Íleo paralítico em três bovinos: relato de caso / Paralytic ileus in three cattle: case report

O íleo paralítico é uma obstrução do tipo funcional, na qual o lúmen intestinal está patente, comprometendo a passagem da ingesta no intestino. Este relato objetiva descrever três casos em vacas com aptidão leiteira, atendidos na rotina hospitalar e diagnosticados com íleo paralítico. Em seus históricos, os proprietários queixavam-se que os animais apresentavam redução do apetite, timpania ruminal, diminuição da produção de leite e eliminação das fezes. Ao exame físico, alguns sinais clínicos apresentaram destaque, como apatia, desidratação, redução da motilidade ruminal e intestinal, fezes em pequena quantidade e com muco, distensão do abdômen e ao balotamento constatou-se a presença de líquido. Na análise do fluido ruminal todos os animais apresentaram o teor de cloreto elevado (>30 mEq/L), caracterizando, dessa forma, um processo obstrutivo. Diante dos achados, suspeitou-se inicialmente de um quadro de obstrução intestinal. Nos casos, a conduta adotada foi realizar uma laparotomia exploratória através do flanco direito, porém constatou-se, que não existia qualquer segmento com obstrução de natureza mecânica, que justificasse as alterações físicas e laboratoriais encontradas. Diante destes resultados, configurou-se um quadro clínico indicativo de íleo paralítico. As vacasforam submetidas a um protocolo terapêutico pós-cirúrgico composto por antibioticoterapia, anti-inflamatório, cálcio, procinético e tratamento de suporte. Os animais manifestaram uma resposta favorável a conduta terapêutica, com restabelecimento da função gastrointestinal e dos demais parâmetros fisiológicos, recebendo alta após uma evolução clínica variando entre dez a doze dias.

Paralytic ileus is an obstruction of the functional type, in which the intestinal lumen is patent, compromising the passage of the intake in the intestine. The objective of this study was to describe three cases in dairy cows treated in the hospital routine diagnosed with paralytic ileus. In their histories, the owners complained that the animals presented reduced appetite, ruminal tympany, decreased milk yield and elimination of faeces. At the physical examination, some clinical signs were prominent in both, such as apathy, dehydration, reduction of ruminal and intestinal motility, faeces were present in small quantity and with mucus present, abdominal enlargement and the succession produced sloshing sounds. In the analysis of the ruminal fluid, the chloride content in both was high (>30 mEq/L), characterizing an obstructive process. In the face of the findings, a diagnosis of intestinal obstruction was initially suspected. In animals, the adopted approach was to perform an exploratory laparotomy through the right flank, but it was verified that there was no segment with mechanical obstruction that justified the physical and laboratorial alterations found. In view of these results, a clinical diagnosis indicative of paralytic ileus was established. The three animals were submitted to a post-surgical therapeutic protocol consisting of antibiotic therapy, anti-inflammatory, calcium, pro-kinetic and supportive treatment. The animals showed a favourable response to therapeutic treatment, with restoration of gastrointestinal function and other physiological parameters, and was discharged after a clinical evolution ranging from ten to twelve days.

Meta-analysis of the effects of lidocaine on postoperative reflux in the horse.

