Intermittent gastroesophageal intussusception in a cat with idiopathic megaesophagus

An adult female domestic shorthair cat was evaluated for chronic upper respiratory disease and vomiting. A diagnosis of idiopathic megaesophagus with intermittent gastroesophageal intussusception (GEI) was made based on radiographic and endoscopic examinations. The GEI was manually reduced by use of a stomach tube during the endoscopic procedure. An incisional gastropexy was performed to prevent recurrence. Gastroesophageal intussusception is a rare condition in cats. In dogs it is usually associated with rapid progression of clinical signs, culminating in death. In this cat, the condition was associated with chronic signs, probably due to the intermittent nature of the GEI.     

Caecal intussusception in the horse: Ultrasonographic findings and survival to hospital discharge of 60 cases (2009–2013)

Diagnosis of caecal intussusception can be challenging. Transabdominal ultrasound is often used as a diagnostic tool in equine colic. Differentiation between caecocaecal and caecocolic intussusception might be useful in the decision process before surgery. The aims of this study were: 1) to assess the usefulness of ultrasound for diagnosis of intussusception and differentiation between caecocaecal and caecocolic intussusception; and 2) to determine survival to hospital discharge after surgery. Therefore, a retrospective case series (2009–2013) was performed of all colic cases with caecal intussusception (n = 60) confirmed at surgery or necropsy. In all horses, the intussusception could be visualised using ultrasound at admission. Caecocolic intussusception (n = 46) was much more common than caecocaecal (n = 14) intussusception and correct ultrasonographic differentiation between both types could be made in 92% of the cases. Ten horses (out of 14) diagnosed with caecocaecal intussusception underwent surgery, of which 8/10 (80%) were discharged, one horse (10%) was subjected to euthanasia during and one (10%) after surgery. Of the 28 (out of 46) operated horses with caecocolic intussusception, 17 (61%) survived to discharge, while 7 (25%) and 4 (14%) were subjected to euthanasia during and after surgery, respectively. Of all horses that underwent surgery, in 13/38 (34%) surgical reduction was possible, while 13/38 (34%) needed partial typhlectomy and 4/38 (11%) needed colostomy because of an irreducible intussusception. Survival to discharge after successful surgery was 12/13 (92%) when only reduction was performed, 11/13 (85%) if partial typhlectomy was needed and 2/4 (50%) after colostomy and partial typhlectomy. In conclusion, abdominal ultrasound is a useful tool in the diagnosis and differentiation of caecal intussusception. Survival to hospital discharge after successful surgery is good.     

Intussusception in dogs and cats: A review of 36 cases

Intussusception is recognized as a common cause of bowel obstruction in small animals. This study documents the clinical and surgical findings in nine cats and 27 dogs diagnosed as having intussusception. The main purposes of the study were to define the predisposing causes and clinical signs of intussusception and to evaluate various surgical techniques commonly employed in its treatment. No common predisposing cause could be established. Diagnosis of intussusception was based most often on clinical signs of bowel obstruction in association with the palpable abdominal mass. The majority of the intussusceptions involved the enterocolic junction. Formation of adhesions was more frequent in cats. Surgical treatments included simple reduction, manual reduction with plication, intestinal resection/anastomosis, and intestinal resection/anastamosis with plication. There was no statistically significant difference (p>0.05) in the recurrence rate of the intussusceptions when the various surgical techniques were compared. Recurrence of an intussusception was not related to either the bowel segment involved or whether a simple reduction, bowel resection, or intestinal plication was performed at the initial surgery.     

Ileal intussusception in 16 young thoroughbreds.

The paper describes the outcome of 16 cases of short-ileal-ileal intussusception in young Thoroughbred horses. The intussusception was often associated with chronic or intermittent low grade abdominal pain. At laparotomy, only the intussusception was reduced in one horse; in another, a myotomy of the thickened stenosed intussusception was carried out after reduction. In 11 cases as ileocaecal bypass anastomosis was performed proximal to the intussusception after its reduction. One horse was subjected to euthanasia during operation because of irreversible intestinal wall damage and another because of intestinal rupture. One foal had a cardiac arrest following reduction of the intussusception. One horse was subjected to euthanasia 4 months post-operatively because of intractable abdominal pain caused by intestinal adhesions. Although several horses suffered episodes of post-operative abdominal pain, and 2 were subjected to a second laparotomy, 12 horses made an eventual complete recovery.     

