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Clinical findings and outcomes of 153 dogs surgically treated for intestinal intussusceptions
Abstract
Objective
To describe perioperative characteristics and outcomes of dogs surgically treated for intestinal intussusception.
Study design
Multi‐institutional, retrospective study.
Animals
One hundred fifty‐three client‐owned dogs with intestinal intussusception.
Methods
Dogs were included when they had undergone surgical treatment of a confirmed intestinal intussusception. Medical records were reviewed for demographics and clinical data, including surgical complications (graded 1‐4). Follow‐up was obtained via telephone interview with owners and referring veterinarians.
Results
Dogs had a median age of 10 months (range, 2‐156), and the most common location for intussusception was ileocolic (66/153 [43%]). Most cases had no identifiable cause (104/155 [67%]). Intestinal resection and anastomosis (IRA) was performed in 129 of 153 (84%) dogs; enteroplication was performed in 28 of 153 (18%) dogs, including 13 with and 15 without IRA. Intraoperative complications occurred in 10 of 153 (7%) dogs, all involving intestinal damage during attempted manual reduction. The median duration of follow‐up after discharge was 334 days (interquartile range, 15‐990; range, 1‐3302). Postoperative complications occurred in 53 of 153 (35%) dogs, including 22 of 153 (14%) with severe (grade 3 or 4) events. Diarrhea, regurgitation, and septic peritonitis were the most common postoperative complications; intussusception recurred in four of 153 (3%) dogs, all within 72 hours postoperatively. Fourteen‐day postoperative mortality rate was 6%.
Conclusion
Surgical treatment of intestinal intussusception was curative in most dogs, even when an underlying cause was not identified. Surgical complications were common, including a 14% risk of life‐threatening short‐term complications.
Clinical significance
Surgical treatment of intestinal intussusception offers an excellent prognosis, but the potential life‐threatening complications should be considered.
... 1,2 In dogs, the etiology usually is unknown, but foreign bodies, intestinal parasites, gastroenteritis, neoplasia, previous abdominal surgery or any condition affecting intestinal motility are potential triggering factors. 1 Ileocolic intussusception is the most common type in small animals. 2,3 A tentative diagnosis can be made clinically by palpation of an abdominal mass but definitive diagnosis usually requires ultrasound examination with identification of a characteristic target-like structure involving the intestines. 4 Spontaneous reduction has been described, but surgical correction is commonly required. ...
... 4 Spontaneous reduction has been described, but surgical correction is commonly required. 3,5 In human medicine, a nonsurgical procedure called ultrasoundguided hydrostatic reduction (USGHR) has been used to correct ileocolic intussusception. It consists of filling the colon with saline using gravity-controlled hydrostatic pressure. ...
... 12 In both small animals and children, the site most commonly involved is the ileocecal area. 2,3 Successful USGHR initially was performed in human medicine with the objective of providing an alternative to hydrostatic reduction using barium enema and fluoroscopy. 7 This technique is used widely in pediatric medicine and is associated with decreased duration of hospitalization and decreased mortality. ...
A 5‐week‐old male intact Golden Retriever puppy was presented for a history of vomiting and diarrhea with hematochezia. Ultrasound findings confirmed the presence of an ileocecocolic intussusception. Surgical correction was declined because of financial concerns. Based on a pediatric procedure used in humans, an ultrasound‐guided hydrostatic reduction (USGHR) was performed. This procedure consisted in injecting saline rectally under controlled pressure to mechanically reduce the intussusception. Reduction of the intussusception and evaluation of potential complications were concurrently evaluated by ultrasound during the procedure. No recurrence was observed the next day and the puppy was discharged. Follow‐up indicated that the dog was still doing well 6 months later. This case report describes a new technique in veterinary medicine allowing successful nonsurgical reduction of an ileocecocolic intussusception in a dog. This procedure is innovative, simple, and substantially decreases the cost and minimizes morbidity potentially associated with surgical management.
