Modified functional end-to-end stapled intestinal anastomosis: technique and clinical results in 15 dogs

OBJECTIVES: To evaluate the use of a gastrointestinal anastomosis (GIA) stapling device to perform small intestinal anastomosis in the dog. METHODS: A retrospective study to evaluate the use of a GIA stapling device to perform small intestinal anastomosis in 15 dogs. RESULTS: Reasons for intervention included dehiscence of a previous enterotomy (four of 15), intestinal neoplasia (five of 15), vascular compromise (three of 15), intussusception (two of 15) and foreign body (one of 15). The mean time taken to perform the anastomosis was 7.7 minutes (range five to 12 minutes). No operative complications were recorded and all dogs recovered from the surgery. Major (two dogs) and minor (six dogs) short-term complications of pyrexia and anorexia were recorded in six dogs. In five of these, the cause was considered to be related to a pre-existing peritonitis. One dog was euthanased five months postoperatively for a multi-centric recurrence of intestinal lymphoma. Six month follow-up confirmed an unremarkable and complete recovery in all remaining dogs. No major or minor long-term complications were recorded in any individual. CLINICAL SIGNIFICANCE: A modified stapled functional end-to-end intestinal anastomosis holds merit and should be considered a viable alternative to other stapled and sutured anastomosis techniques.     

Multifocal eosinophilic enteritis associated with a small intestinal obstruction in a standardbred horse

A seven-year-old standardbred gelding developed marked signs of colic associated with an acute small intestinal obstruction. Surgical exploration revealed three intramural, circumferential constricting lesions in the small intestine, the two most severe of which were in the jejunum and were resected. The horse was euthanased owing to postoperative complications. Histopathological examination confirmed the diagnosis of idiopathic multifocal eosinophilic enteritis.     

Mesenteric rents as a source of small intestinal strangulation in horses: 15 cases (1990-1997)

OBJECTIVE: To describe the clinical findings in horses with small intestinal strangulation through mesenteric rents, and to determine the recurrence and survival rates after surgery. DESIGN: Retrospective study. ANIMALS: 15 horses with small intestinal obstruction via a mesenteric rent. PROCEDURE: Medical records of horses with obstruction of the small intestine via a mesenteric rent between January 1990 and December 1997 were reviewed. The signalment, history, initial physical examination findings, results of abdominocentesis, and clinical laboratory values were recorded. Surgical findings, including location of the mesenteric rent and surgical procedure performed, were recorded. Short- and long-term survival rates were calculated. RESULTS: Most mesenteric rents were located in the mesentery of the small intestine (13 horses). Two horses had multiple mesenteric defects. Seven horses were euthanatized at surgery because of an inability to reduce the entrapped intestine (3 horses), uncontrollable hemorrhage (2), inability to close the rent (1), and the amount of compromised intestine involved (1). Seven horses required intestinal resection and anastomosis. The median length of intestine resected was 2.6 m (range, 0.6 to 4.5 m). The mesenteric rents created during resection were not closed in 2 horses. One of these 2 horses subsequently developed a strangulating obstruction through the open rent. Seven of 15 horses in our study were discharged from the hospital (i.e., short-term survival rate of 47% [7/15]). Long-term follow-up information was available for 5 of the 7 horses (follow-up duration of 5 months to 9 years), of which 2 died as a result of colic, and 1 horse was euthanatized because of severe arthritis (i.e., long-term survival rate of 40% [2/5]). CONCLUSIONS AND CLINICAL RELEVANCE: Inability to reduce the intestinal obstruction, severe hemorrhage from the mesentery, and the length of intestine involved are the main factors that decrease survival rates in horses with small intestinal strangulation caused by mesenteric rents.     

Survival rates and post-operative complications after equine colic surgery

SUMMARY A retrospective analysis of 74 cases that underwent surgery for colic was undertaken to determine short and long term survival rates and the incidence of postoperative complications. In 28 cases colic was related to small intestinal lesions and in 46 cases to large intestinal lesions. Pre-operative packed cell volume and heart rate were found to be inversely related to short-term survival. Twenty-five horses (34%) recovered from surgery and were discharged. Of 18 of these cases with available histories, 6 subsequently had one or more episodes of colic since surgery of which 5 eventually died or were euthanased due to further colic; the remaining 12 have remained free from recurrence of colic for longer than 6 months.     

