Digestive tract obstruction

[ubrch]

Hello,

Chud, the male of a brother and sister pair we've had for just over a year, was breathing heavily and acting funny. My girlfriend noticed this, because I'm presently visiting family. She took him to the vet and an X-ray revealed an obstruction. The vet is caring for him now. We have confidence in them; they're experienced with rabbits. We've been told that this can play out one of three ways:

1.) The obstruction passes overnight. Probability of this occuring is unknown.

2.) The obstruction does not pass, probabiliy also unknown but significant, and Chud enters surgery. Chance of survival through surgery is %2.

3.) The obstruction does not pass, and we elect to have him killed.

So now, I wait.

 

[Leaf]

I'm very suprised at the surgery survival outlook. Why is the percentage so low?

 

[Thumpers_Mom]

Wow :shock:that is an extremely low percentage survival rate. I do hope that this turns out well.

Please keep us posted.ray:

 

[ubrch]

I only know the numbers they gave me. I can extrapolate two pieces of information:

1.) They're probably making up the estimates on the spot. I doubt that they've read a technical article where it has been accurately derived.

2.) %2 chance of survival came up twice. Once when I asked how often rabbits can pass an obstruction, and once when I asked how often surgery succeeds. There's a chance that the vet is simply used to saying "%98" or "%2" when the odds are very high or very low, respectively.

 

[pamnock]

Is your vet familiar with GI stasis in rabbits?

Pam

 

[Pipp]

Very good question from Pam.

Check out the Library files, here:

GI Stasis: What Everyone Should Know

Did the bunny actually eat something like carpet or plastic that might cause an obstruction?

Have they tried Sub Q fluids, Simethicone (if the blockageis causing gas, and it sounds like it is/was),massage, exercise and pain control? (At this stage just make sure they don't administer a gut motility drug).

And the survival rate may not be great for GI surgery, but I'm sure it'snot that bad. It's still a last resort.

Hope Chud comes out of this soon.

sas ray:

 

[naturestee]

GI surgery is dangerous, but not so dangerous that it has only a 2% survival rate. At that point I don't see why a vet would do it. And yet I know my vet does it if the blockage is suspected to be unnatural, such as carpet fibers. And didn't Harper have a GI surgery and come through ok?

Randy (ra7751) rescues seriously ill rabbits, and I remember him saying that when a rabbit has a blockage the best thing is sub-q fluids. And pineapple enzymes in case they help to dissolve the mucous. But what happens with a blockage is that it becomes dehydrated and hard, and you need water to get in and soften the mass. Once it's softened it's easier for the movements of the GI tract to pass it and/or break it up into smaller, easier to move pieces.

Do you have any idea what the blockage might be? Could it be carpet fibers or fabric? Or is it a natural blockage made up hair and food particles?

In any case, this is not something to be decided on over one night. Treating a blockage is a slow process. Rushing it can hurt the rabbit, especially if gut motility drugs are used when a blockage is known. When Sprite had ileus (complete stopping of gut motion), my vet told me to expect it to take several days at least before we start seeing much positive progress.

ray:

 

[ubrch]

Here is what I have learned since I last posted:

On PubMed I found "Gastric dilation and intestinal obstruction in 76 rabbits.", which was published by The Veterenary Record in 2007. Here is the abstract:

"
Eighty-four incidents of gastric dilation (bloat) were investigated in 76 pet rabbits, and an intestinal obstruction was confirmed in 64 of them. In 49 the obstruction was due to pellets of compressed hair, in four to locust bean seeds, in five to neoplasia, in two to postspay adhesions, and in one case each to carpet fibre, tapeworm cysts, a strangulated hernia and diverticulosis. In all but four cases, the obstruction was in the small intestine. The condition affected a variety of breeds fed on a variety of diets. Radiography was a useful diagnostic tool because gas and/or fluid in the digestive tract outlined the dilated stomach and intestines. Twenty-nine of the rabbits died or were euthanased without treatment, and 40 underwent exploratory surgery; of these, 10 died during surgery, three were euthanased because of intestinal neoplasia, eight died postoperatively and 19 recovered. Fifteen rabbits in which radiography indicated that a foreign body had passed out of the small intestine did not undergo surgery; of these, 13 recovered and two died.
"

I have the luxury of being a close relative to an immunologist, and from her I can give you a few definitions:

neoplasia: cancer
postspay adhesions: Scar tissue after spaying
diverticulosis: a potentially lethal infection within small folds of the intestine. Common in older humans; it is assumed that this is also true for rabbits.