... 13 In one study including 153 dogs surgically treated for intestinal intussusceptions, the reported median age was 10 mo. 4 Clinical signs associated with intussusceptions include vomiting, diarrhea, anorexia, lethargy, and hematochezia. 4 Signs can vary depending on the location of the intussusception. ...
... 13 In one study including 153 dogs surgically treated for intestinal intussusceptions, the reported median age was 10 mo. 4 Clinical signs associated with intussusceptions include vomiting, diarrhea, anorexia, lethargy, and hematochezia. 4 Signs can vary depending on the location of the intussusception. Large intestinal intussusceptions may present with hematochezia and tenesmus, whereas small intestinal intussusceptions may present with vomiting and anorexia. ...
A 4 mo old male goldendoodle puppy was evaluated for chronic hematochezia with a history of recurrent rectal prolapse and tenesmus. A colo-colonic intussusception was diagnosed via abdominal imaging. Surgery was elected to reduce the intussusception, wherein a colonic mass was discovered. Colonic resection and anastomosis was performed, and the tissue were submitted for histopathological examination. The puppy was diagnosed with colonic hamartomatous gang-lioneuromatosis based on the presence of markedly hyperplastic submucosal and myenteric plexi with infiltration and expansion of the mucosa and submucosa by Schwann cells and neuronal cell bodies. Ganglioneuromatosis is a rarely reported entity in the veterinary literature, and limited clinical follow up data is available for described cases. In humans, ganglioneuromatosis is associated with a PTEN genetic mutation, which confers increased susceptibility to the development of neoplasia of endocrine organs. Approximately 1 yr after the operation, this puppy appeared clinically normal with no abnormalities on repeated imaging. This case report describes the clinical presentation, surgical treatment, and histo-logic features of colonic hamartomatous ganglioneuromatosis with 1 yr postoperative clinical follow up data in a dog. Although uncommon, ganglioneuromatosis should be considered as a differential diagnosis list as a cause of gastroin-testinal masses in puppies and young dogs. (J Am Anim Hosp Assoc 2023; 59:224-228.
... The clinical signs are depend upon the severity, level, completeness and duration of the obstruction. The most common clinical signs are vomiting, diarrhoea, anorexia, lethargy and hematochezia (Larose et al., 2020) [36] . According to Butler, (1972) [11] the cardinal signs of intussusception are recurrent or sporadic vomiting, abdominal pain, bloody mucoid diarrhea and palpable sausage shaped abdominal mass. ...
... According to the study of Larose et al., 2020 [36] the common intraoperative complication is the tearing and perforation of the diseased intestine during the manual reduction. The intussusceptum portion of the intussusception is the primary part which undergo vascular compromise, ischemic necrosis and intestinal perforation (Cera, 2008) [14] . ...
Objectives
To evaluate the complication rate, mortality rate and putative risk factors for cecal or colonic surgery in dogs.
Materials and Methods
A multi‐institutional retrospective study including dogs that had undergone surgery that involved the cecum or the colon. Medical records from three referral hospitals were reviewed for patient demographics and clinical data. The association between putative risk factors and survival to discharge or complications was assessed using univariable and multivariable analysis.
Results
Seventy‐nine dogs met the criteria to be included in this study. Fifty‐five dogs had full thickness incision surgeries, while 24 dogs had partial thickness surgeries. The complication and mortality rates for full thickness and partial thickness cecal/colonic surgeries were not statistically different. The dehiscence rate of colonic anastomosis in this study was four of 47 (8.5%). On univariate analysis, performing full thickness procedures out of hours had an association with increased complications and mortality. On multivariable analysis, no factors were associated with survival to discharge or complications. There was no association of board‐certified surgeon presence in surgery with complications or mortality.
Clinical Significance
The performance of full thickness cecal/colonic surgery is not associated with a statistically significant increased risk for complications or mortality compared to partial thickness procedures, with a possible increased risk of complications and mortality in full thickness procedures out of hours.