OBJECTIVE: To determine the efficacy of lidocaine at reducing incidence of postoperative reflux (POR) in horses by using quantitative statistical analysis. STUDY DESIGN: Systematic meta-analytical review. SAMPLE POPULATION: Studies on horses undergoing gastrointestinal surgery for small intestinal lesions, identified by systematic search between 2001 and 2017. METHODS: A search with PubMed/MEDLINE, Web of Science, and Google Scholar was performed, followed by secondary searches of veterinary trade journals and bibliographies of relevant articles. The primary outcome measure for this study was the effect of lidocaine therapy on the odds of POR. Subgroup analysis assessed included the timing of lidocaine therapy, incidence of mortality, and incidence of repeat celiotomy. A meta-analysis was performed with a random effects model, with the effect size calculated as an odds ratio (OR) with 95% confidence intervals (CI). Statistical significance was set at P < .05. RESULTS: Among 1933 peer reviewed publications that met the initial search criteria, 12 relevant studies were available for analysis. Lidocaine was associated with an increased incidence of diagnosis of POR (OR 6.3, 95% CI [1.4, 27.0], P = .01). Horses treated with lidocaine were more likely to survive to discharge (OR 6.8, 95% CI [3.9, 11.7], P < .01). CONCLUSION: Lidocaine was associated with an increased survival rate in horses undergoing exploratory celiotomy for small intestinal disease according to this meta-analysis of the recent literature. CLINICAL SIGNIFICANCE: This body of published evidence provides support to administer lidocaine in horses to improve survival rather than preventing POR.

Loss of alpha-smooth muscle actin expression associated with chronic intestinal pseudo-obstruction in a young Miniature Bull Terrier.

BACKGROUND: Chronic intestinal pseudo-obstruction (CIPO) is a rare clinical syndrome in veterinary medicine characterized by severe intestinal dysmotility without evidence of mechanical occlusion of the intestinal lumen. The exact pathogenesis of CIPO is unknown. CASE PRESENTATION: A 1-year-old male Miniature Bull Terrier dog was presented with a history of chronic weight loss, regurgitation, lethargy, vomiting and diarrhea. The dog was submitted for exploratory laparotomy. A full thickness intestinal biopsy was taken and a CIPO was suspected. The clinical condition deteriorated and the dog was euthanized. At gross examination the small intestine was severely dilated. Histologically severe fibrosis of the submucosa and severe atrophy of the tunica muscularis were present in small intestine and colon. Immunohistochemical examination with a panel of antibodies for gastro-intestinal neuromuscular disease-associated antigens revealed a severely reduced expression of alpha-smooth muscle actin in the tunica muscularis. CONCLUSIONS: This case report describes the gross, histological and immunohistochemical findings of CIPO affecting a 1-year-old Miniature Bull Terrier; on the basis of these findings a myopathic form of CIPO is hypothesized in this case.

An update on equine post-operative ileus: Definitions, pathophysiology and management.

Post-operative ileus (POI) is a serious condition which any horse undergoing abdominal surgery is at risk of developing, leading to increased hospitalisation time and resulting costs. Advances in the understanding of the development of equine POI are mainly based on human and rodent literature, where manipulation-induced inflammation has been identified as a trigger, with activation of resident muscularis externa macrophages playing a crucial role in the pathophysiology. Despite many pharmacological trials in all species, there is no single completely successful treatment for POI, highlighting that the condition is multifactorial in cause and requires a multimodal approach to minimise its incidence.

Clinical features and management of equine post operative ileus (POI): Survey of Diplomates of the American Colleges of Veterinary Internal Medicine (ACVIM), Veterinary Surgeons (ACVS) and Veterinary Emergency and Critical Care (ACVECC).

REASONS FOR PERFORMING STUDY: A recent survey of European Colleges (European College of Equine Internal Medicine [ECEIM] and European College of Veterinary Surgeons [ECVS]) revealed the different strategies implemented by, and some of the challenges facing, European clinicians presented with cases of post operative ileus (POI). It was concluded that further comparative analysis of opinions, canvassed from additional colleges of equine veterinary specialism worldwide, would provide valuable additional insight into current POI knowledge on a more global scale. OBJECTIVES: To report and compare the current strategies favoured by American veterinary specialists when managing POI in horses that underwent emergency colic surgery. STUDY DESIGN: Cross-sectional survey. METHODS: Electronic invitations were sent to 814 Large Animal specialists, including 3 colleges: the American College of Veterinary Internal Medicine (ACVIM), American College of Veterinary Surgeons (ACVS) and the American College of Veterinary Emergency and Critical Care (ACVECC). RESULTS: The response rate was 14% (115/814). The majority of respondents (68%) reported an estimated prevalence range of POI of 0-20%. The presence of reflux on nasogastric intubation was the main criterion used to define POI. A lesion involving the small intestine was considered the main risk factor for POI. Anti-inflammatory drugs, intravenous (i.v.) fluids and antimicrobial drugs were the primary strategies used when managing POI. Flunixin meglumine and i.v. lidocaine were the drugs most commonly used in the treatment of horses with POI. Supplementary management strategies targeted mainly the prevention of post operative adhesions, infection and inflammation. CONCLUSIONS: There is a lack of consensus on the clinical definition of POI. Prospective and objective clinical assessment of the effectiveness of the different strategies contained within this and the European survey is necessary in order to identify a standardised approach to the management of equine POI.