I called the vet and asked why her numbers were so low. She said the following:

1.) She had read that article and to put it bluntly, she throught it was wrong. She thought that the majority of the surviving rabbits were actually victims of GI Stasis, and NOT intestinal blockage. She told me that this was the consensus of other vets that she was talking to on some sort of online forum. The same community she referred to also had a consensus that the rate of survival among rabbits with a blockage that undergo surgery is essentially nil.

2.) The chances of Chud actually having a real blockage are approximately %50.

3.) Girlfriend was able to see Chud about an hour ago. He was alert and responsive.

My general impression of this vet was good. She seemed very confident in her opinion and she also seemed current on the literature.


To answer questions:

- We don't know if the bunny ate anything. We can't find any evidence. A week ago we feared he ate a rubber band, but we were never sure.

- I don't know any specifics about the treatment they are giving Chud.

- The likelihood of a blockage made from carpet fibers is low; we have not observed either rabbit eating the carpet with the single exception of when we spilled grenadine on it.



Right now we have paid for nearly hourly Xrays, and overnight care. We have decided that if Chud seems to be getting better, then we will continue care. If he becomes unresponsive and 'dumpy' as the vet calls it, the odds of there being a blockage increase dramatically and we will have him euthanized.

 

[ubrch]

brief update:

Sub-Q fluids and laxative were administered. Latest x-ray shows shrinkage of whatever the distended area is.

 

[Pipp]

ubrch wrote:

Here is what I have learned since I last posted:

On PubMed I found "Gastric dilation and intestinal obstruction in 76 rabbits.", which was published by The Veterenary Record in 2007. Here is the abstract:

"
Eighty-four incidents of gastric dilation (bloat) were investigated in 76 pet rabbits, and an intestinal obstruction was confirmed in 64 of them. In 49 the obstruction was due to pellets of compressed hair, in four to locust bean seeds, in five to neoplasia, in two to postspay adhesions, and in one case each to carpet fibre, tapeworm cysts, a strangulated hernia and diverticulosis. In all but four cases, the obstruction was in the small intestine. The condition affected a variety of breeds fed on a variety of diets. Radiography was a useful diagnostic tool because gas and/or fluid in the digestive tract outlined the dilated stomach and intestines. Twenty-nine of the rabbits died or were euthanased without treatment, and 40 underwent exploratory surgery; of these, 10 died during surgery, three were euthanased because of intestinal neoplasia, eight died postoperatively and 19 recovered. Fifteen rabbits in which radiography indicated that a foreign body had passed out of the small intestine did not undergo surgery; of these, 13 recovered and two died."

This is great info, thanks for posting it.

As far as your vet's opinion goes, I guess I'm a little confused as to why there'd be such a drastic difference re: operating to remove a 'blockage' of natural substancesin a stasis bunny and a foreign material blockage (assuming the rabbit would also be instasis). The dangers lie in putting the bunny under and then getting the GI tract safely restarted, no? Maybe damage/scar tissue re: foreign material? Just seems odd to me.

What was the 'laxitative?'I'm very curious to know that. Personally, I've known a lot of bunnies - 50% -- who have survived the surgery,no breakdowns re: source, but I do think it was at least a 50/50 split. Some were definitely foreign material.

