Ultrasonographic findings of intestinal intussusception in seven cats

The medical records of seven cats with intestinal intussusception that were diagnosed by abdominal ultrasonography and exploratory laparotomy were reviewed. In transverse ultrasonographic sections the intussusception appeared as a target-like mass consisting of one, two or more hyperechoic and hypoechoic concentric rings surrounding a C-shaped, circular or non-specific shaped hyperechoic centre. Part of the intestine representing the inner intussusceptum, located close to the hyperechoic centre and surrounded by concentric rings, was also detected. In longitudinal sections the intussusception appeared as multiple hyperechoic and hypoechoic parallel lines in four cases and as an ovoid mass in three cases. In one case the ovoid mass had a ‘kidney’ configuration. Additional ultrasonographic findings associated with intestinal intussusception included an intestinal neoplasm in one cat. The results of the present study demonstrate that the ultrasonographic findings of intestinal intussusception in cats bear some similarities to those described in dogs and humans, are relatively consistent, and facilitate a specific diagnosis.     

Ultrasonographic signs of intestinal intussusception associated with acute enteritis or gastroenteritis in 19 young dogs

The ultrasonographic pattern of intestinal intussusception was studied in 19 young dogs with acute enteritis or gastroenteritis. The intussusception was observed to be a target-like mass consisting of a hyperechoic or anechoic center surrounded by multiple hyperechoic and hypoechoic concentric rings in transverse sections. In longitudinal sections, the intussusception appeared as multiple hyperechoic and hypoechoic parallel lines, as a tumor-like or pseudokidney mass, and as a trident-like configuration. Ultrasonography may provide a sensitive, specific, and accurate method of diagnosing intestinal intussusception in young dogs.     

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.     

Ultrasonographic diagnosis of small-intestinal intussusception in three foals

Small-intestinal intussusceptions were diagnosed in 3 foals. Cross-sectional ultrasonography through the apex of the intussusceptum revealed a target-like pattern with a thick hypoechoic rim. The thick hypoechoic rim was caused by severe edema of the entering and returning walls of the intussusceptum. At the more proximal portion of the intestines, where parietal edema was less severe, the image appeared as 2 concentric rings and an inner circular area. The outer ring and inner circular area were hypoechoic and represented the returning and the entering wall of the intussusceptum. An additional cross-sectional pattern can be described as double concentric rings, with the inner lumen represented by a central echogenic core. Longitudinal scannings of the involved intestinal section revealed a different view of the same anatomic situation, with 2 hyperechoic areas delineated by 3 stripes of hypoechoic intestine. Ultrasonography of a foal's abdomen provides a clinician with a rapid noninvasive technique that may aid in the differential that may aid in the differential diagnosis of colic. The ultrasonographic diagnosis of intussusception may improve the recognition of a surgical lesion and improve the potential for successful treatment.     

Ultrasonographic features of intestinal intussusception in 10 dogs

Records of dogs that had abdominal ultrasonography and surgical or pathological diagnosis of intestinal intussusception between February 1992 and June 1997 were reviewed retrospectively. Ultrasound images were reviewed with respect to appearance of the intussusception, suspected location, evidence of predisposing cause and concurrent lesions. Ten intussusceptions were found, affecting a variety of breeds. The mean (range) age of affected dogs was 2·5 (0·3 to seven) years (four females and six males) and the reported duration of clinical signs, 48 (one to 150) days. Intussusceptions were jejunojejunal (five dogs), ileocolic (three), caecocolic (one) and colocolic (one). A concentric ring sign was identified ultrasonographically in each dog and anatomical location predicted correctly in five instances. Additional ultrasonographic findings associated with intussusceptions included intestinal neoplasm in two dogs, enlarged abdominal lymph nodes in two, multiple mesenteric cysts in one and intestinal foreign body in a further dog. Thus, ultrasonography enables accurate diagnosis of intestinal intussusception and is a useful method for searching for concurrent or predisposing lesions.     

