Surgical treatment of noncommunicating duplication of the colon in a dog

A 4-month-old sexually intact male Jack Russell Terrier was evaluated because of stranguria and tenesmus. A tubular abdominal mass was palpable abdominally and rectally. Radiographic examination of the abdomen revealed a soft tissue mass located laterally and to the left of the descending colon, which was associated with extraluminal colonic obstruction and urethral compression. During abdominal exploratory surgery, a large cystic mass that was adhered to the antimesenteric border of the descending colon was removed. Porcine small intestinal submucosa was used to reinforce repair of the excision site. Histologic examination of samples of excised tissue identified normal colonic epithelium supported by submucosa and muscular tunics, which was consistent with duplication of the colon. The embryologic etiology of alimentary duplication is poorly understood, and colonic duplication is an extremely rare congenital anomaly.     

Use of pelvic flexure biopsies to predict survival after large colon torsion in horses

OBJECTIVE: To determine if morphologic evaluation of intraoperative biopsies of the large colon could be used to accurately predict outcome in horses with large colon torsion. STUDY DESIGN: Clinical study. ANIMALS: Fifty-four horses with large colon torsion. METHODS: A full-thickness biopsy was collected from the pelvic flexure of the ascending colon after correction of naturally occurring colonic torsion. Morphologic changes were evaluated and graded for interstitial tissue to crypt ratio (I:C ratio), percentage loss of superficial and glandular epithelium, and the degree of hemorrhage and edema. These variables were then used to predict survival. RESULTS: Morphologic variables could be used to correctly predict survival or death in 51 horses (P < .0001). This corresponded to a sensitivity of 95.1% (82.2%-99.2%; 95% CI) and a specificity of 92.3% (62.0%-99.6%; 95% CI). Of 6 horses that had colonic resection, 5 survived; an accurate prediction of outcome based on morphologic criteria was made for each horse. CONCLUSIONS: Interpretation of changes in colonic morphology can be used to accurately predict postoperative survival in horses with large colon torsion. CLINICAL RELEVANCE: Use of frozen colonic tissue sections is a rapid, reliable, and relatively inexpensive method for assessing morphologic damage associated with large colon torsion during surgery. Intraoperative evaluation of pelvic flexure biopsies can aid in the prediction of survival and guide surgical judgment as to the need for colonic resection.     

IMAGING DIAGNOSIS — RADIOGRAPHY,ULTRASONOGRAPHY, AND COMPUTED TOMOGRAPHY OF A GIANT FECALOMA CAUSING STERCORAL PERFORATION OF THE COLON IN A DOG WITH A PROSTATIC ABSCESS

A mixed‐breed dog presented with tenesmus, hematochezia, and abdominal distension of 2 weeks duration. Radiography showed a large round mass with a “soap‐bubble” appearance and shell‐like mineralization in the caudal abdomen. Computed tomography revealed a lamellate mineralized mass 8 cm in diameter and containing air in the descending colon and prostatic abscess. Heterogeneously contrast‐enhanced, irregularly thickened colonic wall with intramural and peritoneal free gas indicated stercoral colonic perforation. Surgical intervention revealed a tumor‐like giant fecaloma in the descending colon adjoining the prostate with extensive wall rupture and fecal peritonitis. Hypothetically, prostatic inflammation may affect colonic motility with resultant fecaloma formation.     

Palliative use of a stent for colonic obstruction caused by adenocarcinoma in two cats

CASE DESCRIPTION-Two adult male castrated cats were evaluated because of a history of constipation, tenesmus, or intermittent vomiting. CLINICAL FINDINGS-Radiography and ultrasonography revealed luminal narrowing in the colon of 1 cat and a colonic mass in the other. A histopathologic diagnosis of colonic adenocarcinoma was made in both cats. TREATMENT AND OUTCOME-Under fluoroscopic guidance, a self-expanding metallic stent was advanced over a wire and across the area of colonic stenosis and deployed. One cat had progressive weight loss but maintained a normal appetite, energy, and a high quality of life. Fecal continence was maintained, and tenesmus was rarely observed. The cat was euthanized because of tumor metastasis 274 days after the colonic stent was placed. The other cat retained fecal continence, and the owners reported subjective improvement in the severity of tenesmus, compared with that prior to stent placement. The cat was euthanized 19 days after stent placement because of perceived decreased quality of life. CLINICAL RELEVANCE-The use of self-expanding metallic stents for alleviation of colonic obstruction secondary to adenocarcinoma in cats appears to be effective. This technique provides a simple, quick, nonsurgical option for palliation in cats with advanced metastatic or systemic disease in which surgical resection may not be possible or warranted.     

