Читать книгу Small Animal Surgical Emergencies - Группа авторов - Страница 242

A three‐year‐old male, neutered Great Dane was evaluated for a 24‐hour history of vomiting, diarrhea, inappetence, and lethargy. A physical examination was unremarkable. The owners elected symptomatic therapy and monitoring, including fasting and subcutaneous fluids, with a plan for recheck if vomiting and diarrhea persisted. Less than 12 hours later, lethargy and inappetence persisted, and the dog was reevaluated. At repeat presentation, the dog appeared dehydrated and painful during abdominal palpation. A tubular structure was palpated in the dorsal mid‐abdomen. Mucoid stool was noted on rectal examination. Abdominal radiographs were taken, and a small bowel obstructive pattern was seen with severe intestinal distension noted (Case Figure 9.1a). Abdominal exploration was recommended. Preoperative bloodwork revealed a mild metabolic acidosis. The remaining complete blood count and serum chemistry were unremarkable. At the time of surgery, the small bowel appeared cyanotic and an intestinal volvulus was identified and corrected. At the time of correction, the bowel appeared normal and viable. A prophylactic gastropexy was performed and the dog was recovered from anesthesia. The dog made an uneventful recovery other than a mild incisional infection that resolved with antibiotic therapy. Three years later, the dog was presented for evaluation of vomiting, diarrhea, inappetence, and lethargy of 12 hours' duration. On physical examination, the dog appeared dehydrated and was tachycardic. Gas distended loops of bowel and a possible mass in the left lateral mid‐abdomen were palpated. The abdomen did not seem painful. Abdominal radiographs were taken (Case Figure 9.1b,c), and marked gas and fluid distension of the bowel was noted. Intestinal volvulus was suspected. Given the prognosis associated with the disease and the dog's history prompting suspicion for recurrence, the owner requested humane euthanasia. Necropsy was declined.

Case Figure 9.1 Lateral abdominal radiograph of a Great Dane with severe, generalized distension of the intestines. Abdominal exploratory surgery was performed and an intestinal volvulus was identified and corrected (a). Three years later, the dog presented because of vomiting, diarrhea, inappetence, and lethargy of 12 hours duration. Two abdominal images were taken because of the large size of the dog (b and c). Marked gas and fluid distension of the bowel was noted. A recurrence of intestinal volvulus was suspected.

Abdominal radiographs are the most practically useful non‐invasive diagnostic tool aiding the diagnosis of intestinal volvulus. Patients typically have severe, prominent gaseous small bowel distension and may have loss of serosal detail (see Case Figure 9.1a). The distended bowel loops may lie parallel to each other and resemble a paralytic ileus [3, 6, 18, 20]. The stomach as well as the descending colon are often not dilated. Abdominal ultrasonography in humans has revealed a characteristic barberpole or whirlpool sign with mesenteric torsion, as the bowel loops encircle the mesenteric vasculature. [27, 28]. Similarly, computed tomography in humans demonstrates a characteristic “whirl sign”, which has also been reported in dogs [22, 29]. Definitive diagnosis is achieved at the time of abdominal exploration or necropsy.