Small intestinal volvulus in 47 cows.

Objective: To describe the findings, treatment, and outcome of small intestinal volvulus (SIV) in 47 cows. Animals and procedure: Retrospective analysis of medical records. Comparison of the findings for 18 surviving and 29 non-surviving cows. Results: The most common abnormal vital signs were tachycardia (68.0%), tachypnea (59.6%), and decreased rectal temperature (51.1%). Signs of colic occurred in 66.0% of cows in the study. Rumen motility was reduced or absent in 93.6% of cows, and intestinal motility in 76.6%. Clinical signs on ballottement and/or percussion and simultaneous auscultation were positive on the right side in 78.7% of cows. Transrectal examination showed dilated small intestines in 48.9% of cows. The rectum contained little or no feces in 93.6% of cows. The principal laboratory abnormalities were hypocalcemia (74.1%), hypokalemia (73.8%), azotemia (62.8%), hypermagnesemia (61.6%), and hemoconcentration (60.0%). The principal ultrasonographic findings were dilated small intestines (87.1%) and reduced or absent small intestinal motility (85.2%). Forty-one of the 47 cows underwent right flank laparotomy and the SIV was reduced in 21 cows. When comparing the clinical and laboratory findings of 18 surviving and 29 non-surviving cows, the groups differed significantly with respect to severely abnormal general condition (16.7 versus 37.9%), rumen stasis (22.2 versus 79.3%), intestinal atony (16.7 versus 48.3%), serum urea concentration (6.5 versus 9.8 mmol/L), and serum magnesium concentration (0.98 versus 1.30 mmol/L). In summary, 38.3% of the cows were discharged and 61.7% were euthanized before, during, or after surgery. Conclusion and clinical relevance: An acute course of disease, little or no feces in the rectum, and dilated small intestines were characteristic of SIV in this study population.

Volvulus de l'intestin grêle chez 47 vaches. Objectif: Décrire les données, le traitement et les résultats du volvulus de l'intestin grêle (SIV) chez 47 vaches. Animaux et procédure: Analyse rétrospective des dossiers médicaux. Comparaison des résultats pour 18 vaches survivantes et 29 vaches non survivantes. Résultats: Les signes vitaux anormaux les plus courants étaient la tachycardie (68,0 %), la tachypnée (59,6 %) et la diminution de la température rectale (51,1 %). Des signes de coliques sont apparus chez 66,0 % des vaches étudiées. La motilité du rumen était réduite ou absente chez 93,6 % des vaches et la motilité intestinale chez 76,6 %. Les signes cliniques de ballottement et/ou percussion et auscultation simultanée étaient positifs du côté droit chez 78,7 % des vaches. L'examen transrectal a montré une dilatation de l'intestin grêle chez 48,9 % des vaches. Le rectum contenait peu ou pas de matières fécales chez 93,6 % des vaches. Les principales anomalies des analyses de laboratoire étaient l'hypocalcémie (74,1 %), l'hypokaliémie (73,8 %), l'azotémie (62,8 %), l'hypermagnésémie (61,6 %) et l'hémoconcentration (60,0 %). Les principaux résultats échographiques étaient une dilatation de l'intestin grêle (87,1 %) et une motilité intestinale réduite ou absente (85,2 %). Quarante et une des 47 vaches ont subi une laparotomie du flanc droit et le SIV a été corrigé chez 21 vaches. En comparant les résultats cliniques et biologiques de 18 vaches survivantes et de 29 vaches non survivantes, les groupes différaient significativement en ce qui concerne l'état général sévèrement anormal (16,7 contre 37,9 %), la stase du rumen (22,2 contre 79,3 %), l'atonie intestinale (16,7 contre 48,3 %), la concentration sérique d'urée (6,5 contre 9,8 mmol/L) et la concentration sérique de magnésium (0,98 contre 1,30 mmol/L). En résumé, 38,3 % des vaches ont reçu leur congé et 61,7 % ont été euthanasiées avant, pendant ou après l'intervention chirurgicale. Conclusion et pertinence clinique: Une évolution aiguë de la maladie, peu ou pas de selles dans le rectum et un intestin grêle dilaté étaient caractéristiques du SIV dans cette population étudiée.(Traduit par Dr Serge Messier).