A 4 mo old male goldendoodle puppy was evaluated for chronic hematochezia with a history of recurrent rectal prolapse and tenesmus. A colo-colonic intussusception was diagnosed via abdominal imaging. Surgery was elected to reduce the intussusception, wherein a colonic mass was discovered. Colonic resection and anastomosis was performed, and the tissue were submitted for histopathological examination. The puppy was diagnosed with colonic hamartomatous ganglioneuromatosis based on the presence of markedly hyperplastic submucosal and myenteric plexi with infiltration and expansion of the mucosa and submucosa by Schwann cells and neuronal cell bodies. Ganglioneuromatosis is a rarely reported entity in the veterinary literature, and limited clinical follow up data is available for described cases. In humans, ganglioneuromatosis is associated with a PTEN genetic mutation, which confers increased susceptibility to the development of neoplasia of endocrine organs. Approximately 1 yr after the operation, this puppy appeared clinically normal with no abnormalities on repeated imaging. This case report describes the clinical presentation, surgical treatment, and histologic features of colonic hamartomatous ganglioneuromatosis with 1 yr postoperative clinical follow up data in a dog. Although uncommon, ganglioneuromatosis should be considered as a differential diagnosis list as a cause of gastrointestinal masses in puppies and young dogs.
Focal and linear gastrointestinal obstructions in dogs and cats are commonly seen and often require emergency surgical intervention in conjunction with attentive medical management. Intestinal fluid accumulation occurs as a result of increased secretion from the gastrointestinal tract, pancreas, and biliary system, along with retention of ingested fluids. Abdominal radiography is frequently used to assess the abdomen in vomiting patients. Ultrasonography is readily available in veterinary medicine and is useful for the diagnosis of intestinal obstructions. Endoscopy is commonly used for foreign body removal in the esophagus and the stomach, but little is published in veterinary and human literature on the use of endoscopy with small intestinal obstruction. Computed tomography is not commonly used for the diagnosis of gastrointestinal foreign body obstruction and intussusception in dogs and cats. Gastric foreign bodies are removed through a longitudinal gastrotomy incision on the ventral surface of the stomach.
A 2-year-old castrated male Great Dane crossbreed dog was presented with a history of diarrhea and suspected intussusception. Abdominal ultrasound revealed a colonic-colonic intussusception. The gastrointestinal tract was explored, and an approximately 5-cm intussusception was discovered mid-colon. All other gastrointestinal structures were normal in appearance. The intussusception could not be reduced manually. A colonic resection and anastomosis were performed together with a left-sided incisional colopexy. The dog recovered from surgery and histopathology revealed the intussusception to be secondary to large cell transmural lymphoma. Sections from the surgical margins revealed proliferation of fibrovascular tissue along the serosal surface segmentally, but no neoplastic cells were identified. The dog was subsequently treated with chemotherapy consisting of doxorubicin and prednisone. No evidence of disease recurrence was noted on ultrasound 9 months after surgery. Approximately 2 years after surgery, the dog is noted to be clinically normal at home with no abnormal findings on physical examination. A complete blood (cell) count and chemistry obtained at this time revealed no significant abnormalities besides mild azotemia. Additional restaging was declined by the owner.
Objective:
To evaluate reporting of surgical complications and other adverse events in clinical research articles describing soft tissue and oncologic surgery in dogs and cats.
Study design:
Systematic literature review.
Sample:
English-language articles describing soft tissue and oncologic surgeries in client-owned dogs and cats published in peer-reviewed journals from 2013 to 2016.
Methods:
CAB, AGRICOLA, and MEDLINE databases were searched for eligible articles. Article characteristics relevant to complications were abstracted and summarized, including reported events, definitions, criteria used to classify events according to severity and time frame, and relevant citations.
