Читать книгу Small Animal Surgical Emergencies - Группа авторов - Страница 240

Intestinal volvulus is a rare condition in small animal veterinary medicine, which limits available information to that which can be extrapolated from case reports and retrospective studies [13–21]. The condition is found primarily in dogs, although a few case reports affecting cats have been published [4, 13, 17]. In dogs, the condition is more commonly found in large breeds, with a higher incidence reported in German Shepherds [12] and English Pointers [9] and rare reports in small breeds [14, 16].

The history associated with presentation is typically considered to be acute to peracute and is often non‐specific (Figure 9.3). Clinical signs include weakness, restlessness, lethargy, recumbency, hematachezia, emesis, hematemesis, diarrhea, abdominal pain, abdominal distension, and/or shock [3, 9, 15].

In most patients, physical examination reveals some degree of hypovolemic, septic, or toxic shock, depending on the duration of clinical signs [15]. Pale mucous membranes, tachycardia, prolonged capillary refill times, and weak peripheral pulses are common findings [12]. Abdominal pain and distension are typical, although not pathognomonic [18, 20].

Differential diagnoses that may present in a manner similar to intestinal volvulus include gastric dilatation and volvulus, intussusception, hemorrhagic gastroenteritis, viral gastroenteritis, intestinal foreign body obstruction, and trauma. While cause and effect is impossible to establish definitively owing to the paucity of reports in the literature, cases of intestinal volvulus have been reported to occur concurrent with other gastrointestinal diseases such as foreign body ingestion, parvovirus, gastric dilatation and volvulus, pancreatic insufficiency, lymphocytic–plasmacytic enteritis, ileocolic neoplasia, previous abdominal surgeries, congenital malformations, and trauma [6, 9, 10, 12, 16, 22]. While a relationship among these conditions is only speculative, identification of intestinal volvulus should prompt thorough evaluation for an underlying cause. One study demonstrates an association between intestinal volvulus and prior prophylactic gastropexy in a population of military working dogs [23]. Although rare, recurrence of intestinal volvulus is possible (Case Report 9.1).

Figure 9.1 Diagram of the visceral branches of the aorta with their principal anastomoses, ventral aspect.

Source: H Evans and A de Lahunta (eds.) [2]. Reproduced with permission from Elsevier.

Figure 9.2 Intraoperative photograph illustrating the classic appearance of intestinal volvulus. Note the obvious diffuse necrosis and distension of the bowel.