INTESTINAL TYMPANY AND VOLVULUS IN CENTRAL AMERICAN RIVER TURTLES (DERMATEMYS MAWII).

Ten cases of small intestinal tympany with or without volvulus were documented in Central American river turtles (Dermatemys mawii). These turtles were under managed care at the Philadelphia Zoo in Philadelphia, PA, USA, with one case followed after transfer to a different institution. The primary clinical presentation was abnormal buoyancy in nearly all cases (9/10) and anorexia in two cases (2/10). Five of 10 turtles with suspected or radiographically confirmed small intestinal tympany recovered (5/10), whereas five cases (5/ 10) resulted in death or euthanasia. In all fatal cases (5/5), small intestinal volvulus was identified at gross necropsy, with concurrent colonic volvulus identified in 2/5 cases. Other notable necropsy findings were hepatic lipidosis (3/5) and thrombosis of intestinal or renal vasculature (2/5). In all fatal cases (5/5), there was short (1 to 2 days) clinical progression from abnormal buoyancy to death or euthanasia. In the majority of cases (6/10), an abrupt change in diet, notably the overfeeding of fresh fruit or excessive amounts of mulberry (Morus spp.) browse, or ingestion of indigestible foreign material, occurred prior to presentation. Temporary suboptimal environmental temperatures were suspected prior to the onset of clinical signs in 4/10 cases. Optimal husbandry conditions including nutrition and environmental temperature appear vital to preventing this condition. Recognition of early clinical signs of this condition, such as abnormal buoyancy and anorexia, and environmental correction or medical therapy, may prevent fatality and result in a better outcome in these cases.

Primary small intestinal lymphangiosarcoma in a dog presenting with a segmental partial mesenteric volvulus.

A 3-year-old Great Dane presented with a history of chronic vomiting and diarrhoea. Abdominal computed tomography followed by exploratory laparotomy revealed a perforated, segmental partial mesenteric volvulus, affecting an abnormal section of distal jejunum, which was resected. Histopathology and immunohistochemistry results were consistent with jejunal lymphangiosarcoma. This case represents the first report of primary small intestinal lymphangiosarcoma in dogs and the importance of immunohistochemistry for definitive diagnosis.

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).

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.

FATAL GASTRIC DILATATION AND VOLVULUS IN THREE CAPTIVE JUVENILE LINNAEUS'S TWO-TOED SLOTHS (CHOLOEPUS DIDACTYLUS).

Linnaeus's two-toed sloth (Choloepus didactylus) is one of two extant neotropical species of the family Megalonychidae. Despite their being commonly kept under managed care, the digestive physiology of sloths remains poorly understood. Gastrointestinal disease has been reported as a primary or contributing cause of morbidity and mortality in captive two-toed and three-toed (Bradypus spp.) sloths. Gastric dilatation due to gas accumulation ("bloat") has been reported in sloths; however, a literature search failed to yield any published mention of gastric volvulus in any sloth species. Following an inquiry sent to the electronic mailing lists of the American Association of Zoo Veterinarians, the European Association of Zoo and Wildlife Veterinarians, and the LatinVets community, three cases of fatal gastric dilatation and volvulus (GDV) were identified in one male and two female Linnaeus's two-toed sloths from institutions in the United States, Canada, and Germany. All cases occurred in juvenile sloths <1 yr of age. Two animals were primarily hand reared, whereas one was reared primarily by its dam. Two animals were found dead with no overt premonitory signs, whereas one animal died following a 3-wk course of waxing and waning clinical signs consistent with gastric gas accumulation. In all cases, GDV was diagnosed on postmortem examination. Similar to other species, the condition is likely subsequent to a combination of host- and husbandry-related contributing factors. Further research into sloth husbandry is required in order to take an evidence-based approach to their management.

