Small intestinal obstruction secondary to kinetic sand ingestion in a dog.

Objective: To describe a case of small intestinal obstruction secondary to kinetic sand ingestion in a dog. Animal: An 11-year-old neutered male shih tzu dog with a 2-day history of anorexia. Procedure: Abdominal radiographs revealed a small intestinal bowel loop dilated with radiopaque material, consistent with sand ingestion. The dog's only sand exposure was to kinetic sand. After 8 h of medical management, radiographs were consistent with a small intestinal obstruction. Results: The dog underwent exploratory laparotomy, which revealed distal jejunal and ileal distention with palpable soft foreign material that could not be milked into the colon. The sand was removed through a single enterotomy. The dog was discharged 4 d after surgery. Conclusion and clinical relevance: The hydrophobic properties of kinetic sand may make it more likely than regular sand to cause intestinal obstruction that requires surgery. With the increasing popularity and availability of kinetic sand for domestic use, clinicians should have a high index of suspicion for kinetic sand impaction and secondary intestinal obstruction.

Obstruction du petit intestin à la suite de l'ingestion de sable à modeler (Kinetic Sand) chez un chien. Objectif: Description d'un cas d'obstruction du petit intestin secondaire à l'ingestion de sable à modeler chez un chien. Animal: Chien shih tsu mâle castré âgé de 11 ans avec une historique d'anorexie depuis 2 jours. Procédure: Des radiographies abdominales ont révélé une anse du petit intestin dilatée avec du matériel radio-opaque, compatible avec une ingestion de sable. Une exposition à du sable à modeler était la seule exposition connue pour ce chien. Après 8 h de gestion médicale, les radiographies étaient compatibles avec une obstruction du petit intestin. Résultats: Une laparotomie exploratoire a révélé une distension du jéjunum distal et de l'iléon avec du matériel étranger mou palpable qui ne pouvait être transité dans le côlon. Le sable a été retiré à la suite d'une entérotomie simple. Le chien a obtenu sont congé médical 4 j après la chirurgie. Conclusion et signification clinique: Les propriétés hydrophobes du sable à modeler le rendent plus propice que le sable régulier à causer une obstruction intestinale et de nécessiter une chirurgie. Avec la popularité et disponibilité grandissante du sable à modeler pour usage domestique, les cliniciens devraient avoir un degré élevé de suspicion pour l'impaction par le sable à modeler et l'obstruction intestinale secondaire.(Traduit par Dr Serge Messier).

Iron-related markers of inflammation in horses with colic.

The aim of the study was to compare and correlate levels of ferritin, transferrin, iron and APPs in healthy horses and those surgically treated for strangulating colic. On admission, measurements of inflammatory markers related to iron and total protein, fibrinogen, albumin, haptoglobin and ceruloplasmin were made. The study comprised 22 horses, divided into a control group (CG) of healthy horses (n = 10) and horses with surgically treated acute abdomen (n = 12), obstruction group (OG). The OG was subdivided according to the affected intestinal segment (small vs. large) and according to outcome (survivors vs. non survivors). The OG had higher haptoglobin (34.8±14.2 mg/dL vs 20.8±7.21 mg/dL) and transferrin (487±161 mg/dL vs 369±71.4 mg/dL) values and lower iron (96.9±65 µg/dL vs 218±105 µg/dL) values than the CG. The OG horses with large intestine obstruction had lower values of transferrin (374.6±130 mg/dL) than horses with small intestinal obstruction (598.6±98.9 mg/dL). There was no difference in outcome between horses with large and small intestinal obstruction. Ferritin levels were moderately correlated with total protein (r = 0.594; P = 0.042) and albumin (r = 0.584; P = 0.046) in OG. In the multivariate exploratory analysis, fibrinogen levels were higher in animals that did not survive. In conclusion, haptoglobin, transferrin and iron were useful inflammatory markers for colic in horses. The correlation of ferritin with other APPs shows a possible role of ferritin as an APP in horses. Fibrinogen levels are higher in horses with greater risk of death from strangulating obstructions.

Lidocaine constant rate infusion improves the probability of survival in rabbits with gastrointestinal obstructions: 64 cases (2012-2021).

OBJECTIVE: To determine the survival to discharge rate of rabbits with gastrointestinal obstructions treated with lidocaine constant rate infusion (CRI) and other factors associated with survival. ANIMALS: Cases of gastrointestinal obstruction in rabbits (n = 56, including 64 events) that had presented to a veterinary teaching hospital from 2012 to 2021. METHODS: This was a retrospective study in which data on rabbits with evidence of gastrointestinal obstruction were extracted from veterinary teaching hospital medical records over a 9-year period. Systemic lidocaine treatment, breed, sex, age, temperature at presentation, blood glucose at presentation, and time to discharge or death were evaluated with univariate and multivariate logistic regression to identify factors significantly associated with survival to hospital discharge in rabbits with gastrointestinal obstruction. RESULTS: Comparatively, 89.7% of rabbits treated with lidocaine CRI (n = 39) survived to hospital discharge, while only 56% of rabbits that were not treated with lidocaine CRI (25) survived. In the final multivariate analysis, 2 factors were associated with survival to discharge: rabbits treated with systemic lidocaine and male rabbits had increased odds of survival compared to those not treated with systemic lidocaine and female rabbits, respectively. CLINICAL RELEVANCE: Results demonstrated that rabbits with gastrointestinal obstruction and treated with a lidocaine CRI were more likely to survive compared to rabbits not treated with lidocaine CRI.

