Quality ofLife
Congenital aganglionosis would be expected to have both short-term and long-term complications and a reasonably poor prognosis would be realistic. This disease would require intensive owner commitment to performing daily enema procedures.
Surgery is indicated in infants with this condition overall having a good long-term outcome, 86% of patients had excellent anorectal function, and appeared well adjusted in a long-term follow-up study (Moore, Albertyn, and Cywes 1996). Subtotal colectomy could be considered in canine and feline pediatric patients with congenital mega-colon. Secondary megacolon potentially would carry a fair prognosis if the underlying cause can be corrected within 6 months, for example, pelvic osteotomy. In cats, there are reported excellent long-term outcomes after subtotal colectomy although intestinal anastomosis dehiscence carries an 80% mortality rate (Wylie and Hosgood 1994). Postoperative constipation rates can be as high as 45%, requiring euthanasia or further surgery (Sweet et al. 1994). In dogs with acquired mega-colon, excellent shortterm outcome, with complete recovery reported within 28 days in one study with a combination of both surgical and medical management (Prokic et al. 2010). Surgical management of eight large breed dogs with hypertrophic mega-colon allowed return of normal defecation within 5 to 10 weeks (Nemeth et al. 2008). Despite no intraoperative complications, one dog in this study suffered fatal septic peritonitis postoperatively.Quality of life considers many facets such as physical and emotional suffering, and specifically pain. The distress experienced by the pet owner/carer should not be ignored and contributes significantly to outcome due to this effect on compliance. Concerns of pet owner/carer that is responsible for chronic medical management of a dog or cat include the impact of the medical management on work and social life, the constant need for veterinary visits, worry that the cat or dog may need hospitalization, the inability to leave the pet in a boarding facility, and the deep concern that the pet may be suffering.
Ultimate success of managing a chronic disease requires addressing these quality-of-life concerns.The diagnosis of congenital mega-colon has implications in terms of long-term outcome. In humans, 6.1% of children suffered a long-term complication of fecal soiling post- operatively (Moore et al. 1996). A similar complication in a dog or cat may not manifest in psychosocial maladjustment but certainly could be a cause for owner stress.
The underlying etiology of secondary mega-colon will impact on the quality of life of both the pet and the owner. Dysautonomia is an obvious example of a patient that is completely dependent on medical management and nursing by the owner. In a study that monitored the longterm response to treatment of 40 cats diagnosed with feline dysautonomia, only nine of the cats survived, and a full year was required for recovery, no doubt a testament to the perseverance of the owners (Sharp et al. 1984).
Cats or dogs that have persistent obstipation despite medical management are candidates for subtotal colectomy, which is considered a satisfactory option as opposed to euthanasia, which would be the probable outcome, assuming there are no financial limitations. Perioperative complications, including dehiscence and peritonitis, need to be discussed, although long-term complications are minimal.
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