Left and right displaced abomasum and abomasal volvulus: comparison of clinical, laboratory and ultrasonographic findings in 1982 dairy cows.

BACKGROUND: Although left and right displacement of the abomasum and abomasal volvulus are well-known disorders of cattle, a comparative evaluation of the clinical, laboratory and ultrasonographic findings of these types of abomasal displacements has not been undertaken. Therefore, the objective of this study was to compare these conditions in a large population of cows. The medical records of 1982 dairy cows with left displaced abomasum (LDA, n = 1341), right displaced absomasum (RDA, n = 338) and abomasal volvulus (AV, n = 303) were searched for the results of clinical, laboratory and ultrasonographic evaluations. RESULTS: The main clinical findings were an abnormal demeanour in 48.2% of the cows, reduced rumen motility in 89.7% and decreased intestinal motility in 61.1%. Ballottement and simultaneous auscultation and percussion and simultaneous auscultation were positive on the left side in 96.9% of the cows with LDA and on the right in 98.5% of the cows with RDA and in 99.3% of the cows with AV. Ultrasonography was useful for diagnosing LDA in 97.9% of the cows and RDA/AV in 90.2% of the cows. The laboratory findings characteristic of abomasal reflux syndrome varied in severity; 83% of the cows had hypokalaemia, 67% had increased rumen chloride concentration, 67% had an increased base excess and 50% had haemoconcentration. Based on the clinical signs, a definitive diagnosis was made in 75.0% of the cows with LDA and in 22.5% of the cows with RDA/AV. Ultrasonography was required for a definitive diagnosis in another 22.0% of the cows with LDA and in 53.0% of the cows with RDA/AV. Laparotomy or postmortem examination was required for reliable differentiation of RDA and AV. CONCLUSIONS: LDA, RDA and AV differ with respect to the severity and the frequency of several abnormal clinical, laboratory and ultrasonographic findings as well as the methods required for a diagnosis.

Large Colon Volvulus in a Neonatal Foal Secondary to Atresia Coli.

An 18 hours old foal presented with a suspected meconium impaction. There was no response to treatment and a tentative diagnosis of atresia coli (AC) was made. Surgical intervention was declined and the foal was euthanized 12 hours after admission. Type 3 AC was confirmed on post-mortem examination, with the colon ending at the left ventral colon. A 1,080 large colon volvulus (LCV) at the sternal flexure was present. It is speculated that AC could predispose the foal to LCV. Histopathology was not performed but would be useful in further cases of AC.

Early career clinicians euthanize more dogs with nontraumatic hemoabdomen but not gastric dilatation and volvulus than more experienced clinicians.

OBJECTIVE: To determine if clinician experience influenced the euthanasia rate in 2 common surgical emergencies. ANIMALS: 142 dogs with nontraumatic hemoabdomen (NTH) due to suspected ruptured splenic mass and 99 dogs with gastric dilatation-volvulus (GDV) where the owner either elected surgery or euthanasia. PROCEDURES: Medical records were reviewed for dogs that had either NTH or GDV. For each patient, the owner's decision to pursue euthanasia versus surgery was recorded. The primary clinician was categorized as an intern, defined as a clinician with < 12 months experience, or a non-intern, defined as a clinician with more than 12 months experience. The euthanasia rates were compared used a Fisher exact, and the 95% CI was calculated for the risk of euthanasia if the primary clinician was an intern compared with a non-intern. If a difference was identified, subgroups comparing time of day, referral status, age, Hct, total solids, lactate, and heart rate were evaluated using a t test with a Bonferroni correction for the continuous variables and a Fisher exact for categorical variables. RESULTS: For dogs with NTH, the euthanasia rate for cases primarily managed by non-interns (52%) was significantly lower than that of interns (76%; P = .005). The relative risk of euthanasia associated with NTH when the case was treated by an intern was 1.44 with a 95% CI of 1.1229 to 1.8567. For 99 dogs with GDV, the rate of euthanasia was not different between interns and non-interns. CLINICAL RELEVANCE: The euthanasia rate for dogs with NTH may be impacted by the level of experience of the clinician. Support of new clinicians during challenging conversations should be provided.

