Extrahepatic biliary duct obstruction secondary to duodenal foreign bodies in 2 dogs.

Two dogs, a 5-year-old neutered male boxer dog and a 2-year-old neutered male Australian cattle dog, were evaluated for vomiting and inappetence. Both dogs were icteric on physical examination, and had hyperbilirubinemia, elevated liver enzymes, and inflammatory changes on diagnostic blood analysis. A proximal duodenal obstruction causing extrahepatic biliary duct obstruction (EHBDO) was suspected in both cases after diagnostic imaging was performed. Exploratory laparotomy confirmed duodenal foreign bodies in both cases. This case report defines duodenal foreign body as a differential diagnosis for EHBDO in dogs.

Obstruction extra-hépatique de canaux biliaires secondaire à des corps étrangers duodénaux chez deux chiens. Deux chiens, un Boxer mâle castré âgé de 5 ans et un berger australien mâle castré âgé de 2 ans, furent évalués pour des vomissements et de l'inappétence. Les deux chiens étaient ictériques lors de l'examen physique, et l'analyse sanguine a montré la présence d'hyperbilirubinémie, de niveaux d'enzymes hépatiques élevés et de changements inflammatoires. Une obstruction duodénale proximale causant une obstruction extra-hépatique des canaux biliaires (EHBDO) était suspectée dans les deux cas à la suite des examens d'imagerie effectués. Une laparotomie exploratrice a confirmé la présence de corps étrangers duodénaux dans les deux cas. Ce rapport de cas identifie les corps étrangers duodénaux comme diagnostic différentiel lors d'EHBDO chez les chiens.(Traduit par Dr Serge Messier).

Duodenoduodenostomy for obstruction of the sigmoid flexure of the duodenum in cattle.

OBJECTIVE: To describe clinical findings, surgical treatment, and outcome associated with duodenoduodenostomy for treatment of duodenal obstruction secondary to adhesions associated with the sigmoid flexure of the duodenum. STUDY DESIGN: Retrospective study (1996-2016). ANIMALS: Fourteen Holstein cattle. METHODS: Medical records of cows treated at 3 academic surgical referral centers with duodenoduodenostomy for duodenal obstruction secondary to adhesions associated with the sigmoid flexure of the duodenum were reviewed. Data that were collected included signalment, physical examination results, laboratory results, diagnostic findings, treatments, and survival to discharge. Owners were contacted for follow-up information. RESULTS: Affected cattle ranged in age from 4 months to 5 years. Electrolyte abnormalities, including severe hypochloremia, were present in all cases. Abnormalities included cranial duodenal distension without concurrent distension of the descending duodenum and palpable focal adhesions in the region of the sigmoid flexure of the duodenum. Duodenoduodenostomy involved a stapled (n = 11) or sutured (n = 3) side-to-side anastomosis between the cranial duodenum and descending duodenum. Thirteen of 14 cattle that were treated with duodenoduodenostomy survived to hospital discharge. Long-term follow-up was available in 8 cows, and 7 of those 8 survived for at least 1 year. CONCLUSION: Short- and long-term survival were favorable after duodenoduodenostomy in cattle with adhesions associated with the sigmoid flexure of the duodenum. CLINICAL SIGNIFICANCE: Duodenoduodenostomy results in acceptable survival and future productivity in cows with obstruction at the sigmoid flexure of the duodenum.

Catastrophic gastric rupture in a horse secondary to psyllium pharmacobezoars.

A mare was euthanized because of gastric rupture secondary to complete duodenal obstruction by 2 bezoars located in the pylorus and proximal duodenum. Infrared spectroscopy showed that the bezoars were composed of psyllium. The mare had been receiving treatment with a pelleted psyllium product at 4 times the recommended dosage. Veterinarians should be aware that treatment of colic in horses with pelleted psyllium products could be associated with gastric impaction.

Rupture gastrique catastrophique secondaire à des pharmacobézoards de psyllium en boulettes chez un cheval. Une jument a été euthanasiée en raison d'une rupture gastrique secondaire à une obstruction duodénale complète par deux bézoards situés dans le pylore et le duodénum proximal. La spectroscopie infrarouge a montré que les bézoards se composaient de psyllium. La jument avait reçu un traitement composé d'un produit de psyllium en boulettes à quatre fois la dose recommandée. Les vétérinaires devraient être au courant que le traitement des coliques chez les chevaux avec des produits de psyllium en boulettes pourrait être associé à une impaction gastrique.(Traduit par Isabelle Vallières).