Small intestinal strangulation in 60 cattle - clinical, laboratory and ultrasonographic findings, treatment and outcome.

BACKGROUND: Intestinal strangulation is constriction of the intestine by a band of tissue, ligament or blood vessel causing partial or complete intestinal obstruction. This retrospective study describes the clinical, laboratory and ultrasonographic findings, treatment and outcome of 60 cows with intestinal strangulation. RESULTS: The general condition was abnormal in all cows (60/60), 23.3% (14/60) had nonspecific signs of pain, 40.0% (24/60) had signs of colic and 48.3% (29/60) had signs of somatic (parietal) pain. The most common digestive tract abnormalities were, in decreasing frequency, reduced or absent intestinal motility (100%, 60/60), reduced or absent faecal output (98.3%, 59/60), reduced or absent rumen motility (93.4%, 56/60), dilated small intestines on transrectal palpation (63.3%, 38/60), positive ballottement and swinging auscultation (BSA) and/or percussion and simultaneous auscultation (PSA) on the right side of the abdomen (58.3%, 35/60) and at least one positive foreign body test, most commonly the back grip, in 33.9% (20/59) of the cows. Other common findings were reduced skin surface temperature (67.8%, 40/59), reduced skin turgor (51.7%, 31/60), prolonged capillary refill time (49.2%, 29/59), enophthalmus (48.3%, 29/60) and moderate to severe scleral injection (46.6%, 27/58). The most common laboratory findings were hypokalaemia (58.3%, 35/60), haemoconcentration (57.6%, 34/59), base excess (51.1%, 24/47), hyperproteinaemia (45.8%, 27/59), hyperbilirubinaemia (43.3%, 26/60), acidosis (42.6%, 20/47) and azotaemia (38.3%, 23/60). The principal ultrasonographic findings were subjectively reduced or absent small intestinal motility and dilated small intestines, but the strangulation could not be visualised by ultrasonography. With one exception, all cows underwent a right flank laparotomy to resolve the strangulation by transection or resection of the impinging tissue. Forty-nine (81.7%) cows were discharged and 11 (18.3%) were euthanized before, during or after surgery. CONCLUSIONS: Without laparotomy, intestinal strangulation could be clinically (transrectally) diagnosed in only 10% of the cows. A laparotomy is therefore essential for the correct diagnosis. The prognosis is good with prompt surgical treatment.

Prognostic indicators for survival in surgically managed small intestinal obstruction in pet rabbits: 141 presentations (2011-2021).

OBJECTIVE: To determine prognostic relevance of various patient factors and intraoperative variables associated with surgical management of small intestinal obstruction in pet rabbits. ANIMALS: 114 pet rabbits with 141 presentations of small intestinal obstruction treated surgically between June 2011 and December 2021. METHODS: In a retrospective observational study design, medical records were reviewed for rabbits with small intestinal obstruction that had undergone surgical intervention. Data were collected on variables of interest and outcome (survival to hospital discharge). Univariable and multivariable logistic regression analyses were performed to identify variables associated with survival. RESULTS: Overall survival was 75.2% (106/141). Specifically, 95.7% (22/23) of presentations involving rabbits < 25 months survived. The odds of survival on univariable modeling were significantly lower in presentations of rabbits > 72 months compared with those < 25 months (OR, 0.05; 95% CI, 0.01 to 0.40; P = .005). Rectal temperature, clinicopathologic findings, etiology of obstruction, presence of full-thickness gastrointestinal wall injury, and previous small intestinal obstruction surgery did not show significant effects on survival. In a multivariable model that controlled for plasma potassium and calculated plasma osmolarity and tonicity, the odds of survival in presentations of rabbits > 72 months were 95% lower than those < 25 months (OR, 0.05; 95% CI, 0.01 to 0.50; P = .012). CLINICAL RELEVANCE: Surgical intervention should be considered a suitable treatment option for small intestinal obstruction in rabbits < 72 months and carried a good prognosis. The most common etiology was consistent with a compressed hair pellet, and extraluminal digital manipulation into the cecum was a successful surgical technique in most presentations.

Histopathologic diagnosis and patient characteristics in cats with small intestinal obstructions secondary to trichobezoars.