Counterclockwise gastric dilatation and volvulus in a dog.

A 6-year-old neutered male golden retriever mix dog was presented for investigation of acute restlessness, increased respiratory effort, non-productive retching, and anorexia. Initial abdominal radiography revealed marked gastric dilation with a normal gastric shape and position, along with mineralized granular material in the pyloric region, consistent with a pyloric outflow obstruction secondary to suspected sand impaction. The dog was stabilized with gastric trocharization and medical management with intravenous fluids, antiemetics, polyethylene glycol via a nasogastric tube, and analgesia was initiated. The dog developed aspiration pneumonia during hospitalization and became oxygen-dependent. There was no significant improvement of clinical status despite 72 h of medical management, and surgical intervention was subsequently recommended. Exploratory laparotomy revealed a counterclockwise gastric dilatation and volvulus. The stomach was repositioned into normal anatomic position and an incisional gastropexy was performed. The dog was maintained in the intensive care unit for 4 d postoperatively. Currently, 3 mo postoperatively, the dog is healthy without recurrence of clinical signs. Key clinical message: Counterclockwise gastric dilatation and volvulus is a rare condition in veterinary medicine; however, it should be considered in a patient with acute gastric distension and signs of pyloric outflow obstruction when characteristic radiological signs of clockwise gastric dilatation and volvulus are absent, and there is radiological evidence of persistent gastric foreign material despite medical management. Misdiagnosis of counterclockwise gastric dilatation and volvulus can delay definitive surgical intervention and lead to higher morbidity and mortality.

Dilatation gastrique dans le sens inverse des aiguilles d'une montre et volvulus chez un chien. Un chien golden retriever mâle castré âgé de 6 ans a été présenté pour évaluation à la suite d'agitation aiguë, d'un effort respiratoire accru, des haut-le-coeur non productifs et d'anorexie. La radiographie abdominale initiale a révélé une dilatation gastrique marquée avec une forme et une position gastrique normales, ainsi qu'un matériau granulaire minéralisé dans la région pylorique, compatible avec une suspicion d'obstruction de l'écoulement pylorique secondaire à une impaction par du sable. Le chien a été stabilisé avec une trocarisation gastrique et une prise en charge médicale avec des fluides intraveineux, des antiémétiques, du polyéthylène glycol via une sonde nasogastrique, et une analgésie a été initiée. Le chien a développé une pneumonie par aspiration pendant l'hospitalisation et est devenu dépendant de l'oxygène. Il n'y a pas eu d'amélioration significative de l'état clinique malgré 72 h de prise en charge médicale et une intervention chirurgicale a été recommandée. La laparotomie exploratrice a révélé une dilatation gastrique dans le sens inverse des aiguilles d'une montre et un volvulus. L'estomac a été repositionné en position anatomique normale et une gastropexie incisionnelle a été réalisée. Le chien a été maintenu en unité de soins intensifs pendant 4 jours après l'opération. Actuellement, 3 mois après l'opération, le chien est en bonne santé sans récidive des signes cliniques.Message clinique clé :La dilatation dans le sens inverse des aiguilles d'une montre et le volvulus gastriques sont une affection rare en médecine vétérinaire; cependant, cela doit être envisagé chez un patient présentant une distension gastrique aiguë et des signes d'obstruction de l'écoulement pylorique en l'absence de signes radiologiques caractéristiques de dilatation gastrique dans le sens des aiguilles d'une montre et de volvulus, et en cas de preuve radiologique de corps étranger gastrique persistant malgré la prise en charge médicale. Un diagnostic erroné de dilatation gastrique dans le sens inverse des aiguilles d'une montre et de volvulus peut retarder l'intervention chirurgicale définitive et entraîner une morbidité et une mortalité plus élevées.(Traduit par Dr Serge Messier).

Outcomes of dogs undergoing surgery for gastric dilatation volvulus after rapid versus prolonged medical stabilization.

