New-born mammals only drink breast milk. Even so, they do more than just urinate: stools form in the intestines and so they must also empty their bowels. If the anus is lacking at birth, then severe problems come about within a few days.

Pig
The congenital defect described above, in which the rectum ends blindly, frequently occurred in pigs in the past. The defect has meanwhile virtually disappeared in pig stocks thanks to selective breeding. If a piglet is lacking an anus, then the belly will swell within a few days. The piglet will stop drinking from the sow and will die within a week.

002

sow with a litter of piglets

Every piglet counts
It is Sunday morning. A farmer enters the Veterinary Surgery at Utrecht University. The treatment of the horses and cows that are present as patients is almost finished. He has brought along a piglet of only a few days old in the boot of his car. One of a litter of twelve, this piglet has not drunk from the sow since yesterday. The small animal is skinny, but its belly is swollen. And it has become groggy due to dehydration. The situation is urgent. The farmer knows what the problem is: the arse is lacking. He has seen this on his farm more than once and he knows the piglet will die. But it is usually operable and at the time, the clinic in Utrecht carried out the procedure free of charge. And every piglet counts.

Operation
The piglet is put under an anaesthetic and placed on the operating table. The buttocks are disinfected using iodine and a high-power lamp is put into position. The farmer watches with interest. Using tweezers, I stretch the skin under the tail backwards somewhat and I cut off a small piece. These leaves a small round hole. Using the blunt ends of a small pair of scissors, I look for the blind end of the intestine and soon find it. The intestine needs to be loosened and pulled back a bit. I turn my head to the side when I cut off the blind end of the intestine. Watery manure squirts into the operating room. The contents of the rectum were under pressure. The open end of the intestine must then be sutured to the skin. It is delicate work and requires one’s utmost concentration.

Complication
A dull thud sounds as I work on the third suture: the farmer has fallen backwards onto the concrete floor of the clinic. He is unconscious and pale as death. I had not been keeping an eye on him and I am quite startled. Interns and a clinic aide carry him to the hall and place him on a bench. The operation continues without any further complications. When the piglet wakes up, so does the farmer. He is very pale, but refuses any help. He pulls himself up and wants to go home. He puts the piglet back in his car and leaves.

Outcome
The next morning, I find the farmer’s telephone number in the patient’s report. His wife answers the phone and I inquire after her husband. She seems surprised, and her response is unexpected: "Extraordinary doctor; he is running around the pig-sty!"
I am momentarily at a loss for words. Then I grasp the misunderstanding: "Well good; so the pig is fine. But your husband, how is he doing?" Then it is quiet on the other end of the line. "My hubby? Why do you ask? Nothing special, just like always." I tell her about his fainting during the operation and that he lost consciousness for a few minutes. But this fails to impress her: "Oh, that! That happens all the time: it doesn’t take a lot for him to keel over." She again assures me that the pig is doing fine and the conversation ends.

004

‘he is running around the pig-sty’

Costs
The economy has meanwhile superseded the value of this surgery. Because how much does a pig cost? And what does a veterinary surgeon charge per hour? You don’t need a calculator to do the numbers. Except, you would not wish the slow death resulting from the inability to empty one’s bowels on anyone. And so, for reasons of animal welfare, the operation was not a bad idea at all. In the words of a farmer years later: "What good is a million guilders in my back pocket if I can’t shit?"