OBJECTIVES: The aim of the present study was to describe the distribution of gastrointestinal histopathology findings associated with gastrointestinal obstructions secondary to trichobezoar formation in cats. METHODS: A total of 100 surgical gastrointestinal biopsies were obtained from 44 cats with gastrointestinal obstructions secondary to a trichobezoar. Medical records, including signalment, type and duration of clinical signs, surgical reports and histopathologic analysis, were reviewed for each cat. RESULTS: Biopsies taken near the site of the trichobezoar were more likely to show neutrophilic inflammation and mucosal erosion/ulceration compared with biopsies taken elsewhere in the small intestine. Lymphoplasmacytic and mixed lymphocytic and eosinophilic populations were the most common histopathologic findings from all biopsies followed by alimentary small cell lymphoma. Biopsy samples were more likely to represent a diagnosis of alimentary lymphoma in cats older than 10 years. CONCLUSIONS AND RELEVANCE: Gastrointestinal biopsies taken at the time of surgery in cats with trichobezoar obstructions may represent an important diagnostic tool for further evaluation of potential feline chronic enteropathy. Biopsies taken at the site of the obstruction should be interpreted cautiously as the presence of a trichobezoar may induce an acute inflammatory reaction. The resultant histologic interpretation at this site may not represent the chronic state of the intestinal mucosa, supporting the utility of obtaining multiple biopsies orad and aborad to the obstruction.

Partial volvulus, entrapment, and extraluminal obstruction of the jejunum in a cat.

A 2-year-old, spayed female, domestic shorthair cat was presented in compensated hypovolemic shock after 24 h of anorexia, vomiting, and lethargy. An enterotomy had been performed at 9 mo of age to remove a foreign body. Due to inconclusive findings on abdominal imaging, an exploratory laparotomy was done. An adhesion at the root of the mesentery, likely associated with the previous surgery, had resulted in partial volvulus, entrapment, and extraluminal obstruction of the jejunum. Transection of the adhesion allowed repositioning of the bowel without the need for resection. The cat was discharged from the hospital 7 d postoperatively. Adhesions have not previously been reported to cause small bowel volvulus in cats. Key clinical message: Abdominal adhesions as a cause of clinical disease in cats have apparently not been reported. This case report demonstrates how malposition of the gastrointestinal tract, secondary to adhesions, should be included as a differential diagnosis for feline patients presenting with acute abdomens. Previous abdominal surgery is a risk factor for development of adhesions. This case emphasized the importance of Halsted's principles of surgery to reduce the risk of postoperative adhesions, even in species not predisposed to forming adhesions.

Volvulus partiel, piégeage et obstruction extraluminale du jéjunum chez un chat. Une chatte à poil court, stérilisée et âgée de 2 ans a été présentée en choc hypovolémique compensé après 24 h d'anorexie, de vomissements et de léthargie. Une entérotomie avait été réalisée à 9 mo d'âge pour retirer un corps étranger. Étant donné les trouvailles d'imagerie abdominales non-concluantes, une laparotomie exploratoire a été effectuée. Une adhérence à la base du mésentère, probablement associée à la chirurgie antérieure, avait entraîné un volvulus partiel, un piégeage et une obstruction extraluminale du jéjunum. Une transection de l'adhérence a permis un repositionnement de l'intestin sans le besoin d'une résection. Le chat a obtenu son congé de l'hôpital 7 j postchirurgie. Des adhérences n'avaient pas encore été rapportées comme pouvant causer un volvulus du petit intestin chez les chats.Message clinique clé :Des adhérences abdominales comme cause de maladie clinique chez les chats ne semble pas avoir déjà été rapportées. Le présent cas montre comment le mauvais positionnement du tractus gastro-intestinal, secondaire à des adhérences, devrait être inclus dans la liste des diagnostics différentiels chez les patients félins présentés avec un abdomen aigu. Une chirurgie abdominale antérieure est un facteur de risque pour le développement d'adhérences. Le cas présent souligne l'importance du principe d'Halsted de chirurgie de réduire les risques d'adhérences post-opératoires, même si l'espèce n'est pas prédisposée à former des adhérences.(Traduit par Dr Serge Messier).

Acid-base and electrolyte evaluation in dogs with upper GI obstruction: 115 dogs (2015-2021).

OBJECTIVES: Metabolic alkalosis, although uncommon in small animals, has been previously associated with gastrointestinal obstructions. Depending on the population and disease process evaluated, previous prevalence of metabolic alkalosis is reported as ranging from 2% to 45% in canine patients. The objective of this study was to determine the prevalence of metabolic alkalosis and other acid-base and electrolyte disorders in a cohort of dogs with a confirmed upper gastrointestinal obstruction. MATERIALS AND METHODS: Electronic medical records were reviewed to identify dogs who presented for vomiting with evidence of an upper gastrointestinal obstruction from January 2015 to October 2021. Patients were enrolled only if a preoperative venous blood gas was obtained and analysed in house. Traditional acid-base analysis was utilised to determine an acid-base status before relieving the obstruction. When available, post-operative venous acid-base status was determined within 24 hours after surgery, and compared to preoperative results. RESULTS: A total of 115 dogs were included in the study. Twenty-five out of 115 (22%) dogs displayed either a simple metabolic alkalosis or a mixed acid-base disturbance before surgery. Twenty-seven out of 115 dogs (37%) had a normal acid-base status at entry. Seventy-one dogs had pre- and post-operative venous blood gas results available. Metabolic alkalosis was resolved in nearly all patients post-operatively, with no patients displaying a simple metabolic alkalosis. A mixed metabolic acidosis and respiratory alkalosis was the most common condition post-operatively, found in 25 of 71 (35%) dogs. Severe derangements of electrolytes were infrequent preoperatively (3/115; 2.6%). A majority of patients in this study exhibited hypokalaemia (64.4%), hypochloraemia (72.8%) and hyponatraemia (77.4%) on preoperative venous blood gases. Venous pH, Pv CO2 , bicarbonate and base excess were significantly higher preoperatively when compared to the post-operative results. CLINICAL SIGNIFICANCE: This study found the prevalence of pre-operative metabolic alkalosis in dogs with a documented upper gastrointestinal obstruction to be lower than previously reported. Surgical or endoscopic alleviation of the upper gastrointestinal obstruction resulted in resolution of metabolic alkalosis in nearly all patients.