Surgical Treatment of Colic Results in 181 Horses

A retrospective study was performed of 181 horses that underwent an exploratory celiotomy because of acute abdominal disease. Forty-four horses died or were euthanized during surgery. Of the 137 horses that recovered from anesthesia, 72 died of associated diseases or complications, 86 were discharged from the hospital of which 60 survived at least 7 months. Horses with disorders affecting the small intestine had a significantly lower survival rate. Causes of death early in the postoperative period included long bone fracture, shock, ileus, gastric rupture, and peritonitis. After discharge from the hospital, deaths were attributed to colic of unknown cause, malabsorption syndrome, adhesive small bowel obstruction, small and large intestinal volvulus, perforated bowel, and laminitis. Of the 60 horses that were alive at the time of survey, 93.3% had returned to their previous use. A second occurrence of the initial acute abdominal disease was not documented in any horse.     

Small intestinal ganglioneuromatosis in a dog

A 6-week-old Staffordshire Bull Terrier cross was presented with a 4-week history of vomiting and small bowel diarrhoea. Abdominal ultrasound showed thickening of the distal jejunum and ileum. The dog underwent two exploratory laparotomies, during which grossly abnormal sections of intestine were resected. The patient developed septic peritonitis 48 h after the second surgery, caused by dehiscence of an intestinal anastomosis, and was euthanased. All intestinal tissue samples were examined histopathologically and a diagnosis of gastrointestinal ganglioneuromatosis was made. Intestinal ganglioneuromatosis is rare and this case represents a novel occurrence in the small intestine of a dog.     

Tube gastrostomy in dogs

Tube gastrostomy was performed in 19 dogs over a period of 36 months. Indications for tube gastrostomy included non-oral feeding for the management of oesophageal injuries (nine cases) and dysphagia resulting from oral or pharyngeal trauma (two cases) and decompression and, or, gastropexy for gastric diseases including gastric dilatation volvulus (four cases), gastric outflow diseases (three cases) and gastric neoplasia (one case). All the tubes were placed surgically and left in situ for periods of up to 14 days. Feeding was by frequent bolus administration of a proprietary enteral food initially followed by homogenised commercial dog food. The tubes were readily managed and patency maintained in all cases. Gastric stomata granulated within three days of tube removal. Fourteen dogs recovered and returned to normal oral feeding while three died as the result of their presenting condition. A fourth was euthanased four months after surgery because of recurrence of a gastric malignancy. This review indicates that surgically placed tube gastrostomy is readily performed and is an effective means of providing non-oral alimentation and, or, gastric decompression.     

Intestinal obstruction by trichobezoars in five cats.

Between 1997 and 1999, five domestic crossbred cats (four long haired, one short haired) presented with a palpable abdominal mass and were shown to have small intestinal trichobezoars at laparotomy or necropsy. Hair balls were associated with partial or complete intestinal obstruction and were situated in the proximal jejunum to distal ileum. In four cats obstructions were simple, while the remaining cat had a strangulating obstruction. Three of the cats were 10 years or older, and two were less than 4 years. In the three older cats abdominal neoplasia was suspected and investigations were delayed or declined in two of these cats because of a perceived poor prognosis. Predisposing factors identified in this series of cats included a long-hair coat, flea allergy dermatitis, inflammatory bowel disease and ingestion of non-digestible plant material. This report shows that the ingestion of hair is not always innocuous and that intestinal trichobezoars should be considered in the differential diagnoses of intestinal obstruction and intra-abdominal mass lesions, particularly in long-haired cats.     

Gastric and intestinal surgery.

Gastric surgery is commonly performed to remove foreign bodies and correct gastric dilatation-volvulus and is less commonly performed to treat gastric ulceration or erosion, neoplasia, and benign gastric outflow obstruction. Intestinal surgery, although commonly performed by veterinarians, should never be considered routine. The most common procedures of the small intestinal tract performed in dogs and cats include enterotomy and resection/anastomosis. Surgery of the large intestine is indicated for lesions causing obstruction, perforations, colonic inertia, or chronic inflammation.     