OBJECTIVE: To compare the outcomes of dogs surgically treated for gastric dilatation volvulus (GDV) after rapid versus prolonged medical stabilization. STUDY DESIGN: Prospective cohort study, monoinstitutional. SAMPLE POPULATION: One hundred and sixty-two dogs with GDV. METHODS: Dogs presenting with a GDV were allocated to 1 of 2 groups, immediate or delayed. In the immediate group, dogs were stabilized for 90 min prior to undergoing surgery. In the delayed group, dogs underwent surgery after at least 5 h of stabilization. Medical stabilization included gastric decompression and placement of an indwelling nasogastric tube to prevent further gastric dilatation in all dogs. Short-term outcomes were compared between surgical timings by univariate and multivariate analyses. RESULTS: Dogs (n = 89) in the immediate group underwent surgery a median time of 2.1 h after presentation (range 1.9-2.5 h), whereas those in the delayed surgery group (n = 73) were operated a median time of 9.8 h (range 5.4-13.7 h) after presentation. Survival rates did not differ between dogs undergoing immediate or delayed surgery at discharge (70/89 and 60/73, respectively) or at 1 month postoperatively (68/89 and 55/73, respectively). The degree of gastric torsion was differently distributed between the 2 groups (P = .05). In the immediate group, 19, 52, and 9 dogs had a 0°, 180° and 270° gastric torsion respectively, whereas in the delayed group, 27, 32, and 5 dogs had a 0°, 180° and 270° gastric torsion respectively. Hyperlactatemia 24 h after initiation of fluid therapy was associated with an increased in-hospital mortality risk and at 1 month postoperatively. CONCLUSION: No survival benefit was detected as a result of proceeding to surgery after either a rapid or a prolonged medical stabilization. CLINICAL SIGNIFICANCE: The aggressive stabilization and monitoring protocol described here can be considered as an alternative to stabilize dogs with GDV prior to surgery within 13.7 h of presentation. Further research is required to investigate the potential risks and benefits of prolonged over rapid stabilization and to identify candidates for each approach.

Updated Information on Gastric Dilatation and Volvulus and Gastropexy in Dogs.

Gastric dilatation and volvulus (GDV) is an acute, life-threatening syndrome of dogs, particularly large and giant breeds with a deep chest conformation. Rapid diagnosis is important for prompt initiation of stabilization therapy and surgical correction. Negative prognostic factors include hyperlactatemia not responding to fluid therapy, gastric perforation, or need for splenectomy or gastric resection. Gastropexy is essential for all dogs affected by GDV, following correct gastric repositioning. Prophylactic gastropexy for at-risk breeds can be performed via minimally invasive laparoscopic surgery.

Effects of the Administration of Different Buffered Balanced Crystalloid Solutions on Acid-Base and Electrolyte Status in Dogs with Gastric Dilation-Volvulus Syndrome: A Randomized Clinical Trial.

OBJECTIVE: To investigate the effect of three different buffered balanced crystalloid solutions on acid-base status and electrolyte concentrations in dogs with gastric dilation-volvulus (GDV) syndrome. METHODS: The study design was a prospective, randomized clinical trial of 40 dogs. The dogs were randomly assigned to one of three groups according to the fluid used: Hartmann's solution (H), Plasmalyte (PL), and Ringerfundin (RF). Hemoglobin, albumin, lactate, electrolyte, and acid-base parameters were determined before fluid administration (T0) and at the end of surgery (T1). Results were assessed by one-way ANOVA, Fisher's exact test, the Wilcoxon signed-rank test, the Kruskal-Wallis test, and a linear mixed-effect regression model. A significance level of 0.05 was used in all analyses. RESULTS: Bicarbonate and base excess (BE) levels increased and chloride concentration decreased in the PL group; in contrast, strong ion difference apparent (SIDapp) decreased and chloride concentration increased in the RF group. The mixed-effect model confirmed a significant interaction between the type of solution and time on the changes in bicarbonate, BE, anion gap (AG), SIDapp, and chloride levels. CLINICAL SIGNIFICANCE: Significantly different effects in acid-base parameters were observed in dogs after intravenous administration of H, PL, and RF. However, clinical significance of these changes is lacking, requiring further investigation in a larger randomized controlled clinical trial.