Radiographic and ultrasonographic appearance of a jejunal torsion-volvulus in a dog.

A 1.5-year-old male neutered, 5 kg, Dachshund was referred for anorexia and vomiting for several days' duration. Radiographs revealed concern for a small intestinal obstruction. Ultrasonography revealed a severely distended segment of jejunum containing echogenic fluid that abruptly narrowed, twisted, and transitioned into normal jejunum, along with the presence of a distinct "whirl sign" that resulted from the intestinal segments twisting around themselves. This, in addition to the absence of flow on power Doppler interrogation, was compatible with a focal jejunal torsion-volvulus. The torsion-volvulus was surgically confirmed, a resection and anastomosis was performed, and the dog recovered uneventfully.

Epiploic foramen entrapment in a dog.

OBJECTIVE: To report small intestinal herniation through the epiploic foramen in a dog. ANIMALS: Nine-year-old male castrated Shih Tzu. STUDY DESIGN: Case report. METHODS: The dog presented with an 8-year history of vomiting and regurgitation and acute onset of melena, lethargy, anorexia, anemia, and suspected gastrointestinal mass or obstruction on prereferral imaging. Abnormalities on abdominal radiographs included a large, midcaudal soft tissue structure and cranial displacement and segmental dilation of the small intestine. On abdominal ultrasound, severe gastric dilation, jejunal tortuosity and stacking, and peritoneal effusion were observed. Epiploic herniation of the small intestine and segmental jejunal devitalization was diagnosed on exploratory laparotomy, and the dog underwent hernia reduction, jejunal resection and anastomosis, and nasogastric tube placement. RESULTS: Severe gastric distention and atony persisted 24 h after surgery, despite medical management. The dog was taken to surgery for decompressive gastrotomy and placement of gastrostomy and nasojejunostomy tubes for postoperative decompression and feeding, respectively. Three days after the original surgery, the dog developed a septic abdomen from anastomotic dehiscence and underwent jejunal resection and anastomosis and peritoneal drain placement. Gastric dysmotility gradually resolved with the administration of motility stimulants, removal of gastric residual volume, and nutritional support via nasojejunostomy tube feedings. Three months after discharge, the dog was clinically normal. CONCLUSION: Epiploic foramen entrapment should be considered a type of herniation in dogs. Clinical suspicion should be raised in dogs with unresolving regurgitation and vomiting, visceral displacement, and stacking and distension of small intestine.

Recurrent Colic: Diagnosis, Management, and Expectations.

Most recurrent episodes of non-specific colic are self-limiting, and the results of clinical examinations are unremarkable. Differentiating these cases from serious diseases can be difficult, but repeated evaluations are warranted. Horses presenting with very frequent bouts of colic are more likely to have serious diseases and a higher mortality rate compared to horses presenting with less frequent bouts of transient colic. Horses with recurrent bouts of prolonged colic are more likely to have motility issues or partial intestinal obstruction. Non-gastrointestinal diseases can also cause recurrent bouts of pain ("false colic"). Adhesions are common causes of colic following abdominal surgery.

Accuracy and reliability of tele-ultrasonography in detecting gastrointestinal obstruction in dogs and cats.

OBJECTIVES: To assess the accuracy and interobserver agreement of tele-ultrasonography for the diagnosis of gastrointestinal obstruction in small animals by radiologists with different levels of experience. MATERIALS AND METHODS: A retrospective cross-sectional study including dogs and cats admitted with gastrointestinal signs, between 2017 and 2019, that had abdominal ultrasonographic (US) examination performed and images saved for review. Patients were classified into two categories based on final diagnosis: animals with or without complete or partial gastrointestinal obstruction. Observers with four experience levels interpreted the archived ultrasound examinations, simulating a tele-ultrasonography consultation. Analyses of accuracy, sensitivity, specificity, positive and negative predictive values were obtained for each observer for detection of gastrointestinal obstruction. Agreement between observers for the gastrointestinal obstruction diagnosis was assessed using Fleiss's Kappa statistics. RESULTS: Ninety patients with gastrointestinal signs were included. Of these, 23 of 90 had partial or complete gastrointestinal obstruction. Interpretation of the images by observers via tele-ultrasonography showed intervals of accuracy, sensitivity, specificity, positive and negative predictive values, respectively, of 78.9% to 87.8%, 73.9% to 100%, 77.6% to 89.6%, 55.9% to 70.8% and 90.9% to 100% for diagnosis of gastrointestinal obstruction. Agreement for the gastrointestinal obstruction diagnosis across all reviewers was moderate (Kappa 0.6). CLINICAL SIGNIFICANCE: Tele-ultrasonography had good accuracy for detection of gastrointestinal obstruction, however had a rather low positive predictive value and only moderate interobserver agreement. Therefore, this technique should be used with caution in this clinical context, given the potential surgical decision at hand.