Glycoconjugate histochemistry in the small and large intestine of normal and Solanum glaucophyllum-intoxicated rabbits

Vitamin D participates in mineral homeostasis, immunomodulation, cell growth and differentiation. The leaves of Solanum glaucophyllum contain high levels of 1,25-dihydroxyvitamin D3 as glycoside derivatives and their chronic ingestion generates a hypervitaminosis D-like state. We analyzed changes on carbohydrate expression as a cell differentiation indicator on samples of the small and large intestine of S. glaucophyllum-intoxicated rabbits, using conventional and lectin histochemistry. Male New Zealand white rabbits were intoxicated with S. glaucophyllum during two or four weeks and killed the day after. A group of animals (“possibly recovered group”) were intoxicated during 15 days and killed at day 45 of the beginning of the experiment. We found changes in the lectin binding pattern in the small and large intestine of the intoxicated rabbits. Some of these changes were reverted in the possibly recovered group. Vitamin D could be a new regulator factor of the intestinal glycosylation process.     

Ureterocolonlc Anastomosis in Ten Dogs with Transitional Cell Carcinoma

Ureterocolonic anastomosis (UCA) was performed in 10 dogs with transitional cell carcinoma of the urinary bladder trigone or the urethra, or both. All grossly visible tumor was excised. All of the dogs recovered from anesthesia and surgery and had anal continence with no urine leakage. One dog died of undetermined causes 7 days after surgery. Nine dogs survived 1 to 5 months. The owners of eight of the dogs considered their dog's quality of life to be acceptable. Four dogs were euthanatized because of neurologic disease, three of which also had nausea and vomiting. The neurologic and gastrointestinal signs may have been caused by hyperammonemia, metabolic acidosis, and uremia. Blood ammonia levels were elevated in two dogs with neurologic signs. Hyperchloremic metabolic acidosis that was reversible with bicarbonate therapy was diagnosed in five dogs. All of the dogs were azotemic because of intestinal recycling of urea. Serum creatinine concentrations increased in four dogs after surgery. Drug-induced renal disease may have developed in two dogs. Pyelonephritis developed in five kidneys, two of which had outflow obstruction and two had bilateral hydroureteronephrosis before the UCA. In this small number of dogs, surgical excision of transitional cell carcinoma was not curative with six dogs having confirmed metastatic lesions at the time of death.     

Primary hyperaldosteronism in the cat: a series of 13 cases

Thirteen cases of feline primary hyperaldosteronism were diagnosed based on clinical signs, serum biochemistry, plasma aldosterone concentration, adrenal imaging and histopathology of adrenal tissue. Two cases presented with blindness caused by systemic hypertension, whilst the remaining 11 cases showed weakness resulting from hypokalaemic polymyopathy. Elevated concentrations of plasma aldosterone and adrenocortical neoplasia were documented in all cases. Seven cases had adrenal adenomas (unilateral in five and bilateral in two) and six had unilateral adrenal carcinomas. Three cases underwent medical treatment only with amlodipine, spironolactone and potassium gluconate; two cases survived for 304 and 984 days until they were euthanased because of chronic renal failure, whilst the third case was euthanased at 50 days following failure of the owner to medicate the cat. Ten cases underwent surgical adrenalectomy following a successful stabilisation period on medical management. Five cases remain alive at the time of writing with follow-up periods of between 240 and 1803 days. Three cases were euthanased during or immediately following surgery because of surgical-induced haemorrhage. One cat was euthanased 14 days after surgery because of generalised sepsis, whilst the remaining cat was euthanased 1045 days after surgery because of anorexia and the development of a cranial abdominal mass. It is recommended that primary hyperaldosteronism should be considered as a differential diagnosis in middle-aged and older cats with hypokalaemic polymyopathy and/or systemic hypertension and should no longer be considered a rare condition.     