Gastrojejunostomy without partial gastrectomy to manage duodenal stenosis in a dog.

A nine-year-old female Rottweiler with a history of repeated gastrointestinal ulcerations and three previous surgical interventions related to gastrointestinal ulceration presented with symptoms of anorexia and intermittent vomiting. Benign gastric outflow obstruction was diagnosed in the proximal duodenal area. The initial surgical plan was to perform a pylorectomy with gastroduodenostomy (Billroth I procedure), but owing to substantial scar tissue and adhesions in the area a palliative gastrojejunostomy was performed. This procedure provided a bypass for the gastric contents into the proximal jejunum via the new stoma, yet still allowed bile and pancreatic secretions to flow normally via the patent duodenum. The gastrojejunostomy technique was successful in the surgical management of this case, which involved proximal duodenal stricture in the absence of neoplasia. Regular telephonic followup over the next 12 months confirmed that the patient was doing well.

Duodenal obstruction caused by duodenal sigmoid flexure volvulus in dairy cattle: 29 cases (2006-2010).

OBJECTIVE: To characterize duodenal sigmoid flexure volvulus (DSFV) and determine the prognosis for affected cattle undergoing surgery. DESIGN: Retrospective case series. ANIMALS: 29 dairy cattle. PROCEDURES: The medical records were analyzed for history, signalment, clinical signs, medical management, surgical findings, and outcome. RESULTS: 29 cattle were determined to have DSFV between December 2006 and August 2010. Twenty cattle had had an omentopexy or pyloropexy performed 1 day to 2 years before initial evaluation. Cattle were afebrile, tachycardic, and moderately dehydrated, with a small zone of percussion with a ping at the 10th to 12th right intercostal spaces and associated succussion. Biochemical changes were a severe hypokalemic (mean ± SD, 2.9 ± 0.5 mmol/L; median, 3.1 mmol/L; range, 2.08 to 3.92 mmol/L), hypochloremic (mean, 69.7 ± 11.1 mmol/L; median, 71.7 mmol/L; range, 49.1 to 94.1 mmol/L) metabolic alkalosis (mean total CO(2), 44.5 ± 7.4 mmol/L; median, 45.3 mmol/L; range, 31.5 to 59.6 mmol/L) and hyperbilirubinemia (mean, 32.4 ± 29.0 µmol/L; median, 20.5 µmol/L; range, 7.8 to 107 µmol/L). Surgical findings for DSFV included an empty descending duodenum adjacent to a dorsally displaced and dilated cranial segment of the duodenum, distended abomasum and gallbladder, and a tight volvulus at the base of the duodenal sigmoid flexure. Manual reduction was considered successful if the descending duodenum filled after cranial duodenal massage. Twenty-two patients were successfully treated; the remaining 7 died or were euthanized within 4 days after surgery. CONCLUSIONS AND CLINICAL RELEVANCE: A condition clinically resembling abomasal volvulus but affecting the duodenal sigmoid flexure has been recognized in dairy cattle. When a focal, dorsal right-sided ping and succussion are present combined with severe hypokalemic, hypochloremic metabolic alkalosis and high bilirubin concentration, DSFV should be suspected, especially when there is a history of prior abomasal fixation. After surgical correction, the prognosis is fair to good.

Duodenal Brunner's gland adenoma causing chronic small intestinal obstruction in a dog.

An eight-year-old, neutered, female English springer spaniel was presented with a 14-month history of vomiting, marked weight loss and lethargy, all of which were non-responsive to medical therapy. Abdominal radiographs and ultrasonography showed an intraluminal soft tissue mass extending from the pyloric antrum to the proximal duodenum. Two spherical masses both approximately 8 cm in diameter were removed via a duodenotomy. Histopathological examination showed the first mass to be a trichobezoar and the aboral mass to be a Brunner's gland adenoma. Surgery resulted in a complete resolution of the clinical signs.

Ultrasonographic findings in 2 cows with duodenal obstruction.

Two cases where clinical findings suggestive of proximal ileus resulting in hypokalemic and hypochloremic alkalosis are presented. Ultrasonographs showed distension of the sigmoid flexure along the ventral border of the liver and between the serosal lamellae of the greater omentum in the flank, allowing exact preoperative obstruction localization.