Concentrations of neutrophil gelatinase-associated lipocalin are increased in serum and peritoneal fluid from horses with inflammatory abdominal disease and non-strangulating intestinal infarctions.

BACKGROUND: Neutrophil gelatinase-associated lipocalin (NGAL) is produced in response to inflammation in horses, but it has not yet been investigated as a biomarker in horses with the abdominal disease. OBJECTIVES: To investigate NGAL in serum and peritoneal fluid in horses with the abdominal disease. STUDY DESIGN: Retrospective clinical study. METHODS: Data from medical records of 270 horses admitted with acute abdominal disease (simple obstructions [n = 43], strangulating obstructions [n = 104], inflammatory abdominal disease [n = 99], non-strangulating intestinal infarction [NSII, n = 24]) and 9 healthy control horses were reviewed, and serum and peritoneal fluid samples were retrieved from a biobank. NGAL was measured in serum and peritoneal fluid by ELISA. Differences in NGAL concentrations between groups were assessed. RESULTS: Healthy horses had low serum and peritoneal fluid concentrations of NGAL (median = 21.0 and 9.5 µg/L, respectively). Neither serum nor peritoneal fluid NGAL concentrations (median serum, peritoneal fluid) differed between healthy horses and horses with simple (28.1 µg/L, 13.0 µg/L) and strangulating intestinal obstructions (34.7 µg/L, 38.4 µg/L). Horses with NSII (308.0 µg/L, 2163.0 µg/L) and inflammatory abdominal disease (171.1 µg/L, 314.1 µg/L) had higher serum and peritoneal fluid concentrations of NGAL than the other groups (p < 0.001). Peritoneal fluid NGAL concentrations in horses with NSII were higher than in horses with inflammatory abdominal disease (p = 0.03). MAIN LIMITATIONS: Retrospective study design; small group of control horses. CONCLUSIONS: NGAL is a marker of inflammation in horses with the abdominal disease. The high peritoneal fluid concentration of NGAL in horses with NSII compared to all other groups may render NGAL useful for identifying this condition, which is otherwise difficult to differentiate from other types of peritonitis. Thereby, NGAL may potentially facilitate timely surgical intervention in this group of patients. The results of this study must be evaluated in larger, and preferably prospective, studies to obtain a more comprehensive evaluation of the diagnostic utility of NGAL.

CONTEXTO: Lipocalina associada à gelatinase de neutrófilos (NGAL) é produzida em resposta à inflamação em equinos, mas ainda não foi investigada como biomarcador de equinos com doenças abdominais. OBJETIVOS: Investigar a NGAL no soro e líquido peritoneal (LP) de equinos com doenças abdominais. DELINEAMENTO DO ESTUDO: Estudo retrospectivo. METODOLOGIA: Informação de prontuários médicos de 270 equinos com doença abdominal (obstrução simples [n = 43], obstrução estrangulante [n = 104], doença abdominal inflamatória [n = 99], lesão de infarto não estrangulante [NSII, n = 24]) e nove equinos saudáveis como controle foram revisados, e o soro e LP foram obtidos de um biobank. NGAL foi mensurado no soro e LP através de ELISA. Diferenças na concentração de NGAL entre os grupos foi avaliada. RESULTADOS: Cavalos saudáveis tiveram concentração de NGAL baixas no soro e no LP (mediana = 21.0 e 9.5 µg/L, respectivamente). A concentração de NGAL no soro e no LP não diferiram entre cavalos saudáveis e cavalos com obstrução simples (28.1,13.0) e obstrução estrangulante (34.7, 38.4). Cavalos com NSII (308.0, 2163.0) e doença abdominal inflamatória (171.1314.1) tiveram concentrações mais altas de NGAL no soro e LP quando comparados aos outros grupos (p < 0.001). A concentração de NGAL no LP em cavalos com NSII foi mais alta do que em cavalos com doença abdominal inflamatória (p = 0.03). PRINCIPAIS LIMITAÇÕES: Delineamento de estudo retrospectivo e pequeno grupo de equinos controle. CONCLUSÕES: NGAL é um marcador de inflamação em cavalos com doença abdominal. A concentração alta de NGAL no LP de cavalos com NSII comparado com os outros grupos indica que NGAL pode ser útil em identificar essa condição, o que é usualmente difícil de diferenciar de outros tipos de peritonite. Contudo, NGAL tem o potencial de facilitar a decisão rápida da necessidade de intervenção cirúrgica nesse grupo de pacientes. Os resultados deste estudo devem ser avaliados em uma população maior (e preferencialmente prospectiva) para obter uma melhor avaliação compreensiva da utilidade diagnóstica do NGAL.