Use of cecal bypass via side-to-side ileocolic anastomosis without ileal transection for treatment of cecocolic intussusception in three horses

CASE DESCRIPTION: 3 horses were evaluated for signs of colic; cecocolic intussusception was detected. CLINICAL FINDINGS: Abnormalities detected included diminished intestinal sounds, inflammatory leukogram, dehydration, unremarkable fi ndings via rectal palpation, and ultrasonographic evidence of large intestine intussusception. Laparotomy revealed cecocolic intussusception. TREATMENT AND OUTCOME: Cecal bypass via side-to-side ileocolic anastomosis without ileal transection was performed in each horse by use of an intraluminal anastomosis stapler device. Postoperative complications were minimal, and all horses recovered rapidly and were clinically normal at > 12 months after surgery. CLINICAL RELEVANCE: Cecal bypass via side-to-side ileocolic anastomosis without ileal transection seemed to offer 2 potential advantages over traditional surgical techniques for treating this condition. The risk of abdominal contamination was far less than with techniques in which the colotomy is needed to enable resection of the cecum or techniques in which the ileum is transected. Also, it was technically simpler to perform because there was no need to transect the ileum, oversew the ileal stump, perform cecal resection, or close the mesenteric space created by relocating the jejunal stump to the right ventral colon.     

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.     

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.     

COMPARISON OF RADIOGRAPHY AND ULTRASONOGRAPHY FOR DIAGNOSING SMALL‐INTESTINAL MECHANICAL OBSTRUCTION IN VOMITING DOGS

A cross‐sectional study was performed on acutely vomiting dogs to compare the accuracy of radiography and ultrasonography for the diagnosis of small‐intestinal mechanical obstruction and to describe several radiographic and ultrasonographic signs to identify their contribution to the final diagnosis. The sample population consisted of 82 adult dogs and small‐intestinal obstruction by foreign body was confirmed in 27/82 (33%) dogs by surgery or necropsy. Radiography produced a definitive result (obstructed or not obstructed) in 58/82 (70%) of dogs; ultrasonography produced a definitive result in 80/82 (97%) of dogs. On radiographs, a diagnosis of obstruction was based on detection of segmental small‐intestinal dilatation, plication, or detection of a foreign body. Approximately 30% (8/27) of obstructed dogs did not have radiographic signs of segmental small‐intestinal dilatation, of which 50% (4/8) were due to linear foreign bodies. The ultrasonographic diagnosis of small‐intestinal obstruction was based on detection of an obstructive lesion, sonographic signs of plication or segmental, small‐intestinal dilatation. The ultrasonographic presence or absence of moderate‐to‐severe intestinal diameter enlargement (due to lumen dilatation) of the jejunum (>1.5 cm) was a useful discriminatory finding and, when present, should prompt a thorough search for a cause of small‐intestinal obstruction. In conclusion, both abdominal radiography and abdominal ultrasonography are accurate for diagnosing small‐intestinal obstruction in vomiting dogs and either may be used depending on availability and examiner choice. Abdominal ultrasonography had greater accuracy, fewer equivocal results and provided greater diagnostic confidence compared with radiography.     

Acute enteritis or gastroenteritis in young dogs as a predisposing factor for intestinal intussusception: a retrospective study

Various types of intestinal intussusception were diagnosed in 29 of 220 young dogs with acute enteritis or gastroenteritis, due to canine parvovirus (85 cases) or presumably to other infectious agents, inflammation or less common hypermotility and metabolic derangements (135 cases). As the other causes of the disease were excluded, acute enteritis or gastroenteritis was considered to be the most likely predisposing factor for the intestinal intussusception. The most common type of intussusception was found to be the ileocolic. Of the 21 dogs that underwent surgical resection and anastomosis of the intestine, 18 dogs recovered completely and three died due to complications. The high survival rate was due to the effective pre-operative, surgical and post-operative therapy.     

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.     