Assessment of hemostasis in dogs with gastric-dilation-volvulus, during resuscitation with hydroxyethyl starch (130/0.4) or hypertonic saline (7.5%).

OBJECTIVE: To compare the impact of an IV bolus of hydroxyethyl starch 130/0.4 (HES) or hypertonic saline 7.5% (HS) on hemostasis in dogs resuscitated for gastric-dilation-volvulus (GDV). DESIGN: Open-label, parallel-group randomized clinical trial. ANIMALS: Twenty-three client-owned dogs. INTERVENTIONS: Dogs affected by GDV and shock were randomly assigned to receive HES at 10 mL/kg or HS at 4 mL/kg every 15 minutes. Blood samples were collected for blood gas analysis, PCV, total plasma protein, albumin, standard coagulation profile, and thromboelastometry (ROTEM) at baseline (T0) and at the end of bolus (T1). To assess the differences between the 2 groups at T1, Student's t-test or Wilcoxon rank-sum test was used. To evaluate the differences between T0 and T1, ANOVA for paired data or Wilcoxon matched-pairs signed-ranks test was used. P < 0.05 was considered significant. MEASUREMENT AND MAIN RESULTS: Hemostasis was evaluated by means of prothrombin time, activated partial thromboplastin time, fibrinogen, and ROTEM. The study included 13 dogs in the HES group and 10 dogs in the HS group. Differences were found between groups at T1: increase in clotting time (P = 0.018) and decrease in fibrinogen level (P = 0.021) in the HS-treated group. Between T0 and T1, there were differences for the HES group: increase in clot formation time (P = 0.046), decrease in maximum clot firmness (P = 0.002) in ex-TEM profile, and decrease in maximum clot firmness (P = 0.0117) in fib-TEM profile. Between T0 and T1, the following differences were noted for the HS group: increase in clotting time (P = 0.048) and clot formation time (P = 0.0019), decrease in maximum clot firmness (P = 0.031) and α angle (P = 0.036) in ex-TEM profile, decrease in α angle (P = 0.036) in in-TEM profile, and decrease in maximum clot firmness (P = 0.017) in fib-TEM profile. CONCLUSION: In dogs affected by GDV, HES or HS infusion caused a similar tendency toward hypocoagulability, with few differences between the 2 groups.

Gastric and Large Colon Impactions Combined With Aggressive Enteral Fluid Therapy May Predispose to Large Colon Volvulus: 4 Cases.

To resolve large colon impactions, frequent enteral administration of large volumes of water (8-10 liters in a 500 kg horse) has been suggested. Furthermore, in large colon volvulus, the simultaneous presence of gastric impaction has been described as a possible predisposing factor. To describe the clinical and surgical features of horses with large colon volvulus associated with aggressive enteral fluid therapy performed to resolve an initial large colon impaction. Records of horses that underwent exploratory laparotomy at the Veterinary Teaching Hospital of Turin between 2012-2019 were reviewed. Clinical and surgical features of cases initially diagnosed with large colon impaction that developed a large colon volvulus after enteral administration of large volumes of fluids were retrieved. Four horses met the criteria. In all horses an initial diagnosis of large colon impaction was made by the referring veterinarian. In all cases a sudden increase in pain was noticed shortly after enteral administration of large volumes (8-10 liters) of water. Administration of analgesic didn't resolve the pain in any of the horses that were then referred. A large colon volvulus was found during exploratory laparotomy in all cases. A moderate gastric impaction was also found intraoperatively, which was confirmed by gastroscopy postoperatively. Nasogastric administration of large quantity of fluids with a pre-existing gastric and colon impaction, may reduce the available space in the abdominal cavity and potentially predispose the colon volvulus. More frequent enteral administration of smaller volumes of fluids might be preferred when treating large colon impactions.

