Ch. 92: Small Intestine Flashcards
DePompeo JAVMA 2018 poss pq
Intra-abdominal complications following intestinal anastomoses by suture & staple techniques in dogs
- dehiscence rates?
- subsequent dehiscence rates?
- any pre-op differences between the groups?
Dehiscence rates sutured 15% (12/93) and stapled 5% (4/87)
Subsequent dehiscence in 3/5 (60%) sutured vs 0/11 stapled anastomoses
No difference in serum albumin or preop septic peritonitis or anastomotic location
Gill JAVMA 2019 poss pq
Factors associated with dehiscence and mortality rates following GI surgery in dogs
- overall dehiscence? mortality rate?
- univariate lactate analysis?
- multivariate ASA analysis?
Overall dehiscence rate 5% ; mortality rate 5% (all dogs)
Univariate analysis: lactate increased with ASA status, increased lactate assoc w/ non-survival
Multivariate: ASA > 3 more likely dehiscence (18x) & dogs with ASA > 3 or high lactate less likely to survive
Strelchik JAVMA 2019 poss pq
Intestinal incisional dehiscence rate following enterotomy for FB removal in 247 dogs
- % dehiscence?
- dehiscence + non-survival?
- factors that were not associated with dehiscence?
Intestinal dehiscence in 2% (5/247) enterotomies, & only 2/5 of dehiscence didn’t survive to discharge
Nonsurvival to discharge S more common in dehiscence group vs non dehiscence
No S.A. between dehiscence and suture pattern, albumin, peritonitis, linear FB, location of incision, lactate, hypotension, neutrophils, sx experience, emergency
Sumner JAVMA 2019 poss pq
Evaluation of suture reinforcement for stapled intestinal anastomoses: 77 dogs (2008-2018)
- % dehiscence oversew vs. not?
- what blood work finding was higher in oversewn FEESA?
0 % oversewn dehisced, 15% nonoversewn dehisced
higher preop albumin and lower postop dehiscence rate for dogs with oversewn FEESA
Oversewing the transverse staple line in FEESA was associated with a reduced occurrence of postoperative dehiscence.
Lopez JAVMA 2021
Comparison of patient outcomes following enterotomy versus intestinal resection and anastomosis for treatment of intestinal foreign bodies in dogs
- dehiscence rates?
- ASA score + dehiscence?
- age + dehiscence?
183 single enterotomy, 44 single IRA
Dehiscence rate
Enterotomy = 5%
IRA = 20%
ASA score >3 and older age were associated with greater odds of intestinal dehiscence regardless of sx
Each year increase in age, the odds of dehiscence increased by 1.24
Anderson JSAP 2021
Outcome following surgery to treat septic peritonitis in 95 cats in the United Kingdom
- overall survival rate?
- hypotension + survival?
- abdominal mass or previous dehiscence - Px?
overall survival rate of 66%
intra op hypotension showed an ~82% decrease in the odds of survival
The presence of an abdominal mass or having dehiscence of a previous GI surgery did not confer a worse prognosis
Hoffman JVECC 2022
Retrospective evaluation of gastrointestinal foreign bodies and presurgical predictors for enterectomy versus enterotomy in dogs (2013-2016): 82 cases
list of PE, imaging, and sx findings more likely to need enterectomy?
More likely to require enterectomy:
- longer median duration illness (4 days vs 2 days for EO)
- higher median vomiting score (3 vs 2 for EO)
- altered peritoneal detail on rads
- echogenic peritoneal effusion on AUS
- perforation on ultrasound
- hyperechoic fat on AUS
- linear FB in sx
- perforation in sx
- devitalized bowel in sx
- higher HR
Each beat per minute increase in heart rate above EO group’s mean (119 bpm) increased the odds of an EC being performed by 1.07 times
Odds to receive an EC increased by 5.6 times for each tier of vomiting score
Brand Vet Sx 2019
Effects of needle gauge and syringe size on small intestinal leakage at injection sites
Protective effect for 22g needles both 5 & 10 cm segments
Injection of 20 ml higher odds ratio of leakage vs injection of 10 ml and 12 ml in 5 cm segments
Duffy Vet Sx 2020 poss pq
Ex vivo comparison of the effect of storage temperature on canine intestinal leakage pressures
- initial leak pressure fresh vs. chilled vs. frozen-thawed?
- difference in intraluminal pressure?
- leak location?
