Key gastrointestinal surgeries: Intestinal biopsy - Veterinary Medicine
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Key gastrointestinal surgeries: Intestinal biopsy
Performing an intestinal biopsy should not be intimidating. These veterinarians explainthe technique they use, so you can add this diagnostic tool to your clinical toolbox.


VETERINARY MEDICINE


SURGICAL TECHNIQUE FOR INCISIONAL BIOPSY OF THE INTESTINES


Figures 3,4,5,6,7,8
After thoroughly exploring the abdomen, isolate the affected area of intestine with moistened laparotomy pads. Multiple samples are usually taken, so include all potential biopsy sites and start with the least contaminated area (i.e. the small intestines). Milk the luminal contents away from the biopsy site. Place a full-thickness, 3-0 or 4-0 monofilament stay suture in the antimesenteric wall of the intestines perpendicular to the long axis of the intestines (Figure 1). Attach a hemostat to both ends of the stay suture, and elevate it away from the intestines. With a No. 15 scalpel blade, make an incision through the intestines on one side of the stay suture, angling downward and inward toward the lumen below the suture (Figure 2). Make a similar incision along the opposite side of the stay suture so that the biopsy sample is transected from its intestinal attachments (Figure 3). Drop the stay suture and attached intestinal sample into a formalin container; the pathologist will remove the suture once the sample is fixed.


Figure 9
Close the enterotomy site (Figure 4) with a continuous or interrupted appositional pattern of 3-0 or 4-0 absorbable monofilament suture on a swaged, tapercut needle. To prevent mucosal eversion, perform a modified Gambee suture pattern.9 Insert the needle full thickness about 3 mm from the intestinal edge (Figure 5). Then back out the needle so the tip can exit at the mucosa-submucosa junction (Figures 6 & 7). Upward tension on the needle will facilitate proper placement since it causes the mucosa to roll downward over the needle tip and expose the white line of submucosa. Push the needle through the intestinal wall, and ready it for the next bite. Force the mucosa of the opposite side of the incision downward with the tip of the needle, and place a full-thickness bite, starting at the mucosa-submucosa junction (Figure 8). The first throw on the suture can either be a simple throw or a surgeon's throw and should be tightened enough to appose but not crush the intestinal wall. To prevent loosening, we use a surgeon's throw to begin the knot, particularly when tension is present. Add three or four additional throws to complete the knot (Figure 9). Small biopsy sites can be closed with three sutures: Place the initial appositional suture across the center of the incision, and add an additional suture to each side (Figures 10 & 11).

COMPLICATIONS


Figures 10,11
Complications are rare after intestinal biopsy. In one study, dehiscence of incisional biopsy sites was reported in 1.9% of dogs and was not correlated with systemic albumin concentrations.3 Dehiscence rates are similar for animals undergoing enterotomy for foreign body removal (2.6%).10 In another study, septic peritonitis and death secondary to biopsy site leakage were reported in one of 12 dogs undergoing intestinal biopsy.1

Laura Brandt, DVM
Karen M. Tobias, DVM, MS, DACVS
Department of Small Animal Clinical Sciences
College of Veterinary Medicine
The University of Tennessee
Knoxville, TN 37996-4544

REFERENCES

1. Keats MM, Weeren R, Greenlee P, et al. Investigation of Keyes skin biopsy instrument for intestinal biopsy versus a standard biopsy technique. J Am Anim Hosp Assoc 2004;40:405-410.


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Source: VETERINARY MEDICINE,
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