COLOR DOPPLER ULTRASONOGRAPHY IN PREDICTION OF THE REDUCIBILITY OF INTUSSUSCEPTED BOWEL IN 15 YOUNG DOGS

Color Doppler ultrasonography was performed in 15 young dogs with intestinal intussusception to test the hypothesis that color Doppler findings can be used as a predictor of the manual reducibility of the intussusception at celiotomy. Color flow Doppler ultrasonography indicated blood flow within mesentery of the intussuscepted bowel in 12 of 15 dogs and reduction was achieved in nine of these 12 dogs (75%). In the remaining three dogs and in three dogs where no color Doppler signal were observed, an irreducible intussusception was confirmed at celiotomy. Color Doppler ultrasonography is a useful method for predicting the reducibility of intussusception in dogs.     

Cecal inversion and subsequent colocolic intussusception in a red wolf (Canis rufus gregoryi).

A 2-yr-old female red wolf (Canis rufus gregoryi) presented with weight loss and diarrhea. Abnormal clinical pathology included low serum calcium, sodium, chloride, globulin, and albumin levels. Differential diagnosis included infectious enteritis, intestinal parasitism, inflammatory bowel disease, hepatic or renal disease, and malnutrition. The wolf was treated empirically, but did not improve. A second examination revealed persistent poor musculature and stool quality. Abdominal palpation revealed a firm mass; contrast radiography confirmed an intussusception. Exploratory laparotomy revealed a colocolic intussusception involving the cecum. Following reduction of the colocolic intussusception, cecal inversion (cecocolic intussusception) was identified. Because the cecal inversion could not be reduced, typhlectomy was performed through a colotomy incision. Bacterial culture of peritoneal fluid yielded two strains of Escherichia coli. Postoperatively, the wolf was placed on antibiotics and a soft diet. The diet was gradually returned to its normal formulation and the wolf progressively gained weight. Physical examination 7.5 mo following initial presentation revealed normal body weight and condition. To our knowledge, this is the first recorded incidence of cecal inversion with concurrent colocolic intussusception.     

Belt loop gastropexy in the management of gastroesophageal intussusception in a pup.

Gastroesophageal intussusception and megaesophagus were diagnosed in a 5-week-old German Shepherd Dog. Exploratory surgery was performed, and belt loop gastropexy was used to maintain proper gastric position after manual reduction of the intussusception. The pup survived surgery and was clinically normal when it was 6 months old. Follow-up contrast radiography revealed resolution of the megaesophagus and apparent permanent gastropexy. Previous reports have indicated extremely high mortality for gastroesophageal intussusception, and resolution of megaesophagus in the dog is unusual.     

Intussusception in 12 cats

The medical records of 12 cats presented with intussusception and diagnosed at the University of Sydney Veterinary Teaching Hospital and the Sylvania Veterinary Hospital were reviewed. Eleven cats were less than one year old at the time of diagnosis. No breed or sex predilections were determined. The most consistent clinical signs were anorexia (83 per cent), weight loss (83 per cent) and a palpable abdominal mass (92 per cent). Vomiting (58 per cent) and diarrhoea (50 per cent) were seen less frequently in these cats compared with the reported incidence of these signs in dogs. In 10 cats the intussusception was corrected surgically. Manual reduction was successful in three of the cats but six required end-to-end anastomosis following intestinal resection and in one cat a typhlectomy was performed. Postoperative ileus complicated recovery in three cases. Recurrence of the intussusception at a different site occurred in two of these cases. One cat with recurrence of intussusception died and the cat with ileus but not recurrence was euthanased one month after the original surgery.     