Duodenal obstruction caused by malposition of the gallbladder in a heifer.

A heifer with clinical findings suggesting obstruction of the proximal portion of the intestine was admitted for diagnostic evaluation. Ultrasonographic examination of the abdomen failed to locate the gallbladder in its normal anatomic position. Exploratory laparotomy and manual examination of the proximal portion of the intestine revealed obstruction of the duodenum caused by abnormal positioning of the gallbladder. The obstruction was relieved by replacing the gallbladder to its normal position; however, relapse occurred within 2 days. To resolve and prevent the recurrence of the obstruction without compromising gallbladder function, a novel surgical technique to provide fixation of the gallbladder to the liver was performed. The heifer recovered rapidly, proceeded to develop normally during the following year, and became pregnant.

Gravel obstruction in the abomasum or duodenum of two cows.

Two Holstein cows from dry lot dairies were evaluated because of clinical signs of depression, anorexia, and decreased milk production. Bilateral abdominal distention and decreased fecal output were found on physical examination. Results of serum biochemical analyses indicated that the cows had severe hypochloremic, hypokalemic metabolic alkalosis. On the basis of physical examination and laboratory findings, an obstruction of the abomasum or cranial portion of the small intestine was suspected in these cows and abdominal exploratory surgery was performed. A mass of gravel was found in the pyloric antrum of the abomasum of 1 cow and the descending duodenum of the other cow. The duodenal obstruction was removed by enterotomy, and the pyloric mass was manually reduced during surgery. The cows were treated with antibiotics and isotonic saline solution (NaCl) supplemented with potassium chloride and recovered quickly after surgery.

Ultrasonographic examination of the small intestine of cows with ileus of the duodenum, jejunum or ileum.

The small intestine of 35 heifers and cows with an ileus of the duodenum, jejunum or ileum was examined ultrasonographically. After a clinical examination, the animals were examined from the right flank and thorax with a 3.5 MHz linear transducer, and the findings were verified by a right flank laparotomy or post mortem. Dilated loops of small intestine with a diameter of more than 3.5 cm were visible in at least one location in all the animals; they were seen predominantly in cross-section or longitudinally. The number of loops of dilated intestine visible from the flank or intercostal spaces was markedly influenced by the site of the ileus. In animals with an ileus of the duodenum, only one intestinal loop was usually visible from the flank or from the 12th, 11th or 10th intercostal spaces. In contrast, more than five dilated loops of intestine were usually visible in animals with an ileus of the jejunum or ileum. The largest diameter of intestine measured from the 12th intercostal space was between 6.5 and 9.9 cm in animals with an ileus of the duodenum, between 3.5 and 9.8 cm in animals with an ileus of the jejunum, and between 4.4 and 5.5 cm in animals with an ileus of the ileum. In the majority of the cows, the contents of the intestines were predominantly echogenic, but in the others they were anechoic. The cause of the ileus could be identified by ultrasonography in only a few cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Use of a modified Roux-en-Y procedure for treatment of pyloroduodenal obstruction in a horse.

A modification of the Roux-en-Y anastomosis procedure was used to bypass a pyloroduodenal mass in a 12-year-old Arabian stallion. Clinical signs had consisted of a 4-week progression of ventral and hind limb edema, hypoproteinemia, fecal occult blood, intermittent abdominal pain, weight loss, and gastric reflux. On exploratory celiotomy, an obstructive mass was found in the pylorus and proximal portion of the duodenum. Gastrojejunostomy and duodenojejunostomy were performed by use of stapled side-to-side anastomosis techniques. Inaccessibility of the obstructed pyloric region prevented resection of the affected area.

Cholelith causing duodenal obstruction in a horse.

A 10-year-old Appaloosa stallion was referred for evaluation of colic. At admission, the heart rate, capillary refill time, respiratory rate, and rectal temperature were high. Fifteen liters of reflux was obtained by nasogastric intubation. Palpation of an abdominal mass per rectum elicited signs of pain. At exploratory laparotomy, a mass was palpated in the ascending portion of the duodenum. The small intestine ruptured at the site of obstruction during manipulation. The horse was euthanatized. A large cholelith was the cause of the duodenal obstruction. At necropsy, multiple choleliths of various sizes were found in the pancreatic and common bile ducts and in the stomach.

Experimental model of hypochloremic metabolic alkalosis caused by diversion of abomasal outflow in sheep.