Results:
One hundred fifty-one articles involving 10 522 animals were included. Canine retrospective case series of dogs predominated. Ninety-two percent of articles mentioned complications in study results, but only 7.3% defined the term complication. Articles commonly described complications according to time frame and severity, but terminology and classification criteria were highly variable, conflicting between studies, or not provided. Most (58%) reported complications could have been graded with a published veterinary adverse event classification scheme, although common intraoperative complications were notable exceptions.
Conclusion:
Definitions and criteria used to classify and report soft tissue and oncologic surgical complications are often absent, incomplete, or contradictory among studies.
Clinical significance:
Lack of consistent terminology contributes to inadequate communication of important information about surgical complications. Standardization of terminology and consistency in severity scoring will improve comparative evaluation of clinical research results.
BACKGROUND:
Standardized reporting of intraoperative adverse events is important to enhance transparency. To the best of our knowledge, there is no validated definition and classification of intraoperative complications.
METHODS:
We conducted a two-round Delphi study to develop a definition and classification of intraoperative complications. Experts were contacted by email and sent a link to the online questionnaire. In a pilot study, two independent raters applied the definition and classification in a sample of 60 surgical interventions of low, intermediate, and high complexity and evaluated practicability. Interrater agreement of the classification was determined (raw categorical agreement, weighted kappa, and intraclass correlation).
RESULTS:
In the Delphi study, 40 of 52 experts (77 % return rate) from 14 countries took part in each round. The Delphi study resulted in a comprehensive definition of intraoperative complications as any deviation from the ideal intraoperative course occurring between skin incision and skin closure. The classification foresees four grades depending on the need for treatment (no need, grade I; need for treatment, grade II) and the severity of the complication (life-threatening/permanent disability, grade III; death, grade IV). The pilot study showed good practicability (6 on a 7-point scale) and a high raw agreement of 87 %, a weighted kappa of 0.83 [95 % confidence interval (CI) 0.73-0.94] and an intraclass correlation coefficient of 0.83 (95 % CI 0.73-0.90).
CONCLUSIONS:
While the Delphi process enabled to develop definitions and classification of intraoperative complications by severity, further research including a multicentre international full-scale validation needs to be conducted with the ultimate goal to contribute to standardized reporting in surgical practice and research.
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.
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.
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.
Objectives:
The aim of this study was to report complications, as well as short- and long-term clinical outcomes of cats suffering from surgically reduced intussusception with and without enteroplication.
Methods:
Medical records of cats presented at our institution with intussusception between 2001 and 2016 were reviewed. The following data were retrieved: signalment; history; physical examination; diagnostic imaging, surgical and histological findings; and outcomes. Animals were grouped as with or without enteroplication. Duration of surgery, survival, complication and recurrence rates, duration of hospitalisation, and short- and long-term outcomes were compared.
Results:
Cats with intussusception presented with unspecific type and duration of clinical signs. Male or male castrated cats and Maine Coons were over-represented in both groups. Enteroplication was performed in 48% (10/21) of the cats. Cats in the enteroplication group were significantly younger than those in the non-enteroplication group ( P = 0.023). Duration of surgery, time of hospitalisation, complication rate and outcomes did not differ between the two groups. Two complications in the short term and one complication in the long term were possibly associated with enteroplication. A recurrence of intussusception was seen in 2/17 cats approximately 12 months after initial surgery, both previously treated with enteroplication.
Conclusions and relevance:
Although the number of cases was limited, our results suggest that enteroplication should be cautiously performed in cats with intussusception as it may be associated with major complications in the short and long term, and its efficacy remains unclear. Based on this study, the need for enteroplication in cats following a correction of intussusception could be questioned.
Objective:
To determine the influence of preoperative septic peritonitis (PSP) and stapled versus hand-sewn anastomoses on the dehiscence of intestinal resection and anastomosis (IRA). We hypothesized that the incidence of IRA dehiscence would be greater (1) when performed with PSP and (2) for hand-sewn anastomoses.
