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Comparison of surgically treated large versus small intestinal volvulus
A D VAN C ES
Comparison of Surgically Treated Large Versus Small Intestinal Volvulus Background Intestinal volvulus is the pathologic twisting of a section of bowel around its mesenteric attachment site. Small and large intestinal volvulus is most common in horses, cattle, swine, and humans. The condition occurs uncommonly in dogs and cats, with small intestinal volvulus occurring more commonly than large intestinal volvulus. Intestinal volvulus is a life-threatening condition which warrants medical stabilization and surgical intervention. This pathologic condition results in luminal obstruction and vascular compromise, leading to ischemia, necrosis of the affected bowel segment, and subsequent circulatory shock. The exact etiology of intestinal volvulus is unknown, and it has been associated with numerous underlying causes. The severity of clinical signs is relative to the degree and duration of the volvulus, and clinicopathologic findings are often nonspecific. Successful management requires decompression and anatomic correction of the affected bowel, followed by intensive supportive care. Further surgical treatments include resection and anastomosis of any devitalized intestinal segments followed by left abdominal wall colopexy if the affected segment includes large intestine. Despite early surgical intervention, the condition may result in death as a result of endotoxemia and circulatory shock. According to the previous literature, both small and large intestinal volvulus are associated with an extremely high mortality rate, with only a few reports of successful management. Thus, owners are often given a poor prognosis for survival when one of these conditions is suspected.
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A D VAN C ES
Objectives To evaluate the outcome of dogs with surgically corrected large versus small intestinal volvulus.
Procedure Medical records from multiple sites were searched for dogs that were diagnosed with large and small intestinal volvulus between October 2009 and February 2014. Criteria for inclusion in this study were that dogs had evidence of either large or small intestinal gas distention on radiographs and have a confirmation of either large or small intestinal volvulus on abdominal exploratory. Each medical record was reviewed, and the following information was examined: signalment, previous medical history, presenting complaint, clinical signs, clinicopathologic data, radiology results, surgical treatment date and description, length of hospitalization, and clinical outcome. All owners were contacted to inquire on the status and health of each dog in order to determine outcome following hospital discharge.
Results Fifteen dogs met the inclusion criteria between October 2009 and February 2014. All cases were admitted for diagnostics and supportive care. Diagnostics included abdominal radiographs in all cases. For the large intestinal volvulus group, all radiographs were suspicious for large intestinal volvulus, with the exception of one case in which the radiographs were more consistent with small intestinal volvulus than large intestinal volvulus. For the small intestinal volvulus group, five of the six cases had small intestinal volvulus listed as a primary differential diagnosis. Radiographs on one of the six cases listed small intestinal foreign body as the most likely diagnosis and did not list volvulus as a rule-out. All dogs in both groups who recovered from surgery were maintained in the hospital postoperatively. All were maintained on supportive care including intravenous fluid therapy, pain medication, and antibiotics. Other treatments varied by institution. For the large intestinal volvulus group, all dogs were discharged from the hospital. For the small intestinal volvulus group, only one of the six animals was
ischarged from the hospital and was alive d at last phone follow-up.
Author Conclusions Successful management of large intestinal volvulus is possible, and this study suggests that the survival rate is very good compared to the survival rate for dogs with small intestinal volvulus, which is poor. Given this information, if intestinal volvulus is suspected based on clinical history and radiographic findings, surgical exploratory should be performed in order to confirm the diagnosis and provide owners with an appropriate prognosis
Inclusions Six figures, 6 tables, 12 references.
Editor Annotation Intestinal volvulus is an uncommon but very serious condition. Like gastric dilatation volvulus (GDV), it is considered a surgical emergency. However, unlike GDV, the clinical presentation and radiographic findings for intestinal volvulus may not be as obvious. Though intestinal volvulus can occur in dogs of many breeds and ages, German Shepherds seem to be over-represented both in the literature and my own clinical experience. Intestinal volvulus should be considered a differential diagnosis in any patient with signs of acute abdominal distress, especially in cases with marked gas dilation of the intestine and/ or displacement of the large intestine. Vomiting and tenesmus appear to be common clinical signs. When these conditions are suspected, rapid stabilization and surgical intervention are recommended for the best outcomes. Historically, intestinal volvulus was believed to have a poor prognosis. In some cases, this may negatively influence an owner’s decision to pursue surgery. However, as evidenced by this small case series and others, large intestinal volvulus can have a good prognosis with surgery. On the other hand, small intestinal volvulus continues to have a more guarded to poor prognosis. Further study is necessary to investigate this difference, but it is possible that anatomic differences in blood flow between the small and large intestine or other factors play a role. (TW)
Journals Monitored • American Journal of Veterinary Research • Australian Veterinary Journal • Australian Veterinary Practitioner • Avian Diseases • British Veterinary Journal • Canadian Journal of Veterinary Research • Canadian Veterinary Journal • Journal of Avian Medicine and Surgery • Journal of the American Animal Hospital Association • Journal of the American Veterinary Medical Association • Journal of Small Animal Practice • Journal of Small Exotic Animal Medicine • Journal of Veterinary Dentistry • Journal of Veterinary Emergency and Critical Care • Journal of Veterinary Internal Medicine • Journal of Veterinary Pharmacology and Therapeutics • Journal of Zoo and Wildlife Medicine • New Zealand Veterinary Journal • Research in Veterinary Science • Veterinary and Comparative Orthopaedics and Traumatology • Veterinary Dermatology • Veterinary Immunology and Immunopathology • Veterinary Pathology • Veterinary Radiology & Ultrasound • Veterinary Record • Veterinary Research Communications • Veterinary Surgery ... and more than 20 others
Davis E, Townsend FI, et al. Comparison of surgically treated large versus small intestinal volvulus (2009-2014). JAAHA 2016;52:227-233.