Intestinal Leiomyositis: A Cause of Chronic Intestinal Pseudo-Obstruction in 6 Dogs.

BACKGROUND: Intestinal leiomyositis is a suspected autoimmune disorder affecting the muscularis propria layer of the gastrointestinal tract and is a cause of chronic intestinal pseudo-obstruction in humans and animals. OBJECTIVE: To characterize the clinical presentation, histopathologic features, and outcome of dogs with intestinal leiomyositis in an effort to optimize treatment and prognosis. ANIMALS: Six client-owned dogs. METHODS: Retrospective case series. Medical records were reviewed to describe signalment, clinicopathologic and imaging findings, histopathologic diagnoses, treatment, and outcome. All biopsy specimens were reviewed by a board-certified pathologist. RESULTS: Median age of dogs was 5.4 years (range, 15 months-9 years). Consistent clinical signs included vomiting (6/6), regurgitation (2/6), and small bowel diarrhea (3/6). Median duration of clinical signs before presentation was 13 days (range, 5-150 days). Diagnostic imaging showed marked gastric distension with dilated small intestines in 4/6 dogs. Full-thickness intestinal biopsies were obtained in all dogs by laparotomy. Histopathology of the stomach and intestines disclosed mononuclear inflammation, myofiber degeneration and necrosis, and fibrosis centered within the region of myofiber loss in the intestinal muscularis propria. All dogs received various combinations of immunomodulatory and prokinetic treatment, antimicrobial agents, antiemetics, and IV fluids, but none of the dogs showed a clinically relevant improvement with treatment. Median survival was 19 days after diagnosis (range, 3-270 days). CONCLUSIONS AND CLINICAL IMPORTANCE: Intestinal leiomyositis is a cause of intestinal pseudo-obstruction and must be diagnosed by full-thickness intestinal biopsy. This disease should be considered in dogs with acute and chronic vomiting, regurgitation, and small bowel diarrhea.

Visceral smooth muscle α-actin deficiency associated with chronic intestinal pseudo-obstruction in a Bengal cat (Felis catus x Prionailurus bengalensis).

An adult Bengal cat (Felis catus × Prionailurus bengalensis) with a prolonged history of partial anorexia, regurgitation, and weight loss and a clinical, radiographic, and ultrasonographic diagnosis of persistent megaesophagus and gastrointestinal ileus was submitted for necropsy. The intestinal tract was diffusely distended by gas and fluid with appreciable loss of muscle tone and an absence of luminal obstruction, consistent with the clinical history of chronic intestinal pseudo-obstruction. Histologically, the autonomic nervous system was intact, but the smooth muscle within the gastrointestinal wall exhibited a marked basophilia that was most pronounced in the jejunum. Immunohistochemistry for neurofilament, synaptophysin, CD117, and desmin demonstrated that the number of myenteric ganglia, number of interstitial cells, and leiomyocyte desmin content were similar when compared with the unaffected age- and species-matched control. Immunohistochemistry for smooth muscle α-actin demonstrated a striking loss of immunoreactivity, predominantly in the circular layer of the jejunum, that corresponded with the tinctorial change in leiomyocytes. Transmission electron microscopy revealed loss of myofibrils, loss of organelle polarity, and significantly larger central mitochondria (megamitochondria) in affected leiomyocytes, as well as nonspecific degenerative changes. Although the presence of a primary leiomyopathy and a causal relationship could not be confirmed in this case, leiomyopathies are considered a cause of chronic intestinal pseudo-obstruction in human medicine, and loss of smooth muscle α-actin immunoreactivity is one recognized marker for intestinal dysmotility.