Diagnosis and surgical management of vascular ectasia in a dog

CASE DESCRIPTION: An 8-year-old male Golden Retriever was evaluated because of an 8-week history of intermittent diarrhea with melena and hematochezia that were not responsive to medical treatment and resulted in severe anemia. CLINICAL FINDINGS: Exploratory celiotomy with intestinal and colonic biopsy revealed mild enterocolitis but did not result in diagnosis of the cause of melena and hematochezia. Endoscopy of the upper portion of the gastrointestinal tract and colonoscopy were performed. Multifocal areas of coalescing, tortuous mucosal blood vessels were observed in the cecum and all regions of the colon. A diagnosis of vascular ectasia (VE) was made on the basis of the endoscopic and histologic appearance of the lesions. TREATMENT AND OUTCOME: An ileorectal anastamosis was performed. Melena and hematochezia resolved within 3 days after surgery, and the anemia resolved within 6 weeks after surgery. Surgical resection of the cecum and colon and feeding of a highly digestible diet resulted in long-term (22 months) resolution of clinical signs. CLINICAL RELEVANCE: Initial exploratory celiotomy with intestinal and colonic biopsy failed to reveal the VE lesions responsible for the melena, hematochezia, and anemia. Endoscopic evaluation was necessary for detection of the colonic VE lesions. Surgical resection of the cecum and colon and feeding of a highly digestible diet may result in a favorable outcome in affected dogs.     

Colonic adenocarcinoma with osseous metaplasia in a horse

Rectal palpation of a 30-year-old mixed-breed mare with chronic weight loss and intermittent, refractory abdominal pain revealed a mass in the right caudoventral portion of the abdomen. Hematologic and serum biochemical findings were normal except for slight mature neutrophilia and mildly high alkaline phosphatase activity and total bilirubin concentration. Cytologic examination of a specimen obtained by abdominocentesis revealed equal numbers of nondegenerative neutrophils and macrophages, but no evidence of neoplastic cells. The mare continued to have signs of abdominal discomfort and was euthanatized. Necropsy revealed a large mass at the junction of the right dorsal colon and transverse colon, and several smaller masses in the liver. Histologic characteristics of the small-colon mass were consistent with colonic adenocarcinoma with osseous metaplasia.     

Volvulus of the large colon in a neonatal foal

A one‐day‐old Thoroughbred colt foal was presented for assessment of abdominal pain and reduced urine output. Physical examination of the foal revealed marked abdominal distension, mild tachycardia, tachypnoea and congested mucous membranes. A marked anechoic peritoneal effusion, intestinal hypomotility and mural thickening of the large colon were detected sonographically. Serosanguinous fluid was obtained by abdominocentesis. After haemodynamic stabilisation, the foal underwent general anaesthesia and exploratory laparotomy and a 720° volvulus of the large colon at the sternal and diaphragmatic flexures was identified. After correction of the volvulus, the intraoperative findings were consistent with nonviability of the affected portion of the colon. The owner declined partial colon resection and elected for euthanasia of the foal. Although rare in neonatal foals, large colon volvulus should be considered in foals with signs of abdominal pain, abdominal distension and ultrasonographic findings of colonic mural thickening and luminal distension.     

Type Ia (spherical) communicating colonic duplication in a dog treated with colectomy

A six‐month‐old Labrador retriever presented for investigation of a colonic mass identified as an incidental finding during exploratory coeliotomy. Computed tomography identified a lesion in the colon which occupied part of its lumen and shared blood supply with the remainder of the colon. The lesion was suspected to be a colonic duplication and it was excised by segmental colectomy during exploratory coeliotomy. Histopathology from the excised colon confirmed the diagnosis of a colonic duplication. The dog recovered uneventfully and had no complications. To the authors’ knowledge, this is the first report of an asymptomatic, spherical, communicating colonic duplication and the first report to describe segmental colectomy for the management of this condition in veterinary patients.     

Resection and anastomosis for treatment of strangulating volvulus of the large colon of horses.

Strangulating volvulus of the large colon was treated by resection and anastomosis of the colon in 9 horses. Tissue specimens were obtained at the site of the resection for histologic evaluation. An attempt was made to correlate the appearance of the colon at the time of surgery to the histologic evaluation and the eventual outcome. Six of the 9 horses (66%) survived. This is in contrast to a reported survival of 34.7 to 36% after decompression and reduction of colonic volvulus. Survival after surgery could not be predicted on the basis of visual assessment or histologic examination.     