Differentiating Strongylus vulgaris-associated, non-strangulating intestinal infarctions from idiopathic peritonitis and acute colitis in horses.

BACKGROUND: Horses with non-strangulating intestinal infarction (NSII) are often misdiagnosed with idiopathic peritonitis or acute colitis. Early diagnosis is essential to ensure early surgical intervention and improve survival. METHODS: Clinical and laboratory data from horses admitted to the University of Copenhagen Large Animal Teaching Hospital with NSII, idiopathic peritonitis or acute colitis between 2009 and 2018 were used for univariate comparisons and a multivariable logistic regression model for prediction of NSII. RESULTS: Two hundred and thirty-one horses were included. A multivariable model for the prediction of NSII included gastric reflux (more than 5 L) (odds ratio [OR] 8.7; 95% confidence interval [CI] 2.1-36.2), abnormal findings palpated per rectum (intestinal dilatations/impactions [OR 4.43; 95% CI 1.43-13.38], colon displacements [OR 23.16; 95% CI 5.26-101.97] or intestinal mass [OR 179.7; 95% CI 23.5-1375.5]), white blood cell count (OR 1.2; 95% CI 1.1-1.4), packed cell volume (OR 0.9; 95% CI 0.8-0.9), age (OR 0.9; 95% CI 0.8-1.0) and heart rate (OR 1.1; 95% CI 1.0-1.1). The model had a low false positive rate (5%), but a high false negative rate (50%). LIMITATIONS: Due to the retrospective nature of the study, sample collection was inconsistent, resulting in missing values. CONCLUSION: The model had some capability in predicting NSII. However, the high risk of false negatives means that exploratory laparotomy should be considered in horses with peritonitis of unknown aetiology in areas where Strongylus vulgaris is prevalent and occurrence of idiopathic peritonitis is low.

Clinicopathological and radiographic indicators for orogastric decompression in rabbits presenting with intestinal obstruction at a referral hospital (2015-2018).

BACKGROUND: Orogastric decompression is regularly recommended as a part of both medical and pre-surgical treatment for small intestinal obstruction in rabbits. However, guidelines as to when orogastric decompression is indicated are sparse. METHODS: The medical records of 35 rabbits diagnosed with gastrointestinal obstruction over a 3-year period were examined. Differences in presentation, clinicopathological and radiographic examination findings, treatments and outcome were evaluated. RESULTS: Approximately 49% of the cases evaluated were considered to have non-life-threatening disease, while 51% were considered to have life-threatening disease. The severity of gastric obstruction was correlated with the severity of hyperglycaemia (average 25.7 mmol/L; 463 mg/dl) and corresponding hyponatraemia (Na < 138 mmol/L; 138 mEq/L). These patients were treated with orogastric decompression and medical management only. LIMITATIONS: This is a retrospective study and there are inherent limitations involving the quality of the data and data collection. Additional studies should be completed that strive for larger sample sizes to compare the differences in outcome between surgical and medical management, as well as investigate the outcomes of rabbits with hyperglycaemia and hyponatraemia that did not have an orogastric decompression performed. CONCLUSIONS: Blood glucose and sodium concentrations, in combination with radiographic findings, may aid clinicians in determining if orogastric decompression is indicated to stabilise rabbits with small intestinal obstructive disorders.

Idiopathic anomalous congenital band causing small intestinal obstruction in a 5-month-old dog.

A 5-month-old, intact male, yellow Labrador retriever was presented with a 24-hour history of anorexia and vomiting. Abdominal imaging revealed the presence of a mechanical obstruction in the jejunum and peritoneal effusion. Cytologic evaluation and culture of the effusion prior to surgery identified a suppurative exudate with bacteria consistent with septic peritonitis and suspected to be related to the intestinal lesion. An exploratory laparotomy was performed, and a segment of jejunum was circumferentially severely constricted by an off-white, fibrous band of tissue. Resection and anastomosis of the strangulated segment of jejunum and excision of the constricting band provided resolution of the clinical signs. The dog made a complete recovery. Histologic evaluation revealed the band to be composed of fibrovascular and smooth muscle tissue, consistent with an idiopathic anomalous congenital band. No other gastrointestinal lesions were observed, either grossly at surgery or histologically in the resected segment of intestine. To our knowledge, a similar structure has not been reported in the veterinary literature. Key clinical message: Developmental abnormalities should be included in the differential list for younger patients with signs suggestive of gastrointestinal obstruction.