Extensive myenteric ganglionitis in a case of equine chronic intestinal pseudo-obstruction associated with EHV-1 infection.

A 7-year-old male trotter horse with a history of recurrent colic displayed clinical findings consistent with chronic intestinal pseudo-obstruction (CIP). At laparotomy, an impaction of the descending colon associated with marked atrophy of the right dorsal colon was found. The horse was humanely destroyed and tissues collected at necropsy examination revealed diffuse enteric ganglionitis comprising an infiltrate of CD3(+) T lymphocytes and plasma cells. At all levels of the intestinal tract the number of myenteric ganglia and of normal ganglion cells was decreased significantly. There were chromatolytic or necrotic neurons and the amount of connective tissue surrounding ganglia was increased. Immunohistochemical studies demonstrated slightly reduced expression of neuron-specific enolase and a moderate increase in expression of S100 and glial fibrillary acidic protein in a sample of right dorsal colon taken during the necropsy examination compared with a biopsy sample taken from the same location. Immunolabelling and semi-nested polymerase chain reaction for equine herpesvirus (EHV)-1 performed on the gut were positive, supporting an aetiological relationship between EHV-1 infection and the enteric ganglionitis.

[Gastro-intestinal lymphocytic and sclerosing leiomyositis (pseudoobstruction) in a dog]. / Gastro-intestinale lymfocytaire en scleroserende leiomyositis (pseudo-obstructie) bij een hond.

The clinical, ultrasonographic and radiologic aspects and the pathology of gastro-intestinal lymphocytic and sclerosing leiomyositis (pseudoobstruction) are described in a 14 month old, male American Staffordshire terrier.

Risk factors for equine postoperative ileus and effectiveness of prophylactic lidocaine.

BACKGROUND: Postoperative ileus (POI) is a frequent and often fatal complication of colic surgery. Reliably effective treatments are not available. OBJECTIVES: To determine risk factors and protective factors associated with POI, and to assess the effect of lidocaine IV on short-term survival. ANIMALS: One hundred and twenty-six horses that underwent small intestinal colic surgery and that survived for at least 24 hours postoperatively. METHODS: Retrospective cross-sectional study. The association of 31 pre-, intra-, and postoperative variables with POI and the association of lidocaine treatment with short-term survival were investigated. Associations were evaluated with univariable logistic regression models, followed by multivariable analysis. RESULTS: Significant associations of high heart rate (odds ratio [OR] = 1.05, 95% confidence interval [CI] 1.03-1.08), the presence of more than 8 L of reflux at admission (OR = 3.02, 95% CI 1.13-8.02) and the performance of a small intestinal resection (OR = 2.46, 95% CI 1.15-5.27) with an increased probability of POI were demonstrated. Prophylactic lidocaine treatment was significantly associated with a reduced incidence of POI (OR = 0.25, 95% CI 0.11-0.56). Lidocaine treatment was also significantly associated with enhanced short-term survival (OR = 0.30, 95% CI 0.09-0.98). CONCLUSIONS AND CLINICAL IMPORTANCE: The variables associated with an increased risk of POI can be useful in identifying horses at risk of POI and in providing a more accurate prognosis. The results are supportive for lidocaine IV as an effective prokinetic treatment after small intestinal colic surgery.

Fibrosing gastrointestinal leiomyositis as a cause of chronic intestinal pseudo-obstruction in an 8-month-old dog.

