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Ileocolic intussusception and its surgical management in a Labrador pup.

Introduction

Intussusception is a condition in which a part of the bowel (intussusceptum) invaginates into the lumen of an immediately adjoining part (intussuscipiens) in the direction of normal peristalsis or occasionally in a retrograde direction (Rallis et al., 2000). It occurs more often as an ileocolic intussusception in young dogs (Pietra et al., 2003; Patsikas et al., 2008). Most intussusceptions in young animals are idiopathic, however a number of conditions including ingestion of bones, linear foreign bodies, prior abdominal surgery and intestinal parasitism have been suggested as predisposing factors (Kiyan et al., 2002). Acute enteritis or gastroenteritis has been demonstrated as the most likely predisposing factor for intestinal intussusception in young dogs (Rallis et al., 2000). Present study reports an ileocolic intussusception and its surgical management in a Labrador pup.

History and Diagnosis

A five month old female labrador weighing 12 kg was reported with the history of anorexia, depression, abdominal discomfort, intermittent vomiting, tenesmus and bloody mucoid diarrhea after pup had eaten a rat, twenty five days back. Physical examination revealed that the animal had moderate rise of temperature (103[degrees]F), anaemic, depressed, dehydrated, emaciated with distended abdomen. Digital radiographic examination revealed accumulation of gas proximal to the intussusception (Fig.1). On exploratory celiotomy, ileocolic intussusception was found (Fig. 3). The intussuscepted segments were edematous and congested (Fig. 3). The serosal surfaces of the intussuscepted parts were adherent to one another. The blood vessels in rest of the intestines were engorged (Fig. 2).

Surgical Management

Ringer's lactate and dextrose normal saline was given to correct dehydration and metabolic acidosis. Premedication with cefotaxime (50 mg/ kg), dexamethasone (2 mg/kg) and pentazocine (2mg/kg) was given intravenously. Anaesthesia was induced and maintained with diazepam (0.25 mg/kg intravenously) and ketamine (10 mg/kg intravenously). The animal was positioned in dorsal recumbancy and ventral abdomen was prepared for aseptic surgery. Ventral midline celiotomy was performed. On exploration, ileocolic intussusception was found (Fig. 3). Intussusception was reduced by manipulation and gentle traction of intussusceptum and pressure on intussuscipiens. Atraumatic clamps were applied on the proximal and distal ends of the affected parts, before resection (Fig. 4). The affected parts were resected and end-to-end anastomosis of intestinal segments was performed by applying cushing suturing pattern using a 1-0 polyglactin 910 (Fig. 5 and Fig. 6). The intestine was repositioned into the abdomen. Ventral celiotomy wound was closed in routine manner. Intravenous line of metronidazole solution was maintained during the whole operation.

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Post-operative Care and Outcome

Fluid therapy was continued and the animal was kept nil per os for three days. Owner was advised to provide semisolid diet for next one week. Metoclopramide (0.5 mg/kg intramuscularly) for three days, cefotaxime (20 mg/kg intramuscularly) for seven days and meloxicam (Melonex (a)) (0.5 mg/kg intramuscularly) for five days. Animal had an uneventful recovery.

Discussion

Intussusceptions more commonly found in small animals, especially in German shepherd dogs and Siamese cats (Dixon, 2004). It forms as a result of abnormality within the intestinal wall that alters the intestinal pliability and motility (Sivasankar, 2000; Hedlund and Fossum, 2007). Puppies and kittens are most likely ones to develop intussusceptions (Han et al., 2008). Although it can occurs in any age or species but more than 80% of intussusceptions occurs at first year old puppies (Oakes et al., 1994; Dixon, 2004; Hedlund and Fossum, 2007). Most frequently obseved clinical signs in case of low intussusceptions were bloody mucoid diarrhea, tenesmus, intermittent vomiting and weight loss (Dixon, 2004). Ultrasonography and radiographic evaluation of affected site are very helpful in establishing a definitive diagnosis (Oakes et al., 1994). Accumulation of gas proximal to the intussusception may be observed on plain radiography.

References

Dixon, B.C. (2004). In L.P. Tilley and F.W.K. Smith, Jr. The 5-Minute Veterinary Consult Canine and Feline, 3rd Edn., Lippincott Williams and Wilkins. pp: 721-22.

Han, T.S., Kim, J.H., Cho, K., Park, J., Kim, G. and Choi, S.H. (2008). Double intussusceptions in a ShihTzu puppy. J. Biomed. Res. 9: 55-58.

Hedlund, C.S and Fossum, T.W. (2007). Surgery of the digestive system. In: Small Animal Surgery, Fossum, T. W., (Eds.). 3rd Edn., Mosby Elsevier, Missouri.

Kiyan, G., Tugtepe, H., Iskit, S.H. and Dagli, T.E. (2002). Double intussusceptions in an infant. J. Pediatr. Surg. 37: 1643-44.

Oakes, M.G., Lewis, D.D., Hosgood, G. and Beale, B.S. (1994). Enteroplication for the prevention of intussusception recurrence in dogs: 31 cases (19781992). J. Am. Vet. Med. Assoc. 205: 72-75.

Patsikas, M.N., Papazoglou, L.G. and Adamama-Moraitou, K.K. (2008). Spontaneous reduction of

intestinal intussusception in five young dogs. J. Am. Anim. Hosp. Assoc. 44: 41-47.

Pietra, M., Gentilini, F., Pinna, S., Fracassi, F., Venturini, A. and Cipone, M. (2003). Intermittent gastroesophageal intussusception in a dog: clinical features, radiographic and endoscopic findings, and surgical management. Vet. Res. Commun. 27: 783-86.

Vineet Kumar, Raja Aijaz Ahmad, Rekha Pathak

Division of Surgery

Indian Veterinary Research Institute

Izatnagar

Bareilly--243122 (Uttar Pradesh)

(a)-Brand of Intas Animal Health, Ahmedabad
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Title Annotation:Short Communication
Author:Kumar, Vineet; Ahmad, Raja Aijaz; Pathak, Rekha
Publication:Intas Polivet
Article Type:Report
Geographic Code:9INDI
Date:Jan 1, 2012
Words:857
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