Pet health insurance reduces the likelihood of pre-surgical euthanasia of dogs with gastric dilatation-volvulus in the emergency room of an Australian referral hospital.

AIMS: To determine the association between the presence of pet health insurance and the risk of euthanasia at the time of diagnosis for dogs with gastric dilatation-volvulus (GDV). METHODS: Insurance status at the time of GDV diagnosis was sought for a cohort of 147 non-referred, confirmed cases of GDV that presented to the emergency department of a university-based veterinary hospital in Australia between 2008 and 2017. Insurance status was obtained from the medical record (n=18) or after contacting the owners by phone using a standardised questionnaire (n=129). Animal, clinical and outcome data was retrospectively compiled in a research database. The primary outcome measure was whether or not the dog was euthanised before surgery. The Mantel-Haenszel procedure was used to quantify the association between the presence of pet health insurance and the risk of euthanasia at the time of diagnosis for dogs with GDV, adjusting for the confounding effect of age at the time of presentation using Bayesian methods. RESULTS: Of the 69 dogs for which insurance information could be obtained, 10 (14%) cases were insured at the time of the GDV event and 59 (86%) cases were not. The majority of non-insured dogs (37/59; 63 (95% CI=50-74)%) were euthanised before surgery, while none (0 (95% CI=0-28)%) of the insured dogs were euthanised at that time (p<0.001). Of the 32 insured and non-insured dogs that underwent surgery, four dogs (13 (95% CI=5-28)%) did not survive to hospital discharge. Three dogs (9%) were euthanised during or after surgery and one dog (3%) experienced cardiopulmonary arrest during treatment. The majority of dogs for which insurance status was known did not survive to hospital discharge (41/69; 59%), and 90 (95% CI=7-96)% of deaths were caused by euthanasia prior to surgery. Uninsured dogs were 5.0 (95% credible interval=1.8-26) times more likely to undergo presurgical euthanasia compared with insured dogs. CONCLUSIONS: Euthanasia prior to treatment was most common cause of death in non-referred dogs with GDV; such euthanasia was entirely absent in the cohort of dogs that were insured. CLINICAL RELEVANCE: Financial considerations significantly contribute to mortality of dogs with GDV presented to an emergency room. Financial instruments to reduce the out-of-pocket expense for pet owners confronted with unexpected veterinary expenses have potential to reduce pet mortality.

Redundant mesocolonic mesentery in a Shire colt.

An unusual condition in a 3-month-old Shire colt presented for colic unresponsive to medical therapy is documented in this report. A redundant mesocolonic mesentery resulting in intestinal displacement and volvulus was diagnosed during exploratory celiotomy. The finding was presumed to be congenital, resulting in a loose anatomic configuration that predisposed the intestine to displacement, torsion, volvulus, and entrapment. Key clinical message: This case demonstrates that congenial anatomical anomalies should be included in the differential of younger animals presented for recurrent conditions and highlights the use of exploratory celiotomy to reach a definitive diagnosis.

Mésentère mésocolique redondant chez un poulain Shire. Un état inhabituel chez un poulain Shire âgé de 3 mois présenté pour colique qui ne répondait pas à un traitement médical est présenté dans ce rapport. Un mésentère mésocolique redondant entraînant un déplacement intestinal et un volvulus a été diagnostiqué au cours d'une céliotomie exploratoire. La découverte était présumée congénitale, entraînant une configuration anatomique lâche qui prédisposait l'intestin au déplacement, à la torsion, au volvulus et au coincement.Message clinique clé:Ce cas démontre que les anomalies anatomiques congéniales doivent être incluses dans le diagnostic différentiel des jeunes animaux présentés pour des conditions récurrentes et met en évidence l'utilisation de la céliotomie exploratoire pour parvenir à un diagnostic définitif.(Traduit par Dr Serge Messier).

Colon volvulus in rhesus macaques (Macaca mulatta) at the Oregon National Primate Research Center-Retrospective analysis.