Anneau congénital anormal idiopathique provoquant une occlusion de l'intestin grêle chez un chien de 5 mois. Un Labrador retriever intact mâle âgé de 5 mois a été présenté avec une histoire de 24 heures d'anorexie et de vomissements. L'imagerie abdominale a révélé la présence d'une obstruction mécanique du jéjunum et d'un épanchement péritonéal. L'évaluation cytologique et la culture de l'épanchement avant la chirurgie ont identifié un exsudat suppuré avec des bactéries compatibles avec une péritonite septique et suspectées d'être liées à la lésion intestinale. Une laparotomie exploratoire a été réalisée et un segment de jéjunum était sévèrement resserré sur toute sa circonférence par une bande de tissu fibreux de couleur blanc-cassé. La résection et l'anastomose du segment étranglé du jéjunum et l'excision de la bande constrictive ont permis la résolution des signes cliniques. Le chien s'est complètement rétabli. L'évaluation histologique a révélé que la bande était composée de tissu musculaire fibrovasculaire et lisse, compatible avec une bande congénitale anormale idiopathique. Aucune autre lésion gastro-intestinale n'a été observée, ni grossièrement à la chirurgie ni histologiquement dans le segment réséqué de l'intestin. A notre connaissance, une structure similaire n'a pas été rapportée dans la littérature vétérinaire.Message clinique clé :Les anomalies du développement doivent être incluses dans la liste différentielle des patients plus jeunes présentant des signes évoquant une occlusion gastro-intestinale.(Traduit par Dr Serge Messier).

[Studies on the use of iodine-containing contrast agent diatrizoate in rabbits (Oryctolagus cuniculus)]. / Untersuchungen zum Einsatz des jodhaltigen Kontrastmittels Amidotrizoesäure beim Kaninchen (Oryctolagus cuniculus).

OBJECTIVE: The use of the iodine-containing contrast agent diatrizoate was investigated in healthy rabbits and in rabbits with gastric dilatation and intestinal obstruction. For this purpose, transit times through the gastrointestinal tract and clinical use were investigated during a one year period. In addition, a possible influence on thyroid hormone levels was evaluated. MATERIAL AND METHODS: Transit times of contrast agent through the different intestinal sections were examined radiographically in 14 healthy rabbits. For this purpose, 7 ml/kg of a 300 mg iodine/ml and 600 mg diatrizoate/ml containing solution were administered. Radiographs were obtained at different time intervals. Three different doses (D1 2 ml/kg, D2 7 ml/kg, D3 10 ml/kg) were administered, and blood samples were collected at two time points (60 min, 24 h) to analyze thyroid hormone levels (TT4, fT4, TSH). In addition, 70 rabbits that had received the contrast agent diatrizoate because of gastric dilatation and suspected intestinal obstruction were retrospectively evaluated during a period of one year. Focus was placed on arrival of the contrast agent in the cecum, laboratory changes, and mortalities. RESULTS: In all healthy rabbits, contrast medium was detectable in the cecum after a mean of 45-60 min. In the animals suffering from gastrointestinal obstruction, this was delayed to a mean of 121.2 min. These animals showed hypothermia in 92.4 % and hyperglycemia in 45.9 %. 56.1 % exhibited an increase in urea and 33.9 % an increase in creatinine. In 71.4 % of cases, medical treatment was possible, however 12 % of these individuals succumbed to the disease. 28.6 % of the cases were managed surgically which was associated with a mortality of 50 %. TT4, fT4, and TSH levels displayed significant alterations among the three contrast agent doses (p < 0.05). These changes were found to be transient when follow-up was performed two weeks later. CONCLUSION AND CLINICAL RELEVANCE: When ileus is suspected in rabbits, diatrizoate may be helpful in evaluating the progression of the disease in addition to the use of native radiographs. Sufficient hydration and monitoring of renal function are advisable. Transient changes in thyroid hormones were evident but lacked clinical relevance.

Effects of age, disease and anastomosis on short- and long-term survival after surgical correction of small intestinal strangulating diseases in 89 horses.

BACKGROUND: Although survival rates have been reported after small intestinal surgery for strangulating diseases in horses, none have followed survival for periods relevant to the long lifespan of horses and none have described effect of age, disease and surgical treatments over such long survival periods. OBJECTIVES: To examine effects of age, disease and type of surgery on long-term survival in horses after surgical treatment of small intestinal strangulating diseases over periods relevant to the expected lifespan of a horse. STUDY DESIGN: Retrospective clinical study. METHODS: Post-operative data were gathered from medical records and owner contact for 89 horses with small intestinal strangulation. Survival times from surgery to the date of death or the date of last follow-up were analysed by Kaplan-Meier statistics. Variables of interest were age, type of strangulating disease and surgical correction. Cox proportional hazards regression was used to evaluate these variables. RESULTS: Short-term survival was not affected by any of the variables measured. For long-term survival with Kaplan-Meier statistics, horses ≥16 years old had significantly shorter (P = .002) median survival times (72 months; 95% CI 32.0-96.0) than younger horses (121.7 months; 95% CI 90.0-162), horses without resection had significantly longer (P = .02) survival times (120 months; 95% CI 86-212) than horses that had jejunocecostomy (76.8 months; 95% CI 24-125), and horses with miscellaneous diseases had significantly longer (P = .02) median survival times (161.9 months; 95% CI 72.0-M) than horses with strangulating lipoma (79.8 months; 95% CI 32.0-120.0). In the multivariable Cox Proportional Hazard model, age (HR = 2.67; 1.49-4.75, P < .001) and anastomosis (HR = 0.65; 0.46-0.92, P = .02) had the most significant effect on median survival time. MAIN LIMITATIONS: Limitations were small numbers in some categories, loss of cases to follow-up, owner recall failures and lack of a control group. CONCLUSIONS: The remaining lifespan of older horses at the time of surgery had the greatest effect on survival. Age could influence long-term survival studies after colic surgery, and therefore needs to be considered for survival analyses. Horses that did not require resection and anastomosis had favourable outcomes, underscoring the potential importance of early intervention to reduce the need for resection.