Enterocecocolitis associated with intraepithelial Campylobacter-like bacteria in rabbits (Oryctolagus cuniculus)

We examined 28 suckling, weanling, and young adult rabbits with lethargy, inappetence, and mucinous, semifluid feces. Sixteen of the rabbits had intestinal lesions. In eight of these rabbits, the primary changes were multifocal to diffuse epithelial proliferation and accumulation of lymphocytes, macrophages, or both in the lamina propria of the small intestine, cecum, and sacculated colon. In two of these rabbits, the accumulation of macrophages in the lamina propria was extensive. The other eight rabbits had erosive and suppurative cecocolitis, and four of the rabbits with proliferative lesions also had suppurative cecocolitis. In Warthin-Starry-stained sections of affected intestine, curved or spiral bacteria were visible within degenerated or hyperplastic epithelium, in luminal exudate, or in both. Such organisms were sparse or not found in the other 12 rabbits, which did not have intestinal lesions. The bacteria ultrastructurally resembled intraepithelial Campylobacter-like bacteria previously observed in proliferative enteritis in a variety of species and in acute typhlitis in young rabbits. In immunofluorescence tests, Campylobacter-like bacteria in epithelial cells, crypt lumina, and in luminal exudates in both proliferative and erosive lesions bound monoclonal antibodies and polyclonal antisera prepared against intracellular bacteria found in proliferative enteritis in pigs, hamsters, and ferrets. These observations indicate that a condition similar to proliferative enteritis of swine, hamsters, and other species also occurs in laboratory rabbits.     

Localized tumours of the canine small intestine: a report of twenty cases

During a 10 year period. 20 dogs with primary localized neoplasia of the small intestine were presented at the University of Bristol Veterinary School. Half the tumours were carcinomas, the remainder being lymphosarcomas (5 cases), leiomyosarcomas (3 cases) and leiomyomas (2 cases) Lesions occurred at a variety of locations along the tract, but descending duodenum (6 cases) and terminal ileum (4 cases) were the commonest sites. Clinical findings varied. All dogs except three presented with chronic illnesses, but only seven showed signs immediately referable to alimentary tract disease. Abnormalities were found at radiographic examination in all cases except one and provided or confirmed the indication for laparotomy. Ten animals were destroyed at the time of surgery, two died during the immediate post-operative period and three were later destroyed because of suspected recurrence. Four dogs are reported well at intervals of between nine months and two years following surgery.     

Partial cystectomy for urinary bladder neoplasia: surgical technique and outcome in 11 dogs

Partial cystectomy was performed in 11 dogs with bladder neoplasia (10 with transitional cell carcinoma and one with rhabdomyosarcoma). Between 40 and 70 per cent of the bladder was excised during the partial cystectomies. In eight dogs, all the grossly visible tumour was excised but on histopathological examination of the excised tissue, neoplastic tissue was found to extend to the surgical margins in four of these dogs. A ureteral stoma was excised with the tumour in four dogs necessitating ureteral reimplantation; one dog had both ureteral stomas excised and bilateral ureteral reimplantation. The bladder incision dehisced in two dogs, necessitating a second surgery. Six dogs were polla-kiuric after surgery. Pollakiuria resolved within two months in four dogs and persisted in two dogs. None was incontinent. Local tumour recurrence was suspected in nine dogs based on imaging studies and confirmed in five dogs during post mortem examination. Five dogs were euthanased two to seven months after surgery. Six dogs survived at least one year, two of these dogs remain alive at 17 and 27 months after surgery. It is concluded that partial cystectomy may provide local control of bladder neoplasia.     

Incidence of foreign-body-induced ileus in dogs

While playing or simply because of avidity, dogs may ingest a variety of foreign bodies. Ingested foreign bodies, which are not stopped in the mouth or oesophagus, enter into the stomach. Once a foreign body has passed through the pylorus, jejunum and ileum appear to be the most common sites of the small intestine obstruction. The records of 103 cases, treated at the Clinic for Surgery, Orthopaedics and Ophthalmology of the Veterinarian Faculty, University of Zagreb from January 1981 till December 1998 were analysed. The analysis included the incidence of ileus caused by foreign bodies and the distribution of patients by sex, age, breed, duration of illness, site of obstruction, types of foreign bodies and the interrelation between these parameters. The results of our research show that the number of patients with foreign body induced ileus is increasing. Males ingested foreign bodies more often than females. Foreign body induced ileus was more frequently found in animals below 2 years of age. Foreign bodies were mostly ingested by mongrels, but also by popular dog breeds such as Dobermanns, Poodles, Cocker Spaniels and Rottweiler. Most of these ileus cases were found in March and October and the predominant clinical signs included anorexia, dehydration, abdominal tenderness and absence of defecation. The most common site of small intestine obstruction by foreign bodies was the jejunum, and the most effective treatment was enterotomy. Dogs mostly ingested stones, plastic and rubber objects. The treatment was more successful in dogs below 2 years of age. Patients that died post-surgically, died mostly the first day after surgery.     