Comparison of Surgically Treated Large Versus Small Intestinal Volvulus Background Intestinal volvulus is the pathologic twisting of a section of bowel around its mesenteric attachment site. Small and large intestinal volvulus is most common in horses, cattle, swine, and humans. The condition occurs uncommonly in dogs and cats, with small intestinal volvulus occurring more commonly than large intestinal volvulus. Intestinal volvulus is a life-threatening condition which warrants medical stabilization and surgical intervention. This pathologic condition results in luminal obstruction and vascular compromise, leading to ischemia, necrosis of the affected bowel segment, and subsequent circulatory shock. The exact etiology of intestinal volvulus is unknown, and it has been associated with numerous underlying causes. The severity of clinical signs is relative to the degree and duration of the volvulus, and clinicopathologic findings are often nonspecific. Successful management requires decompression and anatomic correction of the affected bowel, followed by intensive supportive care. Further surgical treatments include resection and anastomosis of any devitalized intestinal segments followed by left abdominal wall colopexy if the affected segment includes large intestine. Despite early surgical intervention, the condition may result in death as a result of endotoxemia and circulatory shock. According to the previous literature, both small and large intestinal volvulus are associated with an extremely high mortality rate, with only a few reports of successful management. Thus, owners are often given a poor prognosis for survival when one of these conditions is suspected.
Page 7
Page 8
A D VAN C ES
Objectives To evaluate the outcome of dogs with surgically corrected large versus small intestinal volvulus.
Procedure Medical records from multiple sites were searched for dogs that were diagnosed with large and small intestinal volvulus between October 2009 and February 2014. Criteria for inclusion in this study were that dogs had evidence of either large or small intestinal gas distention on radiographs and have a confirmation of either large or small intestinal volvulus on abdominal exploratory. Each medical record was reviewed, and the following information was examined: signalment, previous medical history, presenting complaint, clinical signs, clinicopathologic data, radiology results, surgical treatment date and description, length of hospitalization, and clinical outcome. All owners were contacted to inquire on the status and health of each dog in order to determine outcome following hospital discharge.
Results Fifteen dogs met the inclusion criteria between October 2009 and February 2014. All cases were admitted for diagnostics and supportive care. Diagnostics included abdominal radiographs in all cases. For the large intestinal volvulus group, all radiographs were suspicious for large intestinal volvulus, with the exception of one case in which the radiographs were more consistent with small intestinal volvulus than large intestinal volvulus. For the small intestinal volvulus group, five of the six cases had small intestinal volvulus listed as a primary differential diagnosis. Radiographs on one of the six cases listed small intestinal foreign body as the most likely diagnosis and did not list volvulus as a rule-out. All dogs in both groups who recovered from surgery were maintained in the hospital postoperatively. All were maintained on supportive care including intravenous fluid therapy, pain medication, and antibiotics. Other treatments varied by institution. For the large intestinal volvulus group, all dogs were discharged from the hospital. For the small intestinal volvulus group, only one of the six animals was
ischarged from the hospital and was alive d at last phone follow-up.
Author Conclusions Successful management of large intestinal volvulus is possible, and this study suggests that the survival rate is very good compared to the survival rate for dogs with small intestinal volvulus, which is poor. Given this information, if intestinal volvulus is suspected based on clinical history and radiographic findings, surgical exploratory should be performed in order to confirm the diagnosis and provide owners with an appropriate prognosis
Inclusions Six figures, 6 tables, 12 references.
Editor Annotation Intestinal volvulus is an uncommon but very serious condition. Like gastric dilatation volvulus (GDV), it is considered a surgical emergency. However, unlike GDV, the clinical presentation and radiographic findings for intestinal volvulus may not be as obvious. Though intestinal volvulus can occur in dogs of many breeds and ages, German Shepherds seem to be over-represented both in the literature and my own clinical experience. Intestinal volvulus should be considered a differential diagnosis in any patient with signs of acute abdominal distress, especially in cases with marked gas dilation of the intestine and/ or displacement of the large intestine. Vomiting and tenesmus appear to be common clinical signs. When these conditions are suspected, rapid stabilization and surgical intervention are recommended for the best outcomes. Historically, intestinal volvulus was believed to have a poor prognosis. In some cases, this may negatively influence an owner’s decision to pursue surgery. However, as evidenced by this small case series and others, large intestinal volvulus can have a good prognosis with surgery. On the other hand, small intestinal volvulus continues to have a more guarded to poor prognosis. Further study is necessary to investigate this difference, but it is possible that anatomic differences in blood flow between the small and large intestine or other factors play a role. (TW)
Journals Monitored • American Journal of Veterinary Research • Australian Veterinary Journal • Australian Veterinary Practitioner • Avian Diseases • British Veterinary Journal • Canadian Journal of Veterinary Research • Canadian Veterinary Journal • Journal of Avian Medicine and Surgery • Journal of the American Animal Hospital Association • Journal of the American Veterinary Medical Association • Journal of Small Animal Practice • Journal of Small Exotic Animal Medicine • Journal of Veterinary Dentistry • Journal of Veterinary Emergency and Critical Care • Journal of Veterinary Internal Medicine • Journal of Veterinary Pharmacology and Therapeutics • Journal of Zoo and Wildlife Medicine • New Zealand Veterinary Journal • Research in Veterinary Science • Veterinary and Comparative Orthopaedics and Traumatology • Veterinary Dermatology • Veterinary Immunology and Immunopathology • Veterinary Pathology • Veterinary Radiology & Ultrasound • Veterinary Record • Veterinary Research Communications • Veterinary Surgery ... and more than 20 others
Davis E, Townsend FI, et al. Comparison of surgically treated large versus small intestinal volvulus (2009-2014). JAAHA 2016;52:227-233.