I hope Chud's is typical stasis and the fluids, fibre, massage, etc, will push it though.



sas ray:

 

[ra7751]

Hi ubrch,

I deal with stasis/ileus all the time. It is very common in rescues. It is almost always a secondary symptom of the root cause. Most of the time this issue can be traced to something eaten....or not eaten. Carpet fibers are very common causes of this condition. Plastic and/or foam is another. Lack of water/dehydration is common. And a diet too high in protein (too many pellets and/or treats)and too low in fiber (grass hay)is also a common cause. Dental issues, general infection or tumors/tissue masses are also to be considered.

I tend to agree with your vet regarding the article you posted a portion of. Sounds like a bunch of poppycock (I have another word for it but this is a family forum). Junk info like that is what you get when you are a"researcher"getting government money andyouhave to spend it all on something before you get a larger amount of money to continue your research. Goes right into the same category as the mating habits of the Martian bulb beetle....useless in the real world.

The initial attacks on stasis should be an exam...with appropriate rads. Assuming we have no tumors or soft tissue masses (as indicated in the rads), the impaction is usually a dehydrated mass of ingesta. Supportive care begins with a large infusion of fluids...either sub-q or IV. Standard protocol calls for a minimum of 5% hydration depending on exam findings. Follow up fluid therapy should be 3%-5% depending on absorbtion. Gentle stomach massages can be helpful. Maintaining body temp in the normal range of 101F-103F will assure that the rabbit does not go into shock and start to suffer organ failure. This can be done by using a regular heating pad on lowest setting or by use of an incubator. Fluid therapy should continue until there is movement in the gut. Usually we manage to get some gut sounds within 3 days or so. At that time, we start syringe feeding a mixture of fresh pineapple juice (fresh squeezed from a real fruit) and start mixing in a fiber element. There is no scientific evidence that pineapple juice officially works, but it has unofficially worked here numerous times. The best fiber element is Oxbow's Critical Care but crushed pellets can be used also. The idea is to get a little solid food in there to provide just a bit of pressure once the gut starts to loosen. Canned pumpkin (not pie filling) is also an excellent provider of fiber and it has a lot of nutrition. A little shot of B Comp can be of help also. We have had rabbits in complete shutdown for over a week before they came out. We also use certain antibiotics (controversial in the vet community) to strike at the harmful bacteria that tends to form in these events. I am also totally against the use of any gut motility drug in a rabbit. I am not a vet...but I have seen more than my share of what happens when using these drugs. In some cases, it is possible to use an enema. That procedure is difficult with an inexperienced person and can result in a perforated intestinal tract. And since gastric ulcers are a common issue in a GI event, it is essential when adding pressure to the gut that it be done is small amounts. An ulcer can easily rupture and results in immediate death.

As far as surgery....that would be indicated generally if the impaction is a tumor or some type of tissue mass. Any surgical procedure carries risk...any medical procedure at all carries risks. It is true in the past that rabbits have not tolerated surgery very well. It was not so much the rabbit's fault as it was the human. For many years, doctors treated rabbits pretty much like cats....don't work. Today's more educated doctors are much better at rabbit surgery. New anesthesias are much safer. And they are better educated at controlling pain and secondary infections. And we know how to repopulate the GI bacteria much better than before. And the rabbit's overall condition comes into play when discussing a surgical resolution no matter what the concern is.

Getting a rabbit thru stasis is sometimes not an overnight event. In the cases when it is caught and properly treated in it's infancy...it can usually be overcome by a big hand full of wet leafy greens. In a mature event, it takes time and a well thought out plan of action.Asmentioned earlier, wehave had GI shutdowns for days with successful resolution. You mentioned you are confident in your vet....if so, let her do her job and get this rabbit thru this event. I would be happy to speak with her if she has any questions on this issue....something I do all the time. Hope your bun comes thru this ordeal happy and healthy.

Randy

 

[ubrch]

another brief update:

The vet has elected to stop periodic xrays, since the abnormality on them is showing a trend of improvement. We are to wait for a call if anything unexpected happens, but no news is good news.