Caecal intussusceptions in horses: a New Zealand perspective

Objective To establish the prevalence of intussusceptions involving the caecum in a population of horses admitted to a university hospital for colic. Design Retrospective clinical study Methods Medical records of all horses admitted to the Massey University Veterinary Teaching Hospital between 1991 and 2004 were examined for information of those horses diagnosed with an intussusception involving the caecum. Results A total of 135 horses were admitted for colic surgery during the study period and 61 horses had a diagnosis of ileocaecal (37), caecocaecal (5) or caecocolic intussusception (19) made either at surgery or necropsy. Of the horses with ileocaecal intussusception, 32 had an incomplete hand-sewn ileocaecostomy without reduction and 29 survived to discharge. All the horses with caecocaecal intussusceptions were diagnosed preoperatively via rectal examination and/or transabdominal ultrasound: 2 were euthanased at surgery and 3 survived to discharge. In the 19 horses with caecocolic intussusceptions, manually reduction at surgery was performed in 6 and 5 of them survived to discharge. A typhlectomy was performed via a colotomy in 6 horses, 3 of which survived to discharge. Conclusions The high prevalence of intussusceptions involving the caecum seen at this referral centre may indicate a higher prevalence in New Zealand than is reported elsewhere in the world. Clinical relevance Intussusceptions involving the caecum should be considered as a differential diagnosis in horses presenting with chronic low-grade colic. Transabdominal ultrasound is useful for identifying caecocaecal and caecocolic intussusceptions. Hand-sewn side-to-side incomplete ileocaecostomy is a quick, effective and safe method of surgical treatment of ileocaecal intussusceptions.     

Incomplete tracheal intussusception in a dog

An 18-year-old male miniature poodle had a chronic nonproductive cough. On radiographic examination, an opacification resembling a foreign body was noticed within the trachea at the level of the sixth cervical vertebra. When the trachea was examined endoscopically, a circumferential flap-like lesion was found. To differentiate the invagination from an annular mass, thoracic computed tomography (CT) of the trachea was performed. There was cranial displacement and invagination of a tracheal segment creating the flap-like lesion. Tracheal intussusception should be considered as a cause of an annular tracheal mass.     

Jejunojejunal Intussusception and Colonic Impaction in a 12-Day-Old Orphan Foal

A 12-day-old, 14.4-kg, female foal of Australian Miniature Pony breed was presented at the National Chung Hsing University Veterinary Medicine Teaching Hospital, Taiwan, with a history of weakness of 2 days’ duration. The mare died of unknown cause on the previous day. Abnormal findings during physical examination included an estimated dehydration of 3 to 5%, dark red oral mucous membranes, elevated heart and respiratory rates, stiffened feces, and absence of intestinal motility on auscultation. Continual nursing care was followed by intravenous fluid therapy and nonsteroidal anti-inflammatory drug and antibiotic treatment. The foal's condition deteriorated rapidly, and feeding was refused. Subsequently, she developed signs of pyrexia and panting. In spite of oxygen supplement, she died 18 hours after admission. Postmortem examination revealed the presence of a jejunojejunal intussusception, 20 cm in length; a torsion of jejunum proximal to the intussusception also was noted. An ulcerative lesion, 3 cm in diameter, was found on the mucosa of duodenum. Large amounts of sand, coat hair, and hay mantling in bloody discharge were observed in a colonic impaction. That it was an acute case was evident by the involvement of intussusception and ulceration, indicating desquamation of the necrotic epithelial cells with edema and distinct infiltration of neutrophils. These results suggested that a practical management strategy for nursing an orphan foal should be performed to avoid a similar case in the future.     

Cecal amputation within the right ventral colon for surgical treatment of nonreducible cecocolic intussusception in 8 horses

OBJECTIVES: To report a surgical technique for treatment of nonreducible cecocolic intussusception and outcome in 8 horses. STUDY DESIGN: Retrospective study. ANIMALS: Eight horses with nonreducible cecocolic intussusception treated by cecal amputation through a right ventral colotomy. METHODS: Data were obtained from medical records and telephone conversations by using a standardized questionnaire. The large colon was exteriorized and, if necessary, evacuated of its contents through a pelvic flexure enterotomy. A second colotomy was made on the ventral surface of the right ventral colon (RVC) centered over or immediately distal to the intussusceptum. In most horses, attempts to manually reduce the intussusception by pushing the cecum from within the RVC through the cecocolic orifice were unsuccessful. Invaginated cecum was then pulled into the RVC and amputated; the cecum was either ligated with umbilical tape or sutured proximal to the site of amputation. After amputation, the remainder of the invaginated cecum was reduced. After further resection to healthy tissue, the typhlectomy was closed with a double-inverting suture pattern. RESULTS: The median horse age was 2 years (range, 1 to 8 years). Duration of colic ranged from 6 hours to 6 months. Median surgical time was 180 minutes (range, 135 to 300 minutes). Median duration of antibiotic therapy was 7 days (range, 5 to 14 days). Median duration of hospitalization was 12 days (range, 6 to 21 days). All horses survived to hospital discharge. One horse died 3 months postoperatively; however, the remainder survived (median survival, 30 months; range, 6 to 96 months) and returned to or exceeded previous function. CLINICAL RELEVANCE: Despite some contamination during surgery, horses with nonreducible cecocolic intussusception that underwent this method of surgical treatment had a good prognosis.     

