Rectal Pull-Through in Cats

Rectal pull through is a surgical procedure used in cats to treat rectal masses that cannot be resected with an anal approach and to treat persistent megacolon. The goal of rectal pull through is to provide access to masses in the colon that would otherwise be difficult to remove and to improve on surgical methods for megacolon treatment. Rectal pull through is common for large rectal masses yet a fairly new technique for megacolon treatment. Your veterinarian may refer to a boarded veterinary surgeon for this procedure. 

Before surgery, the veterinarian will give your cat a thorough physical exam and ensure that your cat is healthy enough for surgery with basic bloodwork. As with most surgery, you cat will need to be kept off food for 24 hours the day before surgery to ensure that there is not an adverse reaction to the anesthetic medications used. In addition, your cat may need stool softeners and soapy enemas to evacuate the bowel prior to surgery (typically before surgery to correct megacolon).

Rectal Mass Surgery

• Patient is placed on their stomach with the rectum and perineum prepared for surgery.
• Clamps are inserted through the anus to clasp the inner wall of the rectum
• Gentle traction is used to pull the rectum and associated mass through the anus so that the mass can be resected
• Once the mass is resected the exposed rectum is inserted back through the anus ensuring that no fecal material is able to contaminate the abdominal cavity (rinsing surgery site with sterile saline)

Megacolon Treatment

• Rectal pull through is performed similar to above with the addition of a midline incision so that the subtotal colectomy can be performed as well.  

Rectal pull through is an effective and long term treatment for megacolon in cats. Rectal pull through improves the speed of surgery and access to the entire colon over other surgical techniques for the management of megacolon. Surgical treatment of megacolon in cats using rectal pull through has long term effects and is a more permanent solution for cats whose megacolon could not be managed medically. 

For treatment of rectal masses, rectal pull through provides greater access to the mass ensuring that the entire mass can be removed. Removal of rectal masses using pull through is especially important in the case of large rectal masses for which other surgical approaches such as perineal would be impossible. 

Your cat will likely be placed on pain medication and antibiotics for the first few days after surgery to reduce pain and swelling associated with surgery and prevent infection associated with a “dirty” surgery. Your cat will need to stay still for the first 10 days after surgery while the stitches are healing and the skin incision site will need to be checked daily for signs of infection (swelling, redness, discharge). Your vet will remove the sutures and check the incision after 10 days. Once your cat is fully recovered from surgery there should be no further maintenance needed.

The cost of rectal pull through surgery can vary depending on the severity of your cat’s case and the cost of living in your region. Typical cost can range from $1,000 to $2,500. 

Rectal pull through surgery is beneficial both in the case of large mass removal and the case of megacolon treatment. This technique offers access to larger masses of the rectum that would be otherwise inoperable. This technique also improves upon previous surgical techniques for megacolon improving speed, simplicity and decreasing the risk of abdominal contamination. After rectal pull through and colectomy for megacolon treatment prognosis tends to be excellent with good return to bowel function returning after the procedure. Prognosis after rectal mass removal depends on the stage and grade of the mass being removed. 

Preventing this procedure involves preventing megacolon and rectal masses. Megacolon is typically congenital, acquired, or idiopathic (underlying cause unknown) and surgery is typically performed on idiopathic cases of megacolon that do not respond to medical management. Since the underlying cause of idiopathic megacolon is unknown it cannot be truly prevented t this time, however, it is good for cat owners to look out for signs of megacolon in their cats as they get older. Preventing rectal masses is also unfortunately difficult to do as cancers or the rectum can be caused by a variety of underlying causes both genetic and environmental.