Interpreting abdominal fluid in colic horses: Understanding and applying peritoneal fluid evidence.

BACKGROUND: Interpreting changes in peritoneal fluid helps clinicians manage colic and other diseases in horses. During abdominal problems in the horse, abdominal fluid characteristics such as color, turbidity, total nucleated and red blood cell counts, cytology, total protein, and l-lactate change in predictable ways, helping the clinician characterize the disease. DESCRIPTION: Normal abdominal fluid in horses is odorless, clear to light yellow in color, and transparent. Peritoneal fluid becomes more turbid with increasing levels of protein, number of WBCs or RBCs, or with gross contamination following intestinal rupture. The color of abdominal fluid will also change with the type and quantity of cells or other elements present. The transformation of peritoneal fluid color from golden to orange to red represents increasing levels of RBCs, common with strangulating intestinal lesions. Serosanguinous defines fluid that is both turbid and orange to bloody because of increased total protein, WBCs, and RBCs, and is considered classic for diseases characterized by intestinal ischemia. Peritoneal fluid may also be red or blood-colored because of a hemoperitoneum, or secondary to blood contamination during sample collection. l-Lactate measurement in the abdominal fluid has proven invaluable for the identification of strangulating intestinal injury. Cytology acts as an important supplement to cell counts in peritoneal fluid, and the normal ratio of non-degenerate neutrophils:mononuclear cells of 2:1 changes during various gastrointestinal diseases. Culture of peritoneal fluid samples should be performed when septic peritonitis is suspected. SUMMARY: Abdominal fluid is a sensitive indicator of intestinal injury and a useful tool to direct treatment. Peritoneal fluid evaluation includes gross visual and olfactory examination, nucleated cell count, total protein, RBC count, lactate levels, cytology, and culture. The changes noted in such variables are related to the type and duration of the abdominal problem. KEY POINTS:  Abdominal fluid interpretation has become central to the triage and management of challenging equine colic patients.  The transformation of peritoneal fluid color from golden to orange to red represents increasing levels of RBCs, common with strangulating intestinal lesions.  Contamination with RBCs at various concentrations may be secondary to vascular (eg, abdominal wall or mesenteric vessels) or splenic trauma during abdominal fluid collection; however, this must be distinguished from orange to red fluid associated with intestinal strangulating obstruction or hemoabdomen  Peritoneal fluid analysis reveals abdominal pathology by recognizing specific changes that occur with disease processes affecting the tissues and organs within this cavity.  Abdominal fluid examination should be used as a tool to direct treatment rather than the definitive test for diagnosis of the acute abdomen  Septic peritonitis in horses most commonly originates secondary to intestinal compromise or accidents (vascular damage, perforation, or surgical manipulation), leading to bacterial translocation into the abdomen.

Jejunal strangulation and incarceration associated with bilateral perineal hernias in a neutered male dog.

CASE DESCRIPTION: An 8-year-old 6.8-kg neutered male Dachshund was presented for evaluation of vomiting, diarrhea, anorexia, and swelling over the right perineal region. The dog had a history of a bilateral perineal herniorrhaphy and castration 14 months prior to presentation. CLINICAL FINDINGS: Bilateral perineal hernias were confirmed by digital rectal examination. Abdominal ultrasonography confirmed the presence of intestine within the right hernia. Three days after admission to the hospital, the region of the right perineal hernia became painful, erythematous, and edematous. Computed tomography revealed jejunal incarceration within the right hernia with dilation of 1 jejunal segment that indicated intestinal obstruction. TREATMENT AND OUTCOME: Abdominal exploratory surgery was performed, during which irreducible small intestinal incarceration was confirmed. Intra-abdominal jejunal resection and anastomosis was performed, and an approximately 13-cm-long section of the jejunum was resected. Bilateral perineal herniorrhaphies with internal obturator and superficial gluteal muscle transposition were performed. Six months after surgery, digital rectal examination of the dog revealed that the repair was intact. The dog had no perineal hernia-related clinical signs at the time of the recheck examination. CLINICAL RELEVANCE: For the dog of the present report, surgical management of small intestinal strangulation associated with a perineal hernia was successful. Although a portion of the small intestines can frequently be found within perineal hernias in dogs, perineal hernia-related small intestinal strangulation has not been previously described, to the authors' knowledge. Veterinarians and clients should be aware of this potential complication secondary to perineal hernia and be prepared to perform an abdominal surgical procedure to address small intestinal incarceration in affected dogs.