Small colon intussusception in a broodmare

A 9-year-old pregnant Standardbred broodmare was evaluated for signs of mild abdominal pain, failure to defecate, and mild abdominal distention. Rectal examination revealed the leading edge of a small colon intussusception, and peritoneal fluid analysis indicated suppurative peritonitis. Surgical management, including reduction of the intussusception and small colon resection with end-to-end anastomosis, resulted in successful outcome (1-year follow-up evaluation). Postoperative complications including dehiscence of the ventral midline surgical incision and simple obstruction at the anastomosis site necessitated a second surgical procedure. Small colon intussusception is an uncommon cause of signs of abdominal pain and is similar to type-IV rectal prolapse.     

Genotype by environment interaction for milk yield in Sarda dairy sheep

Genotype by environment interaction (GEI) for milk yield (ME) wasinvestigated by analyzing 40 140 first lactation records performed in 538 flocks. Flock–year effects from national genetic evaluation were used to define low (L), medium (M) and high (H) yielding environments. Differences observed between adjacent subsets were approximately 20% of the trait overall mean. Sire variance components estimated using multitrait analysis were 58, 82 and 149% of the estimate from the complete dataset (L, M and H, respectively) and genetic correlation coefficient between extreme subsets was 0.66, lower than genetic correlations obtained from randomly sampled subsets. Rank correlation coefficients between estimated transmitting abilities (ETA), obtained independently within L, M and H subsets for 71 AI rams having at least 10 daughters per subset, were lower than one (ranging from 0.42 to 0.56). These results strongly supported the existence of GEI for milk yield in Sarda sheep flocks. The influence of GEI on phenotypic responses in flocks differing in yield level could be due to a reduced expression of genes under conditions of restricted environmental opportunity. Splitting the selection scheme according to farming conditions does not seem a suitable solution for the Sarda breeding program. Thus, to provide farmers with genotypes suitable to exhibit a good phenotypic expression in different conditions, the selection across all environments, in which the descendants are expected to perform, still seems the best option.     

Spontaneous reduction of intestinal intussusception in five young dogs

Five, 3- to 8-month-old dogs had clinical and ultrasonographic findings consistent with intestinal intussusception, but findings were negative on exploratory celiotomy. Ultrasonography had revealed a target-like mass (median maximal diameter 25 mm) on transverse section and multiple hyperechoic or hypoechoic parallel lines (median length 36.8 mm) on longitudinal section. Blood flow in the intussuscepted bowel was detected in most of the cases. In dogs with similar findings, the authors recommend ultrasonographic reexamination of the abdomen after general anesthesia (but before surgery) to exclude spontaneous reduction of the intussusception.     

Obstruction of the cecocolic orifice by ileocecocolic intussusception following jejunocecostomy in a horse

A 4-year-old Thoroughbred stallion was referred for signs of mild to moderate colic, anorexia, and decreased water intake of 3 weeks' duration. Ultrasonographic examination revealed an intussusception, the most common of which would be a cecal inversion or ileocecal intussusception. Surgical exploration identified an ileocecocolic intussusception with extension of the intussusceptum into the right ventral colon; however, the cause of the intussusception could not be identified. The intussusception could not be surgically corrected, and the horse was euthanatized. A side-to-side jejunocecostomy that had been performed previously was identified at necropsy. The ileal stump had intussuscepted into the right ventral colon and become hypertrophied, causing partial obstruction of the cecocolic orifice and clinical signs of colic. In horses requiring an ileocecal or jejunocecal anastomosis, the ileal stump may be left to slough within the cecum as part of the treatment for an irreducible ileocecal intussusception or intentionally inverted into the cecum when the ileal stump is necrotic and cannot be exteriorized and resected. Efforts should be made to minimize the size of the ileal stump to reduce the liklihood of intussusception.     