 

[ubrch]

Another brief update:

Vet says that Chud is eating food on his own, pooping, and is "bright". If his condition continues to improve, he'll come home in about two hours.

We're planning some changes in diet for our rabbits, and I'd like to ask some questions:

I've heard that it's good policy to give the rabbits some sort of bunny laxative on a weekly basis. Do people here concur? What brand of bun-lax is preferred?

I'm redesigning their hay hopper so that both of the bunnies can eat from it at the same time. It may have been that Chud was being pushed away from the hay by his sister (he is not the dominant bun). I would purchase a hay hopper if I could find one large enough for Flemish Giants, but I can't find such a thing. Does anyone know of a product that two ~12lb rabbits can eat from that doesn't have to b e refilled hourly?

 

[SOOOSKA]

Hi I bought a wire type rack from Home Depot (not sold for animals) it works really well too. They also have different sizes. I have the rack for 2 of my pairs of rabbits.

Susan

 

[ra7751]

Hi ubrch,

Please don't take offense to this question....but just where are you getting your information from? A bunny laxative? And someone told you this? My suggestion....there are a lot of talented people on this forum that can help you. Please take advantage of the many talented people on this forum....for your rabbit's sake. I have been rescuing rabbits for many years. Most of my rescues are in very poor health....and those are the ones I like to get. I have a high level of medical ability here. My specialties are gut issues, head tilt and E Cuniculi. I have an advantage of being near a major vet school and I have contacts with some of the best vets in the country. There are many others on this board that have special skills and knowledge...from breeders to veterinary people to rescuers to everyday rabbit slaves. All of them are more than willing to share theirknowledge. I personally feel the talent on this board is superior to any other rabbit forum out there.

A rabbit is a hind gut fermenter and over the years, Mother Nature has evolved their digestive systems to extract as much nutrition as the rabbit needs from what it finds in nature. During the summer, mostly grass and tender leaves and in winter mostly bark. Domestic rabbits are identical to wild rabbits....and in fact are direct relatives of European species. The digestive system of a rabbit requires a diet high in fiber and low in protein. An adult rabbit should always have unlimited grass hay. We feed a variety of grass hays and mix it together. This encourages a natural type foraging and keeps them busy. It's quite interesting to watch them work for that one piece of hay they want. Different types of hay also require different chewing mechanics and thereforewill keep those teeth worn down better. Pellets contain way too much protein for most house rabbits and therefore should be fed in very limited amounts. We feed the highest quality hay and greens so our rabbits get most of their nutrition from that. We feed pellets only to maintain proper weight. Our older buns or ones that have been sick get larger portions. We have some rabbits that add weight so quickly that they are living quite happily and healthy off just unlimited hay and limited greens. Our largest rabbit, Andre The Giant, is now approaching 30 pounds. He gets less than 1/8 cup pellets per day and unlimited hay. If we fed himthe quantity of pellets that many people feed, he might easily reach nearly 40 pounds. Since we are not interested in having any record sized rabbits, we limit his high calorie food to hold his weight down for his overall health. He eats lots of hay.We rarely give treats. We also rarely have gut issues.

The best bunny laxative is all that high fiber hay. What some people use is something like Petro Malt or Laxatone. These products are made for hairballs in cats. The impactions in rabbits are much different. Using these products in rabbits will make an already bad situation worse...and can lead to an impaction. This stuff will bind to the ingesta and tend to dehydrate the mass....and you get an impaction. Rabbits rarely get true hairballs...and the impactions they do get are nothing like a cat.

Here is a link to a hay grower that offers some great hay racks....we have several of them. They also offer some of the best hay you will ever see. It is grown in the mountains on western Virginia. http://bunnybale.com/FeederOrdering.html

Do you use litter boxes? We pack our litter boxes with hay and they just have a ball in there doing all things bunny. We also pack hay inside empty paper towel rolls. And we add a small treat in the middle. Keeps them busy and they eat hay.