Hypochloremic metabolic alkalosis accompanied by hypokalemia and hyponatremia was induced experimentally in 7 adult sheep by diversion (loss) of gastric contents through an Ivan and Johnston cannula placed in the cranial part of the duodenum just distal to the pylorus. Cannula placement was easily accomplished, and cannulae were tolerated well by the sheep. Volume of effluent produced during the 60- to 120-hour period of diversion ranged from 7.7 to 14.9 L and tended to be greatest during the first 24 hours. All sheep became dehydrated, with mean PCV and plasma total protein concentration increases of 94.2 and 61.7%, respectively. Plasma chloride concentration decreased in linear fashion from a prediversion mean of 113 mEq/L (range, 111 to 117 mEq/L) to an end-point mean of 54 mEq/L (range, 45 to 65 mEq/L). Plasma sodium and potassium concentrations also decreased, though potassium concentration increased terminally. There were rapid increases in arterial blood pH and bicarbonate and base excess concentrations during the first 48 hours after diversion. However, during the final stages of diversion, sheep developed superimposed metabolic acidosis with increased plasma lactate concentration and high anion gap.

Surgical management of duodenal obstruction in an adult horse.

A 3-year-old Standardbred stallion was admitted for treatment of acute enterocolitis. The horse improved in response to empiric treatment, but subsequently developed ventral edema, scrotal abscessation, and severe laminitis. Improvement again was seen, but on day 29 of hospitalization, the horse developed rapid heart rate and signs of abdominal pain. Exploratory celiotomy revealed complete obstruction of the descending portion of the duodenum, 20 cm caudal to the duodenal sigmoidal flexure. Three-tier duodenojejunostomy and jejunojejunostomy were performed to bypass the duodenal obstruction.

Hepaticojejunostomy for treatment of common hepatic duct obstructions associated with duodenal stenosis in two foals.

Two female Standardbred foals 2 and 3 months of age were presented with signs of gastroduodenal obstruction that was confirmed with contrast radiography and exploratory surgery. Ventral midline celiotomy was performed, showing stenosis of the duodenum proximal and distal to the hepatopancreatic ampulla. The common hepatic duct, the pancreatic duct, and the sigmoid section of the duodenum proximal to the stenosis were greatly dilated. To bypass the intestinal obstruction, a side-to-side duodenojejunostomy was performed. Obstruction of the common hepatic duct was relieved by side-to-side hepaticojejunostomy. In addition, jejunojejunostomy was performed distal to the other anastomoses. Both foals recovered. On admission, the foals' total bilirubin, aspartate aminotransferase, and gamma glutamyl transferase levels were greatly elevated. During the subsequent 6 to 8 months, they returned to normal. Six months after the first surgery, one foal was readmitted with an acute abdominal crisis. At surgery, there was greater than 360 degrees clockwise rotation of the mesenteric root involving most of the jejunum. At necropsy, the previously created stomas were patent. The liver and bile duct were grossly and histologically normal. The second foal continues to progress normally 12 months after surgery.

Effects of experimental duodenal occlusion on electrical activity of the proximal duodenum in cattle.

An electromyographic study of the proximal duodenum in cattle is presented. Changes of motility patterns were studied after induced mechanical obstruction of the descending duodenum in five healthy cows. Special attention was paid to the ratio of antegrade and retrograde motility. Induced duodenal obstruction of which the duration was at most 48 hours, resulted in abrupt disorganisation of the migrating myoelectric complexes; the phases of regular spiking activity disappeared completely or reappeared in a disorganised pattern, and the phases of irregular spiking activity consisted of repetitive groups of spike bursts with prolonged duration and increased propagation velocity. Retrograde peristaltic contractions in the proximal duodenum were observed. Relief of obstruction resulted in a rapid reorganisation of the cyclic pattern of the migrating myoelectric complexes, which indicates normalisation of intestinal activity.

Small intestinal obstruction associated with wood chewing in two horses.

Although wood chewing by horses is recognised as a common vice, there are few reports of specific disease associated with the habit. Two cases of acute obstruction of the small intestine by solid aggregations of wood splinters are described in horses which were both habitual wood chewers. Details are presented of the clinical findings in these cases, including the surgical treatment of acute colic. Both horses returned to full working fitness. The authors review the syndrome of enterolithiasis in horses, and discuss the causes and significance of wood chewing as a stable vice.