Mean Initial LP for fresh 52.9 mmHg, chilled 51.8 mmHg, frozen-thawed 29.8mmHg
No difference in max intraluminal pressure between groups
Major difference in leakage location
- chilled/freeze: suture holes
- fresh: incisional line
Fealey Vet Sx 2020
Initial leak pressures of 4 anastomosis techniques in cooled cadaveric canine jejunum
list pressures
ILP medians:
- control 331.8mmHg
- hand-sewn 35.17mmHg
- barbed suture 25mmHg
- FEESA 28.8mmHg
- FEESA-oversew 35.9mmHg
Mullen Vet Sx 2020
Gastrointestinal thickness, duration, and leak pressure of six intestinal anastomoses in dogs
- what is thickest?
- ILP vs. peristaltic pressures?
- fastest to complete?
Stomach thicker than everything else
The ILP of all anastomoses exceeded maximum intraluminal peristaltic pressures.
Stapled anastomoses were faster to complete
Duffy Vet Sx 2020 poss pq
Influence of overseeing the transverse staple line during functional end-to-end stapled intestinal anastomoses in dogs
- impact of oversewing?
- Cushing vs. simple continuous?
Oversewing the transverse staple line after FEESA increased MLP and decreased the occurrence of leakage at this location.
Oversewing with a Cushing pattern increased ILP compared with oversew with a simple-continuous pattern
Chu Vet Sx 2020
Ex vivo comparison of leakage pressures and leakage location with a novel technique for creation of functional side-to-side canine small intestinal anastomoses
- were anastomoses made using EBVS?
- Histopath findings?
- how to increase ILP with EBVS anastomosis?
Functional side-to-side small intestinal anastomosis was consistently achieved with an EBVS device. Histological examination was consistent with collagenous fusion without cavitation defects.
Augmentation of EBVS anastomoses with simple interrupted sutures along the anastomotic fusion line increased ILP compared with stapled anastomoses
Duffy Vet Sx 2022 poss pq
Influence of barbed suture oversew of the transverse staple line during functional end-to-end stapled anastomosis in a canine jejunal enterectomy model
- types of suture? pattern?
- difference in ILP or MLP?
- speed?
All oversewn with Cushing pattern (Bison, unidirectional barbed, bidirectional barbed)
No differences were detected in ILP or MLP between the experimental groups
FEESAs closed with a transverse staple line oversew using barbed suture, regardless of barb orientation, were completed faster and resulted in similar resistance to anastomotic leakage compared to monofilament suture
Mullen JAVMA 2021
Evaluation of intraoperative leak testing of small intestinal anastomoses performed by hand-sewn and stapled techniques in dogs: 131 cases (2008-2019)
- % leak tested?
- which technique more likely to undergo leak testing?
- % dehiscence of those leak tested?
- did dehiscence differ b/w leak test and not?
Intraoperative leak testing was performed during 62/144 (43%) small intestinal anastomoses
Hand-sewn anastomoses were significantly more likely to undergo leak testing than FEESAs
Dehiscence occurred in 5 (8%) of the 62 anastomoses that underwent leak testing
No significant difference in dehiscence was noted between anastomoses that underwent intraoperative leak testing versus those that did not, regardless of anastomotic technique
Mullen Vet Sx 2021
Ex vivo comparison of leak testing of canine jejunal enterotomies: saline infusion versus air insufflation
- which leaked at lower pressures?
- which allowed for ID of location of leak?
Enterotomy closures leaked at lower pressures when injected with air compared to saline
Leakage location found for all air constructs and 14/25 saline constructs
Culbertson Vet Sx 2021
Intraoperative surgeon probe inspection compared to leak testing for detecting gaps in canine jejunal continuous anastomoses: a cadaveric study
- sensitivity? NPV?
- location ID’d?
Probing was 100% sensitive with a 100% negative predictive value at detecting gaps compared with leak testing
The location of all anastomotic leaks was accurately identified with PT and confirmed during LT
Chang Vet Sx 2021
Influence of preconstructed effector loop location using a barbed unidirectional suture on leakage pressures following canine enterotomy closure
- mean ILP between groups?
- difference in MIP?
- influence on repair time?
- leakage locations?
- where should effector loop be placed?
Mean ILP for 0mm group was lower compared to all experimental groups with ILP ~40% lower
No difference in MIP among groups
Repair time increased as the distance of the effector loop increased > 5 mm
Leakage from 0mm group at incisional line (75%) compared to suture holes in other groups
Effector loop location should be placed > or = 5mm from the beginning of the incisional line
Duffy Vet Sx 2022 poss pq
Influence of crotch suture augmentation on leakage pressure and leakage location during functional end-to-end stapled anastomoses in dogs
- 4 treatment groups
- initial leak pressure (order greatest-least)
- max leak pressure (order greatest-least)
- % leak at crotch for each group?