Study design:
Retrospective.
Animal populations:
Client-owned dogs at Michigan State University Veterinary Teaching Hospital.
Methods:
Records of dogs surviving 72 hours after IRAs between 2003 and 2013 were reviewed for age, gender, neuter status, weight, presence of PSP, preoperative albumin, IRA indication and location, anastomotic technique, suture type, postoperative dehiscence and timing, duration of hospitalization, last follow-up, and other complications. Univariate logistic regression and chi-square analysis were used to screen prognostic factors; factors with P < .3 were included in a multivariate analysis.
Results:
Two hundred and ten IRAs in 198 dogs fulfilled the inclusion criteria. Dehiscence was diagnosed in 11.4% cases, 6.6% without PSP, and 21.1% with PSP (P = .01). Indication for IRA did not influence the risk of dehiscence. No association was detected between anastomotic technique and IRA dehiscence in dogs without PSP (stapled 4.2%, hand-sewn 8.1%); however, stapled anastomoses were less likely to dehisce in dogs with PSP (stapled 9.7%, hand-sewn 28.9%). Risk factors for dehiscence included PSP (P = .005) and hand-sewn technique (P = .02).
Conclusion:
Our results confirmed that PSP is a risk factor for dehiscence of IRA and suggest that patients with PSP may be a unique surgical population, in which stapling may be preferred over hand-sewn anastomoses after enterectomies.
The endocrine system regulates the secretion of hormones from several peripheral organs under the direction of the hypothalamus (HPT) in concert with the hypophysis or pituitary gland. In patients with endocrine disorders, management of the endocrine disease is as important as the more usual aspects of anesthetic management (e.g., blood pressure, cardiac function, ventilation). This requires an understanding of the physiology and pathophysiology of endocrine function, which is challenging because of the complex relationships that exist between the HPT, the pituitary gland, and their peripheral target organs. This chapter discusses the physiology and pathophysiology of the pancreas, thyroid, adrenal, and parathyroid glands. This is followed by a discussion of the anesthetic management of the most common disorders of these organs seen in small animals. The conditions discussed include diabetes mellitus, hypercortisolism, insulinoma, pheochromocytoma (PHEO), hypothyroidism (HOT), and hyperthyroidism (HT).
Intussusceptions occur primarily in dogs younger than 1 year of age and are most commonly found at the ileocecocolic junction. Intussusceptions may, however, occur at other locations within the gastrointestinal tract, including the gastroesophageal junction and pylorogastric region. Gastroesophageal and pylorogastric intussusceptions result in more acute, severe clinical signs than do intussusceptions within the small intestine. Radiographic studies, including contrast-enhanced and non-contrast-enhanced radiographs, and ultrasonograms are extremely helpful in making a diagnosis of intussusception. Immediate systemic stabilization of the patient, followed by surgical correction of the intussusception, is critical to a successful outcome. Enteroplication techniques used to prevent recurrence of intussusception are not without potential complications and should be performed in accordance with specific guidelines.
Intussusception is defined as the invagination of one portion of the bowel into an immediately adjacent portion. Etiology, symptoms, diagnosis, and treatment are different in the pediatric and adult populations. In the pediatric population, most cases are idiopathic and result in the common scenario of ileocolic intussusception. Factors involved in causation include anatomic features of the developing gastrointestinal tract and infectious influences. In adults, the intussusceptum is typically the result of a mucosal, intramural, or extrinsic lead point that acts as a focal area of traction pulling the proximal portion of bowel into the peristalsing distal portion. The diagnosis and management in the pediatric population is relatively standardized with nonoperative reduction via air or contrast enemas attempted first. In the adult population, intussusception presents a preoperative diagnostic challenge; although surgical intervention is mandatory, intraoperative management remains controversial.
To review the histological findings in the intestine from dogs and cats with intussusception.