Caeco-caecal and caeco-colic intussusception in two half-sibling Standardbred horses

This report describes caecal intussusception in two young half-sibling Standardbred horses. Both horses presented showing signs of low-grade abdominal pain. The horses remained haemodynamically stable despite signs of abdominal pain and associated tachycardia. Exploratory celiotomy was undertaken in both horses due to persistent abdominal pain and a poor response to administration of analgesic medications. Exploration of the abdomen revealed caeco-caecal intussusception in one horse and caeco-colic intussusception in the other horse. An underlying cause for caecal dysfunction and subsequent intussusception was not identified in either patient. Manual reduction of the intussusception was successful in both cases. The horses recovered uneventfully from surgery.     

Transversus abdominis muscle as a gastric or intestinal on-lay flap in two dogs and one cat

Historically, omentalisation and serosal patching have been used to augment gastrointestinal wall defects or incisions where gastrointestinal viability is of concern. This report describes the novel use of a transversus abdominis muscle on-lay flap to augment and provide support to compromised intestine in three cases. The muscle flap was used to support: the ileum following reduction of an intussusception in a dog (case 1), the gastric wall following gastric strangulation, dilation and volvulus in a diaphragmatic rupture in a cat (case 2) and the jejunum following enterotomy and full-thickness ulcer resection with primary repair in a dog (case 3). All animals were discharged within 4 days postoperatively with no short- or long-term complications reported by either the referring veterinary surgeons on routine postoperative examination or on telephone follow-up with the owners (case 1: 10 months, case 2: 30 months, case 3: 6 weeks). The creation of a flap of the transversus abdominis muscle may provide a useful alternative or adjunct to previously described techniques for supporting the gastrointestinal tract when gastrointestinal tissue viability is questionable or resection is not feasible. Further prospective clinical evaluation studies would be indicated to determine whether the muscle flap remains viable or compare whether this technique should be recommended over conventional methods.     

Computed tomographic findings in a Bluetick Coonhound with a longitudinal thoracic tracheal tear

A 9‐year‐old intact male Bluetick Coonhound presented for progressive subcutaneous emphysema of 5 days’ duration due to a suspected tracheal tear. Cervical computed tomography (CT) and thoracic CT were performed after failure to identify the tracheal tear with tracheoscopy. A longitudinal tracheal tear was identified starting 4.3 cm cranial to the tracheal bifurcation and extending caudally over a distance of 3.6 cm. Severe pneumomediastinum, subcutaneous emphysema, and retroperitoneal gas were also present. A follow‐up CT 7 days postoperatively confirmed the successful repair of the tear with partial resolution of the presurgical secondary pathology and the patient recovered uneventfully.     

Variants of a genomic island in Aeromonas salmonicida subsp. salmonicida link isolates with their geographical origins

Aeromonas salmonicida subsp. salmonicida is a fish pathogen. Analysis of its genomic characteristics is required to determine the worldwide distribution of the various populations of this bacterium. Genomic alignments between the 01-B526 pathogenic strain and the A449 reference strain have revealed a 51-kb chromosomal insertion in 01-B526. This insertion (AsaGEI1a) has been identified as a new genomic island (GEI) bearing prophage genes. PCR assays were used to detect this GEI in a collection of 139 A. salmonicida subsp. salmonicida isolates. Three forms of this GEI (AsaGEI1a, AsaGEI1b, AsaGEI2a) are now known based on this analysis and the sequencing of the genomes of seven additional isolates. A new prophage (prophage 3) associated with AsaGEI2a was also discovered. Each GEI appeared to be strongly associated with a specific geographic region. AsaGEI1a and AsaGEI2a were exclusively found in North American isolates, except for one European isolate bearing AsaGEI2a. The majority of the isolates bearing AsaGEI1b or no GEI were from Europe. Prophage 3 has also a particular geographic distribution and was found only in North American isolates. We demonstrated that A. salmonicida subsp. salmonicida possesses unsuspected elements of genomic heterogeneity that could be used as indicators to determine the geographic origins of isolates of this bacterium.