4 treatment groups
- no crotch (NCS)
- simple interrupted (SICS)
- Two simple interrupted (TCS)
- simple continuous (SCCS)
Initial leak pressure greater after placement of TCS and SCCS than NCS and SICS
Maximal leak pressure greater for SICS, TCS, and SCCS compared to NCS
Leakage - anastomotic crotch:
- 8/12 (66%) NCS
- 6/12 (50%) SICS
- 1/12 (8%) TCS
- 0/12 (0%) SCCS
Quitzan Vet Sx 2022
Influence of staple line number and configuration on the leakage of small intestinal functional end-to-end stapled anastomosis: an ex vivo study
- where was leakage most seen?
- where would benefit from 3 rows?
Placing 3 rows of staples in the transverse line (with or without a third row in the vertical staple line) improved resistance to leakage of FEESAs in normal cadaveric specimens
Smith JAVMA 2019
Retrospective study of survival time and prognostic factors for dogs with SI ACA treated by tumor excision w/ or w/o adjuvant chemotherapy (29 dogs)
- MST?
- influence of age on survival?
- variable NOT assoc. w/ survival?
Overall MST 544 d with 1 yr survival rate 60% and 2 yr survival rate 36%
Age = significant predictor of survival
- dogs < 8 yr age S longer MST (1193d)
- dogs > 8 yr (488d)
LN mets, chemotherapy, NSAID, and other variables not associated with survival times
Tidd Vet Sx 2019
Outcomes in 40 cats with discrete intermediate- or large-cell GI lymphoma masses treated with surgical mass resection (2005-2015)
- % survival to discharge?
- survival LI vs. SI?
- survival complete excision vs. not?
- impact of GI perf?
36/40 (90%) survived to discharge
Cats with LI masses lived S longer (675d) vs SI 64d and gastric 96d
Complete surgical excision positively associated with survival (370 vs 83d)
no S difference in MST for cats with GI perforation vs w/o
Lee_VRU 2023
CT findings may be useful for differentiating SI adenocarcinomas, lymphomas, & spindle cell sarcomas in dogs
CT findings for each tumor…
Adenocarcinomas tended to show endophytic growth, intestinal obstruction, & a heterogeneous enhancement pattern.
Lymphomas tended to show eXophytic growth, contrast enhancement of the intestinal tumor mucosal layer, a homogeneous enhancement pattern, & presence of abdominal lymphadenopathies.
SCSs tended to show lobulated growth, a large cystic portion w/in the tumor, a heterogeneous enhancement pattern, a large size w/ fat stranding sign, & lower HU values in postcontrast images.
De Magistris VRU 2023
CT features of gastrointestinal spindle cell, epithelial, & round cell tumors in 41 dogs
- growth pattern?
- lymphadenomegaly?
- mineralization?
The growth pattern was concentric (epithelial), eccentric (spindle cell) & mixed (round cell tumors)
Spindle cell tumors had the largest main volume & involved the outer GI layer w/ an unaffected inner layer
Leiomyosarcomas/GIST showed irregular margins compared to leiomyomas
Only lymphomas showed multifocal GI involvement
Lymphadenomegaly was: Widespread in lymphomas, Regional in leiomyosarcomas-GISTs & adenocarcinomas, Absent in leiomyomas
Mineralization more common in spindle and absent in lymphoma
Andrews JAVMA 2018
Investigation of potential risk factors for mesenteric volvulus in military working dogs
risk factors and odds ratio?
Risk factors associated with MV:
- German Shepherd breed (OR 11.5)
- increasing age (OR 2)
- hx of prophylactic gastropexy (37%) (OR, 65.9)
- hx of other abdominal surgery (after gastropexy & requiring new anesthetic episode) (OR 17)
- GI disease (OR 5.4)
Holloway VRUS 2019
US and histo features in 8 cats with fibrotic small intestinal stricture
- US findings?
- Histopath?
Ultrasonographic findings included
- gastric distension (8/8) and generalized (3/8) or segmental (5/8) intestinal dilation consistent with mechanical obstruction
- Wall thickening was mild to moderate (3-6 mm). Normal wall layering was disrupted in all cats.
- Strictures were predominantly hypoechoic (7/8) and associated with hyperechoic peri-intestinal mesentery (6/8)
Histopathology showed
- transmural disease with fibrosis and inflammation (8/8), often (6/8) extending into the bordering mesentery.