On average, about at least 90% of our rabbit's diets are primarily different types of grass hays, very limited pellets/treats and carefully monitored greens.

Randy

 

[seniorcats]

Hi ubrch,

Randy's answer was great. I have been a house rabbit owner for 18 years and have never had a single episode of GI stasis. I can't imagine using a cat hair ball remedy or laxative on my rabbits.

My rabbits routinely live to be age 12, 13, 14, 15 years old. We feed unlimited hay - usually 2 to 3 varieties - local timothy we mix with brome and orchard or meadow grass. The bunnies get a largegreen salad every night. Unlimited fresh water. I find they prefer drinking from bowls to using a water bottle.

The other important part ofavoiding GI issues, at least to me, is making sure my rabbits get plenty of exercise and time to run. I am fortunate because they have their own rabbit-proofed room and are free roam all the time.If your rabbits are confined, it's my opinion they need at least 4 hours out of confinement each day.

As for a hay hopper, I bought Rubbermaid bins with a front opening and keep them in front of their litter boxes. I find they like to have multiple hay stations around the room. Each of my rabbits eats at least a pound of hay a day.

Good luck with your bunnies.

 

[Pipp]

Yah Chud!! :bunny18 Keep it up buddy!



(How is he doing?)



sas :wiggle

 

[ubrch]

Please don't take offense to this question....but just where are you getting your information from?

One of the veterenarians at Eastern Exotic Veterenary Clinic, in northern Virginia.

A bunny laxative?

Yes. Girlfriend was given a sample of something she pronounced as "Laxatone" to take home.

And someone told you this?

It was not transmitted telepathically, or implied through subtle changes in body language.

My suggestion....there are a lot of talented people on this forum that can help you. Please take advantage of the many talented people on this forum....for your rabbit's sake.

So far, the opinion of my veterenary clinic and those posting on this thread have been mostly the same.

An adult rabbit should always have unlimited grass hay.

This was also the advice given to me by my vet when we first acquired our rabbits, and I asked about diet.

Pellets contain way too much protein for most house rabbits and therefore should be fed in very limited amounts.

They share about 1.5 to 2 cups, daily.

We rarely give treats.

We give approximately 1 to 2 grapes daily to our rabbits. One likes white table grapes, the other likes concord grapes.

The best bunny laxative is all that high fiber hay. What some people use is something like Petro Malt or Laxatone. These products are made for hairballs in cats. The impactions in rabbits are much different. Using these products in rabbits will make an already bad situation worse...and can lead to an impaction. This stuff will bind to the ingesta and tend to dehydrate the mass....and you get an impaction. Rabbits rarely get true hairballs...and the impactions they do get are nothing like a cat.

Is this statement from your own experience, from some other source, or both?

Here is a link to a hay grower that offers some great hay racks....we have several of them. They also offer some of the best hay you will ever see. It is grown in the mountains on western Virginia. http://bunnybale.com/FeederOrdering.html

BunnyBale is our hay supplier as well, but I found their hay racks to be very small.

Do you use litter boxes?

Yes.

We pack our litter boxes with hay and they just have a ball in there doing all things bunny.

My cage design has three tiers. The bottom tier is lined with CareFresh, and that serves as their litter. The middle tier is where we feed them, and the top tier is where we put a blanket, and where they prefer to sleep.

We also pack hay inside empty paper towel rolls. And we add a small treat in the middle. Keeps them busy and they eat hay.

That sounds like a good idea.

 

[ubrch]

Chud is home and seems to be active and normal.

 

[seniorcats]

ubrch wrote:

Chud is home and seems to be active and normal.

That's good news.

Hay fiber content is generally 45% to 65%which is why it is so good for keeping the digestive system working properly. You may want to look at the fiber content of your pellets. I am using a tmiothy based pellet which has a 28%fiber content.That is an increase of %10 over the alfalfa pellet I previously used.

useful article from DVM Susan Brown, http://www.animalnetwork.com/Critters/library/nutrition/rabnutrition.asp