Medical records and histopathology reports of dogs and cats with intussusception were reviewed retrospectively.
Fourty-nine animals (31 dogs and 18 cats) were identified for inclusion. Tissues examined com-prised the intussusception alone in 29 animals (16 dogs and 13 cats), and the intussusception with additional intestinal biopsies in 20 animals (15 dogs and 5 cats). Twenty-eight of 49 (57·1%) animals, comprising 19 of 31 (61·3%) dogs and 9 of 18 cats (50%) had abnormalities detected on histological examination of tissue. Eleven of 29 (46·9%) cases where only the intussusception was submitted achieved a histological diagnosis, compared to 17 of 20 (85%) where additional biopsies were submitted (P=0·003). Cats (median age 36 months, range 2 to 174) were significantly older than dogs (median age 7·5 months, range 1 to 125 months, P=0·010) and were significantly more likely to have underlying neoplasia (5 of 9; 55·6%) compared to dogs who were more likely to have inflammatory causes (17 of 19; 89·5%, P=0·020). There was no association between histological diagnosis and location of the intussusception (P=1·000).
Histological abnormalities were detected in more than half of the animals. Diagnosis of intestinal disease in animals with intussusception may be improved by submission of additional biopsy samples. Cats with intussusception are more likely to be older and have underlying neoplasia than dogs which are more likely to have inflammatory disease.
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.
To identify risk factors for failure to survive and development of septic peritonitis following full-thickness gastrointestinal incision in dogs. Design-Retrospective cohort study.
Dogs that underwent gastrointestinal surgery from 1998 through 2007 at the University of Georgia Veterinary Teaching Hospital. Procedures-Medical records of dogs undergoing a full-thickness gastrointestinal incision were reviewed, and information regarding dog history, clinicopathologic findings, surgery characteristics, and outcome was collected.
Records for 197 dogs (225 surgeries) were evaluated. In 35 (16%) surgeries, the dogs died prior to hospital discharge. After 28 (12%) surgeries, dogs developed septic peritonitis. For 45 (20%) surgeries, dogs had preoperative septic peritonitis; of those, approximately a third resulted in continued septic peritonitis (17/45; 38%) or death (15/45; 33%). Of the 180 surgeries performed in dogs lacking preoperative septic peritonitis, 11 (6%) resulted in development of septic peritonitis and 20 (11 %) resulted in death. When all surgeries were considered, common risk factors for development of septic peritonitis included preoperative septic peritonitis, low preoperative serum albumin and plasma protein concentrations, and intraoperative hypotension. Presence of a foreign body was a protective factor.
Multiple factors were associated with failure to survive and development of septic peritonitis after gastrointestinal surgery in dogs. Aggressive perioperative attempts to increase protein concentrations and intraoperative surgical strategies to decrease the chance of a poor outcome may be indicated in dogs with risk factors identified in this study.
A severity grading system is essential to reporting surgical complications. In 1992, we presented such a system (T92). Its use and that of systems derived from it have increased exponentially. Our purpose was to determine how well T92 and its modifications have functioned as a severity grading system and to develop an improved system for reporting complications.
129 articles were studied in detail. Twenty variables were searched for in each article with particular emphasis on type of study, substitution of qualitative terms for grades, grade compression, and cut-points if grade compression was used. We also determined relative distribution of complications and manner of presentation of complications.
T92 and derivative classifications have received wide use in surgical studies ranging from small studies with few complications to large studies of complex operations that describe many complications. There is a strong tendency to contract classifications and to substitute terms with self evident meaning for the numerical grades. Complications are presented in a large variety of tabular forms some of which are much easier to follow than others.
Current methods for reporting the severity of complications incompletely fulfill the needs of authors of surgical studies. A new system-the Accordion Severity Grading System-is presented. The Accordion system can be used more readily for small as well as large studies. It introduces standard definition of simple quantitative terms and presents a standard tabular reporting system. This system should bring the field closer to a common severity grading method for surgical complications.