Acellular Urinary Bladder Matrix in a Collagenase Model of Superficial Digital Flexor Tendonitis in Horses

The objective of the present study was to determine the efficacy of urinary bladder matrix (UBM) in collagenase-induced superficial digital flexor (SDF) tendonitis by using clinical, ultrasonographic, and histologic data. A total of eight healthy adult horses were used in this study. Bilateral forelimb SDF tendonitis was created in the horses by injecting collagenase. After 14 days, one randomly selected forelimb SDF tendon was blindly treated with UBM and the opposite tendon was treated with a control (saline). Clinical and ultrasonographic parameters including lameness, lesion size, ultrasonographic fiber pattern, and echogenicity were measured throughout the study. After 84 days, horses were euthanized and SDF tendon lesions from the two groups were compared statistically using an analysis of variance with significance set at P ≤ .05.Results showed that there were no significant differences between the treated and control tendons for any of the clinical, ultrasonographic, gross, or histologic variables. UBM does not appear to be an effective treatment for collagenase-induced SDF tendonitis. However, there may be differences in clinical tendonitis that might render the treatment more effective in the clinical setting.     

Jejunal Intussusception: A Complication of Functional End-to-End Stapled Anastomoses in Two Ponies

Jejunojejunal intussusception occurred after jejunal resection and stapled functional end-to-end anastomosis in two pony mares. In both mares, the lead point of the intussusception was the stapled functional end-to-end (FEE) anastomosis. The stapled free ends of jejunum were oversewn with an inverting suture pattern. A possible explanation for development of the intussusception was the acute angle created in the intestine by the FEE anastomsis. This angulation may have impaired flow of ingesta causing motility changes that predisposed the site to intussusception. Because the oversewn blind intestinal ends acted as the lead point for formation of the intussusception, it may be inadvisable to oversew the stapled anastomotic ends.     

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.     

ULTRASONOGRAPHIC FEATURES OF INTESTINAL ENTRAPMENT IN DOGS

The clinical and ultrasonographic features of postoperative intestinal entrapment were assessed in five dogs. Four had vomiting and lethargy, and one had peracute collapse and hematochezia. Ultrasonographic findings in four of five dogs were similar, being characterized by focally hyperechoic mesentery and abdominal effusion, surrounding a single loop of amotile and dilated intestine. In some dogs, the affected intestinal loop had a thickened or corrugated wall, or alteration of wall layering. In one dog, the site of entrapment could be directly visualized. In the most severely affected dog, a large volume of echogenic peritoneal effusion was present, as well as fluid dilation of multiple intestinal loops. The ultrasonographic appearance of intestinal entrapment is similar to that of intestinal perforation or infarction by other causes.     

EFFECTS OF CORN OIL ADMINISTERED ORALLY ON CONSPICUITY OF ULTRASONOGRAPHIC SMALL INTESTINAL LESIONS IN DOGS WITH LYMPHANGIECTASIA

Lymphangiectasia is one of the causes of protein‐losing enteropathy in dogs and characteristic ultrasonographic small intestinal lesions have been previously described. The purpose of this study was to determine whether corn oil administered orally (COAO) would result in increased conspicuity of these characteristic small intestinal ultrasonographic lesions in dogs with lymphangiectasia. Affected dogs were included if they underwent corn oil administered orally and had a surgical full‐thickness intestinal biopsy diagnosis of lymphangiectasia. Control dogs had normal clinical examination and standard laboratory test findings. Ultrasound images of duodenum, jejunum, and ileum were obtained prior to and 30, 60, 90, and 120 min after corn oil administered orally for all dogs. Parameters recorded for each ultrasound study were intestinal wall thickness, mucosal echogenicity, and presence or absence of hyperechoic mucosal striations (HMS) and a parallel hyperechoic mucosal line (PHML). Nine affected and five controls dogs were included in the study. Seven of the nine dogs with lymphangiectasia had hyperechoic mucosal striations prior to corn oil administered orally. Jejunal hyperechoic mucosal striations were significantly associated with lymphangiectasia at multiple time points (P < 0.05) and were best identified in dogs with lymphangiectasia 60 or 90 min after corn oil administered orally. Increased mucosal echogenicity was observed in all dogs at multiple time points after corn oil administered orally. A parallel hyperechoic mucosal line was present in the jejunum in 4/5 healthy and 6/9 dogs with lymphangiectasia at one or more time points after corn oil administered orally. Findings indicated that corn oil administered orally improves conspicuity of characteristic ultrasonographic lesions in dogs with lymphangiectasia, however some of these lesions may also be present in healthy dogs that recently received a fatty meal.