Colonic volvulus is an uncommon, often life-threatening condition, in non-human primates. Twenty-six cases of colonic volvulus in rhesus macaques (Macaca mulatta) were identified in necropsy records spanning 38 years at the Oregon National Primate Research Center (ONPRC). This report represents the largest collection of colonic volvuli in rhesus macaques.

Evaluation of a staged technique of immediate decompressive and delayed surgical treatment for gastric dilatation-volvulus in dogs.

OBJECTIVE: To evaluate a staged technique of immediate decompressive and delayed surgical treatment for gastric dilatation-volvulus (GDV) in dogs. ANIMALS: 41 client-owned dogs with confirmed GDV from 2012 through 2016. PROCEDURES: Medical record data were collected regarding patient signalment, diagnostic test results, gastric lavage findings, surgical findings, and short-term survival status. For all dogs, gastric decompression was performed by orogastric intubation and gastric lavage in the same anesthetic episode. If this stage was successful, subsequent corrective surgery (laparotomy and gastropexy) was delayed and performed in a second anesthetic episode. RESULTS: 6 dogs underwent corrective surgery in the same anesthetic session as for decompression and stabilization, 2 of which had gastric necrosis. Thirty-five dogs underwent corrective surgery in a second anesthetic episode a mean of 22.3 hours (range, 5.25 to 69.75 hours) after presentation, during which gastric necrosis was identified in 2 dogs. The mortality rate for delayed-surgery patients was 9% (3/35). Time from presentation to surgery was not associated with surgeon subjective assessment of gastric health status or mortality rate. Intraoperative identification of gastric necrosis was associated with nonsurvival. Single plasma lactate concentrations and percentage change in serial lactate concentrations were associated with intraoperative gastric health status and mortality rate. CONCLUSIONS AND CLINICAL RELEVANCE: The observed mortality rate for delayed-surgery patients was comparable to rates reported for other GDV treatment techniques. Results suggested that delaying corrective surgery is possible for certain dogs, but careful case selection would be important and no reliable preoperative case selection criteria were identified. Additional research is needed to further investigate the potential risks and benefits of staged versus immediate surgical treatment of GDV in dogs.

Comparison of histomorphometric characteristics of dorsal colon and pelvic flexure biopsy specimens obtained from horses with large colon volvulus that underwent resection.

OBJECTIVE: To determine the degree of histomorphometric damage in dorsal colon and pelvic flexure biopsy specimens (DCBSs and PFBSs, respectively) obtained from horses with large colon volvulus (LCV) and assess the accuracy of predicting short-term outcome for those horses on the basis of DCBS or PFBS characteristics. ANIMALS: 18 horses with ≥ 360° LCV that underwent large colon resection. PROCEDURES: During surgery, biopsy specimens from the dorsal colon resection site and the pelvic flexure (when available) were collected from each horse. Interstitial-to-crypt (I:C) ratio (ratio of the lamina propria space occupied by the interstitium to that occupied by crypts), hemorrhage within the lamina propria (mucosal hemorrhage score [MHS] from 0 to 4), and percentage losses of glandular and luminal epithelium were determined in paired biopsy specimens and compared to determine optimal cutoff values for calculating the accuracy of DCBS and PFBS characteristics to predict short-term outcome (survival or nonsurvival after recovery from surgery). RESULTS: Paired biopsy specimens were obtained from 17 of the 18 horses. The I:C ratio and percentage glandular epithelial loss differed between DCBSs and PFBSs. For DCBSs, an I:C ratio ≥ 0.9 and MHS ≥ 3 each predicted patient nonsurvival with 77.8% accuracy. For PFBSs, an I:C ratio ≥ I and MHS ≥ 3 predicted patient nonsurvival with 70.6% and 82.4% accuracy, respectively. CONCLUSIONS AND CLINICAL RELEVANCE: Although different, histomorphometric measurements for either DCBSs or PFBSs could be used to accurately predict short-term outcome for horses with LCV that underwent large colon resection, and arguably PFBSs are easier to collect.