Pylorogastric intussusception in the dog: a case report and literature review

A 10-month-old, neutered male Saint Bernard presented for evaluation of acute, severe vomiting. A soft-tissue mass was noted within the stomach on survey abdominal radiographs. The diagnosis of pylorogastric intussusception was made during exploratory celiotomy. The intussusception was manually reduced at surgery, the pyloric antrum was enlarged, and the duodenum was permanently affixed to the abdominal wall in an attempt to prevent recurrence of the intussusception. The dog recovered, has gained weight (5 kg), and has had only one isolated episode of vomiting during the one year since discharge from the hospital. This report documents the fourth reported case of pylorogastric (i.e., duodenogastric, gastrogastric) intussusception in the veterinary literature and is the first report that details the surgical management of the disease.     

Ultrasonographic and computed tomographic features of a true gastro-gastric intussusception with concurrent foreign bodies in a dog

A 2-year-old intact male Cane Corso dog was presented for acute weakness, vomiting, and diarrhea. Abdominal ultrasound revealed the stomach had severe wall edema and a target appearance. Computed tomography was consistent with a gastro-gastric intussusception and concurrent mineral-like gastric foreign bodies. After reduction of the intussusception, bilateral incisional gastropexy was performed to prevent recurrence. True gastrogastric intussusception is a rare condition and should be considered if the stomach has severe wall edema with a target sign on abdominal ultrasound. Computed tomography was useful to confirm this rare diagnosis and screen the entire abdomen for concurrent lesions.Key clinical message:This case highlights the usefulness of a CT examination to confirm this rare diagnosis, to determine the position of gastric compartments, and to detect potential concurrent lesions prior to surgery.     

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.     

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.     

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.     

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.     

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.     

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.     

Gastroduodenal intussusception in a young dog

A 21-month-old German shepherd crossbreed presented with a nine-month history of intermittent vomiting, anorexia and melaena interspersed with periods of clinical normality. Investigations suggested recurrent pancreatitis and the vomiting resolved with supportive therapy but recurred two weeks later. Abdominal radiographs revealed evidence of an intermittent abdominal mass which, on uitrasonography, had the typical appearance of an intussusception. At laparotomy, a gastroduodenal intussusception was found obstructing the pancreatic and bile duct outflows with perforation of the duodenal wail. The dog was euthanased. Postmortem examination and histology showed no obvious cause for the intussusception but confirmed pancreatic involvement. This is believed to be the first case of gastroduodenal intussusception reported in an animal.     

1例犬细小病毒病继发肠套叠的诊断与治疗

犬细小病毒病会导致幼犬严重腹泻，甚至便血，往往会继发肠套叠。肠套叠的症状与犬细小病毒病较为相似，也会导致病犬精神沉郁、食欲废绝、呕吐等，宠物医生往往会误认为该症状是由犬细小病毒病所致，误诊不仅治疗无效，还延误治疗的最佳时间。采用X射线和B型超声2种影像学相结合的方法对1例由犬细小病毒病导致肠梗阻的幼犬进行诊断，确诊为肠套叠后对其进行手术治疗，术后7d，该犬手术切口未发生感染并愈合良好。主要对该病的诊治经过作一介绍，以期为兽医临床诊治幼犬肠套叠提供参考。     

Complications of enteroplication for the prevention of intussusception recurrence in dogs: 35 cases (1989-1999).

OBJECTIVE: To compare complication and recurrence rates in dogs treated for intussusception that underwent enteroplication to rates in dogs treated for intussusception that did not undergo enteroplication. DESIGN: Retrospective study. ANIMALS: 35 dogs with intestinal intussusception. PROCEDURE: Information on signalment, clinical signs, potential predisposing causes, surgical technique, opioid administration, use of enteroplication, postoperative complications, and whether the intussusception recurred was obtained from the medical records. RESULTS: Dogs ranged from 8 weeks to 10 years old. Opioids were administered in the perioperative period in 34 dogs. Enteroplication was performed in 16 dogs. Complications of enteroplication that required a second surgery were identified in 3 dogs. None of the 16 dogs that underwent enteroplication had a recurrence of intussusception, whereas 1 of the 19 dogs that did not undergo enteroplication had a recurrence. Rate of intussusception recurrence and likelihood that a second surgical procedure would be required were not significantly different between dogs that underwent enteroplication and dogs that did not. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that enteroplication may be associated with life-threatening complications in dogs, but the likelihood of a dog requiring a second surgical procedure following surgical correction of intussusception was not different between dogs that underwent enteroplication at the time of the initial surgery and dogs that did not.     

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.     

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.     

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.     

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.     

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.     

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.     

Intussusception following renal transplantation in dogs (author's transl)]

In a consecutive and non-selected study of 54 kidney transplanted dogs, 12 cases of intussusception of the small intestine developed in 8 dogs. The patogenesis is still unknown. It has been postulated that the time of the operation (4--7 hours) and the segmental termination of the post-operative atony in the intestine are essential factors in this fatal complication. The last 16 dogs in this material were peroperatively treated with antikolinergics (Mestinon NFN), which was continued until normal function of the intestine. In these dogs there were no evidence of intussusception. The value of this profylaxis is open to discussion and it is essential to solve the problem of intussusception through a "blind" and controlled trial.