To determine signalment, history, and outcome of cats with gastrointestinal tract intussusception and to identify physical examination, diagnostic imaging, surgical, histologic, and necropsy findings in affected cats.
Retrospective case series.
20 cats with intussusception.
Medical records were evaluated for information on signalment; history; physical examination, diagnostic imaging, surgical, histologic, and necropsy findings; and outcome.
Ten cats were < 1 year old, and 9 were >or= 6 years old. Anorexia (14/17), lethargy (12/17), and vomiting (12/17) were the most common reasons for examination. Dehydration (13/18), poor body condition (12/18), signs of abdominal pain (8/18), and an abdominal mass (8/18) were the most common physical examination findings. Abdominal radiography revealed intestinal obstruction in all 10 cats in which it was performed; abdominal ultrasonography revealed intussusception in all 7 cats in which it was performed. The most common intussusception was jejuno-jejunal (8/20), and no intussusceptions were found proximal to the duodenum. Eleven of 13 cats that underwent laparotomy required intestinal resection and anastomosis. Histologic examination revealed intestinal lymphoma or inflammatory bowel disease in 7 of 8 cats >/= 6 years old and idiopathic intussusception in 7 of 8 cats < 1 year old.
Results suggested that in cats, intussusception has a bimodal age distribution, is most commonly jejuno-jejunal, often requires surgical resection and anastomosis, is often associated with alimentary lymphoma or inflammatory bowel disease in older cats, and is readily diagnosed by means of ultrasonography.
Medical records of 31 dogs that had undergone surgery for correction of intussusception during a 14-year period were reviewed. Enteroplication was performed on 9 dogs during the initial surgery, and intussusception did not recur in any of these dogs. Intussusceptions recurred in 6 of 22 dogs without enteroplication. Five of these dogs had undergone resection of the primary lesion and anastomosis and 1 dog had undergone manual reduction of the intussusception. Intussusceptions recurred proximal to the initial lesion in 4 dogs, and at the same site in 2 dogs. Enteroplication was performed in 4 dogs following surgical correction of recurrence of an intussusception, and further recurrences were not seen in any of these dogs. Enteroplication did not cause any apparent adverse effects and decreased the probability of recurrence of intussusception in these dogs.
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.
Retrospective study.
35 dogs with intestinal intussusception.
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.
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.
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.
To identify factors associated with leakage following intestinal anastomosis in dogs and cats.
Retrospective study.
90 dogs and 25 cats.
Medical records of all dogs and cats that underwent intestinal resection and anastomosis between 1991 and 2000 were reviewed, and information on 27 factors was recorded.
Anastomotic leakage was identified in 13 of the 90 dogs but in none of the 25 cats. Preoperative factors significantly associated with development of anastomotic leakage in dogs included preoperative peritonitis, serum albumin concentration, a left shift, and indication for surgery (dogs with intestinal foreign bodies were more likely to have leakage than dogs that underwent surgery for any other cause). Postoperative and case management factors significantly associated with development of leakage included duration of hospitalization, supplemental alimentation, whether the dog ate the day after surgery, blood product administration, and outcome (died vs survived). Discriminant analysis was performed, and dogs with 2 or more of the following factors were predicted to develop anastomotic leakage: preoperative peritonitis, intestinal foreign body, and serum albumin concentration < or = 2.5 g/dL. The model accurately predicted whether leakage would develop in 67 of 80 (84%) dogs.
Results suggest that a variety of factors may be associated with development of intestinal anastomotic leakage in dogs. In particular, dogs with 2 or more of the following risk factors are predicted to be at high risk for developing anastomotic leakage: preoperative peritonitis, intestinal foreign body, and serum albumin concentration < or = 2.5 g/dL.
Veterinary Anesthesia and Analgesia: The Fifth Edition of Lumb and Jones
- JG Adams
- JP Figueiredo
- TK Graves