- mucosa was the most severely affected layer and epithelial injury accompanied the mucosal fibrosis/inflammation
Putterman Vet Sx 2019
CASE REPORT
Successful vascularized jejunal patch graft to treat severe orad duodenal injury secondary to foreign body obstruction in a dog
Vascularized jejunal graft incised on antimesenteric border creating rectangular segment, trimmed and sutured to duodenal recipient site as patch graft to repair defect
Recovered well without complications, w/I 2 weeks appetite & bowel movements normal, no episodes of vomiting, infrequent regurgitation resolve with medical management
Larose Vet Sx 2020
Clinical findings and outcomes of 153 dogs surgically treated for intestinal intussusceptions
- most common location?
- % intra-op complications?
- % post-op complications?
- % recurrence?
- 2-week mortality rate?
Single intussusception noted in 152 dogs; ICJ 43.1%
Intraoperative complications occurred in 10 of 153 (7%) dogs
Postoperative complications occurred in 53 of 153 (35%) dogs
intussusception recurred in 4/153 (3%) dogs, all within 72 hours postoperatively
Fourteen-day postoperative mortality rate was 6%
Maxwell Vet Sx 2020
Outcomes of dogs undergoing immediate or delayed surgical treatment for gastrointestinal foreign body obstruction: a retrospective study by the Society of Veterinary Soft Tissue Surgery
- % post-op complications for delayed sx?
- intestinal viability with delayed?
- impact on anesthesia/sx time when delayed?
- faster feeding and discharge?
- did overall outcome differ?
60% of post-op complications occurred in dogs that presented with clinical signs of > 3 days duration
Intestinal necrosis and perforations were more common when surgery was delayed
Enterectomies as well as the duration of surgery and anesthesia were increased when surgery was delayed
Immediate surgery was associated with earlier return to feeding and discharge from the hospital
Outcomes did not differ between dogs treated immediately or over 6 hours after presentation
Luce JAVMA 2022
Gastrointestinal foreign body obstruction is not associated with abnormal point-of-care pancreas-specific lipase test results in dogs
The proportions of abnormal SNAP cPL test results in the GIFBO and non-GIFBO groups were 12% (3/25) and 16% (4/25), respectively, with no significant difference
Turner JSAP 2021
Assessment of the clinical usefulness of ultrasound-guided cytological specimens obtained from gastrointestinal lesions in dogs and cats
- % clinically useful?
- what 2 factors increased usefulness?
67% were clinically useful
of slides and thickness of lesion were associated w/ clinically useful samples in univariate analysis
Farrell JVECC 2020
CASE REPORT
Gastrointestinal obstruction secondary to activated charcoal granule impaction in a dog
- initial presentation
- US findings
- Sx findings
Initially evaluated/treated for Carprofen toxicity
Discharged after 72 hours of hospitalization then re-presented 2 days later
US diagnosed obstruction due to foreign material, medical management failed
Sx found black granular foreign material consistent with charcoal granules
Pavlova JVIM 2021
Medical conditions associated with gastroduodenal ulceration or erosion in 168 dogs: 2008-2018
5 conditions…
- NSAID 6.3x
- Steroids 3.0x
- GI neoplasia 13.5x
- GI mechanical disease (FBs, GD, GDV) 4.8x
- Working dog breeds compared to mixed breeds 2.8x
Miles VRU 2021
Influence of repeat abdominal radiographs on the resolution of mechanical obstruction and gastrointestinal foreign material in dogs and cats
- % resolved based on location?
- # of animals that went to sx?
Radiographic resolution was dependent on location of dilation:
- 37.5% were gastric
- 17% SI
- 11% had gastric and SI obstruction
Forty-nine animals without resolution went to surgery
Puzio JVECC 2023
Delay of definitive care in cats and dogs with gastrointestinal foreign body obstruction following antiemetic administration: 537 cases (2012–2020)
- assoc w/ time to care?
- assoc w/ hospitalization?
- assoc w/ complications?
- contraindicated?
Antiemetic administration in patients with GIFBO was associated with increased time to definitive care and length of hospitalization but not GIFBO associated complications
Antiemetics not inherently contraindicated for suspected GIFBO
Mullen VSURG 2023
**Prospective, randomized, clinical trial **
A quantitative evaluation of the effect of foreign body obstruction and enterectomy technique on canine small intestinal microvascular health
- objective?
- microvascular density?
- conclusions?
- perfusion in handsewn vs. stapled?