An 8-month-old, female, mixed-breed dog presented to the Iowa State University Veterinary Teaching Hospital with a 1-month history of vomiting and diarrhea. An exploratory laparotomy was performed revealing markedly distended and fluid-filled small and large intestines that were not obstructed. The clinical condition of the dog did not improve subsequent to exploratory surgery, and it was euthanized. At necropsy, both the small and large intestines were distended (approximately 4 cm in diameter) and fluid-filled, and the wall was thin. The abdominal cavity contained approximately 500 ml of a brownish clear fluid. Microscopic lesions of the intestines were confined to the intestinal tunica muscularis and muscularis mucosae and consisted of locally extensive-to-diffuse replacement of the smooth muscle by fibrous tissue and multifocal infiltration by a moderately dense mononuclear inflammatory infiltrate. A unique finding was the presence of similar microscopic lesions in the tunica muscularis of the urinary bladder and stomach.

Caecal impaction and chronic intestinal pseudo-obstruction in a dog.

A 10-year-old female neutered cross-breed dog presented with a 4-month history of chronic intermittent diarrhoea and vomiting. Abdominal ultrasound showed dilated loops of small intestine and a suspected faecolith. Exploratory surgery revealed a caecal impaction and a typhlectomy was performed. Histopathological examination of caecal and full thickness small intestine sections demonstrated atrophy of smooth muscle fibres as well as an influx of plasma cells, lymphocytes and macrophages, and mild lymphoplasmacytic and eosinophilic enteritis. This combination of caecal impaction and chronic intestinal pseudo-obstruction has not been reported previously in the dog.

Equine myenteric ganglionitis: a case of chronic intestinal pseudo-obstruction.

A 4-year-old Standardbred mare was referred to the New York State College of Veterinary Medicine for colic evaluation. Physical examination revealed a small colon impaction which initially responded to conservative medical management. Her signs soon recurred, however, and an exploratory celiotomy was recommended. At surgery the small colon impaction was confirmed. The impaction was evacuated and a surgical biopsy was submitted for histopathologic evaluation. Microscopic examination of H&E and Trichrome sections revealed a massive mononuclear cell infiltration of the myenteric plexus. In addition, there was remarkable fibrosis within the neuropil of the myenteric ganglia and interganglionic fascicles. Postoperatively, the mares's colic signs recurred within two weeks and she was euthanatized. Samples of the proximal and distal small colon as well as the original biopsy site were obtained. Over the intervening two weeks, the inflammatory infiltrate within the myenteric ganglia had subsided, while the previous intraganglionic and fascicular fibrosis had increased substantially. The number of myenteric neurons appeared diminished when compared to age-matched controls. There was evidence of neuronal degeneration among the surviving neurons including central chromatolysis and cytoplasmic vacuolization. Furthermore, many degenerate axons were observed with the electron microscope. This scenario represents an equine example of chronic idiopathic intestinal pseudo-obstruction (CIIP) which has been extensively described in the human literature. In this case, the syndrome arose as a consequence of recurrent inflammatory injury to the mare's enteric nervous system, thereby altering normal gastrointestinal motility. The ensuing neurogenic functional obstruction manifested as frequent bouts of small colon impactions. Equine CIIP should be considered in the differential diagnosis of colic.

Postpartum atony of the small and large intestine in a Holstein cow: a case of pseudo-obstruction.

A four-year-old Holstein, 23 days postpartum, was presented with abdominal distention. Gas filled viscera were detected in the right paralumbar fossa and pelvic canal. Surgery revealed cecal and colonic distention and generalized intestinal atony. There was no other evidence of gross pathology. The condition deteriorated during five post-operative days. Gross postmortem findings were not remarkable; histopathology revealed ganglionitis of the cranial mesenteric ganglion and myenteric plexus. A brief review of relevant literature for a differential diagnosis and an etiology is discussed.