Jejunojejunal intussusception associated with a transmural adenocarcinoma in an aged cow

After 3 days of intestinal obstruction, a proximal jejunojejunal intussusception was resected during surgery in an adult Holstein cow. A transmural adenocarcinoma was found at the proximal margin of the intussusception. The cow recovered well from surgery and produced milk and embryos to expectation. During the seventh month after surgery, the cow developed pneumonia and, therefore, was euthanatized. Disseminated abdominal and thoracic neoplasia was observed at necropsy.     

Detection of apoptotic cells in intestines from horses with and without gastrointestinal tract disease

OBJECTIVE: To identify apoptosis in equine intestines and determine whether apoptosis is associated with gastrointestinal tract disease or a specific tissue layer of intestine. ANIMALS: 38 horses that underwent surgery or were euthanatized for small or large intestine obstruction, strangulation, or distension and 9 control horses euthanatized for reasons other than gastrointestinal tract disease or systemic disease. PROCEDURE: Specimens were collected at surgery from intestine involved in the primary lesion and distant to the primary lesion site or at necropsy from several sites including the primary lesion site. Histologic tissue sections were stained with H&E, and apoptosis was detected by use of the terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling technique. The number of apoptotic cells per hpf was counted in the mucosa, circular muscle, longitudinal muscle, and serosa. RESULTS: Apoptotic nuclei were seen in all layers of intestine. An increased number of apoptotic cells was found in the circular muscle of the intestine from horses with simple obstruction, compared with strangulating obstruction or healthy intestine. Intestine distant from a primary strangulating lesion had higher numbers of apoptotic cells than did intestine distant from a simple obstructive lesion or intestine taken at the site of a strangulating or simple obstructive lesion. CONCLUSIONS AND CLINICAL RELEVANCE: Intestine from horses with obstructing or strangulating lesions in the small intestine and large colon had high numbers of apoptotic cells possibly because of ischemic cell injury and subsequent inflammation. Whether substantial apoptosis affects intestinal function is not yet known.     

Obstructive inflammatory laryngeal disease in three cats

Three cats with upper respiratory tract obstruction due to laryngeal inflammation are presented. Cervical radiography showed the presence of a soft tissue mass in the laryngeal region in all cases, and laryngoscopy allowed direct visualization of a mass associated with the larynx. Laryngeal samples were obtained by a combination of fine needle aspiration, cutting biopsy forceps, by ventral laryngotomy, and at post-mortem. Histopathology of the laryngeal samples showed the presence of a predominantly granulomatous inflammation, with macrophage and lymphocyte infiltration. One case was euthanased due to severe dyspnoea. The remaining two cases underwent combined medical (corticosteroid and antibiotic) and surgical (permanent tracheostomy or excision of laryngeal tissue by ventral laryngotomy) treatment. One case died of an undetermined cause 15 weeks after surgery while the other case remains clinically well 20 months after diagnosis. Recognition of the existence of granulomatous laryngitis is important as clinical signs and radiographic findings are indistinguishable from laryngeal neoplasia.     

Feline gastrointestinal adenocarcinoma: a review and retrospective study

Feline gastrointestinal adenocarcinomas are the most common nonhematopoietic gastrointestinal tumors in cats. They are highly malignant tumors causing intestinal obstruction due to the annular, stenosing nature to their growth. Current literature is largely based on surveys of pathology records. Therefore, a retrospective study was conducted to evaluate clinical course and prognosis with surgical excision of the tumor. In published reports feline gastrointestinal adenocarcinoma represented 20-35% of gastrointestinal neoplasia in the cat; the average age was greater than ten years; and there was a greater incidence in Siamese. The small intestine accounted for 70% of cases. In this retrospective study, cats usually had a long history of non-specific gastrointestinal disease; weight loss and vomiting were the most common signs. Abdominal radiographs demonstrate intestinal obstruction, and an abdominal mass is often palpable. With intestinal resection and anastomosis, median survival time was 2.5 months (range: 0-24 months). Tubular adenocarcinomas may have a better prognosis than other histological types, especially if metastasis is not present at the time of surgery. A significant disease-free interval is possible in some cases.