutaneous connective tissue capsule (necrotic intestines) and separates the peritoneum. If the hernia ring is smaller, the hernia ring is slightly enlarged by tissue scissors, so that the intestines and mesentery can enter and leave the abdominal cavity. ③ pulled out the intestines along both ends of the necrotic intestines in the hernia sac until the healthy intestines were seen, then protected the intestines with large gauze soaked in penicillin saline and isolated the operation part; according to the number of necrotic parts of the intestines, the scope of intestinal and mesenteric resection was determined and the incision line was determined. The blood vessels on the mesenteric incision line were double ligated on the root side, and then two intestinal forceps were used to clamp the intestines at both ends away from the cutting edge 3~5cm to fix the intestines and block the outflow of intestinal contents; according to the determined incision line, ④ removed and removed the necrotic intestines and mesentery, absorbed the contents of the broken intestines with disinfection gauze, wiped and cleaned, and then rinsed the intestinal mucosa several times with penicillin normal saline.

2.2.2 routine end-to-end anastomosis. In the clinical cases, the caliber of the intestinal tube of the two broken ends are mostly the same, in this case, the intestinal tube is anastomosed with conventional end-to-end anastomosis. Bring the two intestinal tubes together so that the broken ends of the two intestinal tubes are close to each other. First of all, on the mesenteric side of the two intestinal ends and the opposite side of the mesentery, the whole layer of the intestine was sutured about 0.5cm from the broken end with No. 4 silk thread, and each stitch was sutured to fix the two broken ends to facilitate suture. Then use a straight stitch needle from the opposite side of the mesentery to the intestinal wall, and then penetrate into the intestinal wall from the intestinal wall to the other, and tie a knot to make the broken edge of the two intestinal tubes close to each other. Continue to use the continuous full-layer suture method to suture the posterior wall of the two-segment intestinal anastomosis close to the mesentery, pierce the suture needle from one section of the intestinal wall to the outside of the intestinal wall, then insert the suture needle into the intestinal wall from the outside of the other section of the intestinal wall, and tighten the suture to make the proximal mesenteric wall inverted; then suture with continuous horizontal mattress varus before the two-segment intestinal anastomosis until the anterior wall is finished. The end of the thread is fastened to the end of the line that was originally retained. Then remove the intestinal forceps, replace the penicillin saline gauze that protects the intestines, disinfect the hands and instruments, and then suture the outer layer of intestinal anastomosis with intermittent vertical mattress serosa muscle layer suture. After the suture is finished, rinse the intestine with penicillin saline.

2.2.3 simple end-to-end anastomosis. Insert a backing into the proximal intestinal cavity (usually peeled cucumber) to stretch the intestinal wall to facilitate suture; cover the distal intestinal segment directly above the proximal intestinal segment, so that the mucosa of the distal intestinal segment is opposite to the serosa layer of the proximal intestinal segment, and then flip the orifice of the distal intestinal tube so that the serosa overlaps with the serosa. Then, several vertical buttonholes were sutured with the folded line of No. 4 silk thread along the overturned intestinal segment and the proximal intestinal segment, and the knots were tightened between the two intestinal walls; after the intestinal segment was rinsed with penicillin physiological water, the intestinal orifice of the distal intestinal segment was turned back so that its mucosa was on the serosa of the proximal intestinal segment, and then several stitches of intermittent vertical mattress suture were made along its broken end for a week until the entire broken intestinal wall was stitched. Remove the intestinal forceps, crush the backing in the intestinal cavity, push it to the distal end, and rinse the intestinal tube with penicillin saline.

2.2.4 return the intestine to the abdominal cavity, sprinkle an appropriate amount of penicillin powder and streptomycin powder into the abdominal cavity, cut off the excess peritoneum and make a dense continuous suture of the peritoneal orifice; cut off the excess subcutaneous connective tissue by surgery, and gently cut the hernia ring to make a new wound, enter the needle along the hernia ring ring, and the drop needle point is about 1cm beside the hernia ring. When entering the needle, the index finger of the left hand extends between the peritoneum and the muscular layer, and the needle only penetrates the muscle but not the peritoneum, and the needle distance does not need to be too close. After one lap of the needle, a knot is left at the end of the needle and the end of the needle, and the hernia ring is locked by continuous suture. Appropriately tighten the knot left by circular suture and tie the knot, spread an appropriate amount of penicillin powder and streptomycin powder to the wound, remove the excess skin, and suture the skin incision with nodular suture, apply 5% iodine tincture, finally make knot bandage, and then release the affected pig.

2.3 after operation, the pigs were put into a clean enclosure covered with new hay and injected with penicillin twice a day for 7 consecutive days. The pigs were fed with cold boiled water or sugar saline within 7 days after operation, and gradually fed with some digestible feed 7 days later.

3 summary and discussion

3.1 in clinical practice, 278 cases of intestinal necrosis caused by untimely treatment of porcine umbilical hernia were treated. In 120 cases of intestinal suture with conventional end-to-end anastomosis, pigs showed varying degrees of decline in digestive function, reduced food intake, weight loss, constipation, growth and fattening in varying degrees. 158 cases of intestinal canal were sutured with simple end-to-end anastomosis. There was no digestive disorder in any pig after operation, and the feeding and defecation were normal and the growth and fattening was good.

3.2 although the conventional end-to-end anastomosis meets the requirements of anatomy and physiology, it is prone to intestinal stenosis after operation, resulting in digestive disorders, affecting digestion and absorption, and hindering the growth and fattening of pigs. simple end-to-end anastomosis overcomes the problem of postoperative intestinal stenosis, and it is easy to operate and save time. From the point of view of anatomy and physiology, the effect is good.

3.3 simple end-to-end anastomosis is to insert the distal intestinal tube directly outside the proximal intestinal wall, and the first suture uses vertical buttonhole suture, so that the two segments of intestinal tube overlap are closely connected, so that fluid leakage is not easy to occur, and the sutures are all embedded in the intestinal wall. The second suture is also an intermittent vertical mattress valgus suture, which makes the inside and outside of the intestinal canal at the anastomosis smooth and smooth, ensuring the patency of the intestinal cavity and avoiding intestinal adhesion.

3.4 simple end-to-end anastomosis is better than conventional end-to-end anastomosis in the surgical treatment of intestinal necrosis caused by porcine umbilical hernia, and the operation is simple and time-saving, so it can be widely used in clinic.