Gastric impaction associated with displacement and volvulus of the large colon in seven mature horses

Gastric impaction associated with large colon volvulus (LCV) was identified in seven horses. Right dorsal displacement of the large colon and suspected nephrosplenic entrapment was identified in 2 of the 7 horses as well as LCV with concurrent gastric impaction. All horses underwent surgery for LCV and none survived. Five horses died or were subjected to euthanasia intraoperatively or in recovery. One horse was subjected to euthanasia post operatively due to persistent gastric reflux, following resolution of the gastric impaction. One horse was subjected to euthanasia post operatively due to a suspected gastric rupture, which was confirmed on post mortem examination. It is hypothesised that a large mass in the cranial abdomen, such as a gastric impaction may disrupt the normal anatomical large colon alignment or may cause colonic motility or microbiota alterations, and thus increase the risk of large colon displacement and volvulus.     

Cystic ectopic lingual thyroid tissue in a male cat

CASE DESCRIPTION-A 6-year-old neutered male cat was examined because of a 4-week history of abnormal sounds while drinking and a previously noted mass at the base of the tongue. CLINICAL FINDINGS-Oral examination revealed a 1-cm-diameter midline cystic mass on the dorsal aspect of the base of the tongue at the junction of the rostral two-thirds and caudal third of the tongue. Complete blood count and serum biochemical analysis revealed no clinically relevant abnormalities, and serum total thyroxine and free thyroxine (determined by equilibrium dialysis) concentrations were within the reference range. TREATMENT AND OUTCOME-The fluid in the cystic mass was aspirated, and the remaining deflated mass was marsupialized. Histologic and immunohistochemical examination of sections of the excised mass revealed ectopic thyroid tissue. The cat recovered uneventfully from the surgery, clinical signs resolved, and the cat remained euthyroid with no recurrence of the mass as of 8 months after surgery. CLINICAL RELEVANCE-This is the first known reported case of ectopic lingual thyroid tissue in a male cat. In humans, the most common site of ectopic thyroid tissue is at the base of the tongue and the condition is disproportionately found in females, compared with males. In humans with ectopic lingual thyroid tissue, the patient often lacks any other functional thyroid tissue. However, the cat of this report remained euthyroid after mass resection.     

Pancreatic cyst in a cat

CASE HISTORY: A 5-year-old neutered male Cornish Rex cat was presented for evaluation with a history of vomiting over the previous 5 days. CLINICAL FINDINGS: An abdominal mass was palpated, which was shown to be cystic by ultrasound examination. Exploratory surgery revealed this to be associated with the pancreas and it was duly resected. Histopathology was performed on the cystic mass. DIAGNOSIS: Pancreatic cyst with associated chronic active inflammation. CLINICAL RELEVANCE: This is the first report of a true pancreatic cyst in a cat.     

Pancreatic cyst in a cat

CASE HISTORY: A 5-year-old neutered male Cornish Rex cat was presented for evaluation with a history of vomiting over the previous 5 days.

CLINICAL FINDINGS: An abdominal mass was palpated, which was shown to be cystic by ultrasound examination. Exploratory surgery revealed this to be associated with the pancreas and it was duly resected. Histopathology was performed on the cystic mass.

DIAGNOSIS: Pancreatic cyst with associated chronic active infl ammation.

CLINICAL RELEVANCE: This is the first report of a true pancreatic cyst in a cat.     

Volvulus of the colon in a Cat

We report the first case of colonic volvulus in a cat. A 12-year old spayed, female domestic shorthair cat with chronic bowel disease presentated with one-day history of lethargy and anorexia. Physical examination abnormalities included cachexia, poor perfusion, and poor skin turgor. A large, non painful, gas-filled, tubular structure, occupying the majority of the abdominal cavity was noted by palpation. Abdominal radiographs revealed a gas-filled displaced colon. Exploratory laparotomy confirmed a volvulus at the root of the colonic mysetery, along with a partial torsion of the distal colon. The majority of the colon was determined to be necrotic and was surgically resected. Due to persistent hypotension and perceived poor prognosis, the cat was euthanized.     

Biliary cystadenoma in a Maltese dog: clinical and diagnostic findings

A 14-year-old Maltese dog presented for complete medical examination due to intermittent vomiting and diarrhea observed during the previous two days. A single, solitary, lobulated cystic mass was observed in the liver upon ultrasonographic and computed tomographic examination. After surgical hepatic resection to remove the mass, histological examination revealed a multilocular cyst lined by cuboidal to columnar epithelial cells, which is consistent with biliary cystadenoma. Here, we report the clinical, clinicopathological, histopathological, and diagnostic imaging findings of biliary cystadenoma in a dog.     

