The large intestines dangle outside the umbilicus

Should I save this puppy or let it die naturally? Bright red loops of the large intestine of around 10 cm in length glistened in the translucent amniotic fluid, outside his navel, just next to the umbilical cord.

There was no umbilical hernia which is a defect in the abdominal wall around the belly button.  Therefore, it was not possible to push the intestines back into the abdomen.

The umbilical cord contained two arteries and one large vein was normal. It   connected the puppy to the placenta in the normal way. The placenta carried oxygen to the foetus and transports waste products away. 

The large intestines must have prolapsed earlier, developed normally. Now, at Caesarian delivery, they were outside the body.  

This 4th puppy was normal. A most attractive but smaller Chihuahua. Now, what should I do? This was the first time I encountered such a situation. A rare incidence of prolapsed intestines during foetal development.

I removed the fluid from his pink nose and wiped his maroon tongue to clear more fluid.  Usually I clamped the umbilical cord and wiped the back of the puppy's head, after rupturing the amniotic sac. Then I would give the puppy to the breeder to stimulate it to breath.

Now, I could not clamp the umbilical cord as the large intestines were there. They did not obstruct, but if I clamped the cord, the oxygen from the placenta to the puppy would be cut off immediately and I would need to make sure the puppy would breathe and live.  What should I do?

This smallest puppy opened and closed his mouth. A sign of life. No cries but he was alive.  Every puppy delivered live meant a lot to the breeder. 

What were the other options since I could not manually push the large intestines back into the abdomen?  There was another puppy in the uterus and the mother should be on general anaesthesia as such a time as possible in this high-risk pregnancy of multiple puppies.

Get the other puppy out and the bitch out of anaesthesia first?  I could not let this puppy die. 

I cut open the umbilicus area by two mm in front of the umbilical cord. The intestines were still too large. I cut another two mm behind the umbilical cord.  The umbilical vein burst. Greyish-blue blood oozed out.  This was not so serious. I wiped off the blood with a cotton swab.

Time was of the essence.  Now, the hole was big enough. I pointed the end of the blunt forceps at the intestines, starting at the end nearest the umbilicus to manipulate the loops inside. Soon, all the loops went in. I could see the liver lobe as I pulled up and stitched up the very thin muscle layer and skin together with absorbable 3/0 dexon.  3 stitches at 2 mm intervals.  Would the stitches hold sufficiently for the next 14 days? Would the puppy need another surgery?

"Make sure that this puppy get individual nursing every two hourly. After suckling milk, separate the puppy from the mother so that the navel area is clean and the bitch would not lick off the stitches. Cover the stitch with a bandage"  I said to the breeder's assistant. It was one of those unrealistic advices veterinarians sometimes give.        
 

When I visited the puppy in the evening, it was suckling milk with two others from a surrogate nursing bitch. The mother was kept in another pen alone. 

"Di mana ada lagi dua? (Where are two more?)" I had to ask in as best native Malay language as I could pronounce. I feared the worst. They were two healthy puppies and should not be dead.

The breeder's assistant smiled and showed me another nursing pen with a surrogate nursing bitch.  This breeder was really top in his professionalism of not stressing the mother just after Caesarian section.

So, everything was fine for the moment.  It was not practical to bandage such a small puppy. I stuck a piece of sticky Elastoplast on its umbilicus area. Most likely, it would come off.

I hope the puppy would not get bacterial infection inside its abdomen.  On day 2, I visited him. His umbilical cord had turned yellow, indicating a bacterial infection. He died two days later.  Large intestines popping out of the umbilicus in Chihuahuas are uncommon.  However, I had a case from the breeder one week later (see picture above).  The bitch had licked the intestines red. There was no way I could save this Chihuahua.  The breeder would not have the facilities to nurse such pups and usually they do not survive.