OBSTRUCTION OF THE SMALL COLON BY INTRAMURAL HAEMATOMA IN THREE HORSES

SUMMARY Three cases of intramural haematoma of the small colon of horses are presented. In all cases the haematoma obstructed the lumen and caused an accumulation of faeces and gas. The horses were in shock and had acute abdominal pain. Exploratory abdominal surgery revealed the haematomas and showed them to be associated with chronic infection and terminal rupture in one animal which was subsequently killed, and an iatrogenic perforation of the terminal small colon in another which survived after intestinal resection. In the remaining horse, which died without recovering after intestinal resection, no cause was found.     

Bilateral pubic and ischial osteotomy for surgical management of caudal colonic and rectal masses in six dogs and a cat

CASE DESCRIPTION: 6 dogs and a cat were evaluated because of caudal colonic and rectal masses. CLINICAL FINDINGS: Tumors were identified in the caudal portion of the colon (n = 2), in the area of the colorectal junction (2), or in the rectum (3). TREATMENT AND OUTCOME: In all 7 animals, bilateral pubic and ischial osteotomy was performed to provide exposure of the rectum and associated tumor. Masses were successfully removed, and all 7 animals were able to ambulate normally within 3 days after surgery. No complications associated with the osteotomy procedure were identified. CLINICAL RELEVANCE: Findings suggested that bilateral pubic and ischial osteotomy provided sufficient exposure for resection of intrapelvic tumors in dogs and a cat with minimal complications.     

Vascular Injury Associated with Naturally Occurring Strangulating Obstructions of the Equine Large Colon

Ten horses were euthanatized before, during, or after surgery to correct severe volvulus of the large colon. At surgery, the colonic serosa changed from blue-gray, blue or purple toward a more normal pink in seven horses after the volvulus was corrected. The mucosa consistently remained black or dark red. Results of postmortem colonic microangiography revealed perfusion of the serosa and the circular and longitudinal muscle layers, but mucosal perfusion was limited by thrombosis in the muscularis mucosae and submucosa. There was evidence of thrombosis of the mesenteric colic vessels in six horses. Damage to the colonic vascular system, especially thromboembolism in the submucosa, may be an important limitation to colonic viability after surgical correction of volvulus of the large colon.     

Alteration in intestinal morphologic features associated with extensive large-colon resection in horses

Light microscopy, morphometry, and scanning electron microscopy were used to examine the mucosal morphologic features of 7 intestinal specimens (3 from the small intestine; 4 from the large intestine) from each of 8 horses 1 year after sham operation (group 1; n = 3) or extensive large-colon resection (group 2; n = 5). Qualitative light microscopic examination did not reveal differences between groups, but morphometry revealed significantly (P less than 0.05) greater intercrypt area and distance in horses with colon resection and this was most pronounced in the cecum and remaining right ventral and dorsal colon. Crypt area and depth were similar for horses with colon resection and sham operation (P greater than 0.05). Qualitative evaluation of the scanning electron micrographs revealed more prominent crypt orifices in the large intestine of horses with colon resection. The larger intercrypt distance in the colon of horses with resection was not an obvious feature of the qualitative evaluation of the surface with scanning electron microscopy. Small intestinal morphologic features were variable and significant differences were not detected between horses with sham operation and colon resection. Horses adapted to extensive large-colon resection within 1 year by increasing the absorptive (intercrypt) surface area of the remaining large intestine.     

Extensive large colon resection in the pony. I. Surgical procedures and clinical results

The effect of resection of 75% (length measurement) of the large colon in ponies was studied. Ten ponies in good physical condition were divided into two groups: group I consisted of the six experimental ponies and group II of four control ponies. Preoperatively and postoperatively for five months, ten clinicopathological parameters were determined: body weight, venous blood pH, plasma bicarbonate, total plasma protein concentration, serum electrolyte values (sodium, potassium, chloride), and fecal osmolarity. Subjective assessment of attitude and appetite revealed no difference between the groups or within groups at any time. Resection of a major portion of the large colon did not significantly influence the clinicopathological parameters evaluated. The hematocrit of the ponies in group I did decrease during the first postoperative month and this was attributed to whole blood loss associated with the resection procedures. The results of this investigation indicated that resection of 75% of the large colon in ponies is compatible with life.