To investigate sidestream dark field (SDF) videomicroscopy as an objective measure of intestinal viability and determine the effects of enterectomy techniques on intestinal microvasculature in dogs with foreign body obstructions.
Microvascular density (mean) at the site of obstruction (140.84) was lower than healthy controls (251.72).
There was no difference in microvascular parameters (density or perfused boundary region, PBR) between obstructed dogs with subjectively viable and nonviable intestine
Conclusion: SDF videomicroscopy can identify obstructed intestine and quantitate the severity of microvascular compromise (note, unable to establish quantitative guidelines to differentiate viable from nonviable intestine)
Handsewn and stapled enterectomies equally preserve perfusion
Hiebert JFMS 2022 poss pq
Intestinal dehiscence and mortality in cats undergoing gastrointestinal surgery
- % dehiscence?
- % mortality w/i 10 days?
- 2 factors that increased mortality?
Complications: 1/126 = 0.8% (GI dehiscence)
23 cats (18%) died within 10 days of surgery
Cats with preoperative septic peritonitis (PSP) or that developed hypothermia 25–72h postoperatively had sig. higher odds of mortality
Coeuriot JFMS 2022
Ultrasound appearance of the duodenal papilla in clinically healthy cats
- dimensions?
- shape/texture?
- diet in relation to shape?
mean width of 3.13 mm and height of 2.47 mm in the transverse section, and length of 3.98 mm and height of 2.44 mm in the longitudinal section
DP was homogeneous, subjectively isoechoic to fat and had a round and oval shape in the transverse and longitudinal sections, respectively
The animals that were fed a mixed diet had a longer DP than those fed dry food.
Gollnick JFMS 2023
Retrospective evaluation of surgical treatment of linear and discrete gastrointestinal foreign bodies in cats: 2009–2021
% septic peritonitis?
% survival?
- cats with LFB more likely to…
No cats developed postoperative septic peritonitis (0%), and all cats survived (100% survival)
Cats with an LFB had significantly higher:
- body condition score
- albumin
- ASA status
- surgery length
- total cost of visit
- More likely to develop a surgical site infection
- More likely to be administered post-op antibiotics
Otomo Vet Sx 2019
Comparison of outcome in dogs undergoing single-incision laparoscopic-assisted intestinal sx and open laparotomy for simple small intestinal FB removal
- post-op complications?
- % discharged?
- conversion?
- difference in time, hospitalization, recovery?
No postop complications in either SILAIS or OL group
All dogs successfully discharged from hospital
Conversion from SILAIS to OL occurred in 3/13 (23%) cases
No significant difference in duration of hospitalization, duration of time to recovery or sx time between SILAIS and OL
Shamir JAVMA 2019
Evaluation of minimally invasive small intestinal exploration and targeted abdominal organ biopsy with use of a wound retraction device in dogs: 27 cases (2010-2017)
- bx adequate?
- % survival?
All biopsy samples obtained had sufficient diagnostic quality
25/27 (93%) dogs survived to hospital discharge, 3 (12%) dogs had postsurgical abnormalities unrelated to sx technique
Demars JSAP 2023
Surgical removal of intestinal foreign bodies using a laparotomy-assisted endoscopic approach in dogs and cats and comparison with enterotomy
- approach?
- % removed endoscopically?
- difference in surgical time?
approach consisted in maneuvering the intestinal foreign body into the stomach during laparotomy and then removing it via a gastroscopy. If the foreign body was unmovable, an enterotomy was performed
foreign bodies were successfully removed in 25 (43%) cases via endoscopy
Mean surgical time was significantly shorter for laparotomy-assisted endoscopic approach compared to enterotomy
Schwartz JSAP 2018 PQ
Closure of GI incisions using skin staples alone and in combination with suture in 29 cats
Dehiscence?
Included gastrotomy, jejunotomy, jejunal or colonic anastomosis
Foreign body 14/29, neoplasia 6/29, idiopathic megacolon 9,
90% (26/29) survived to discharge – 1 cat had postop CPA and 2/29 cats euthanized (both had neoplasia)
0 had incisional dehiscence
Schwartz Vet Sx 2018 PQ
Disposable skin staplers for closure of linear GI incisions in dogs
Comps?
Dehiscence?
Survival?
Risk factors for dehiscence?
Complications diagnosed in 8/245 (3.3%) dogs including 3/245 (1.22%) that died or were euthanized, 3/245 (1.22%) with incisional dehiscence, and 2/245 (0.81%) with attachment of linear FB to staples at lumen
Dehiscence was noted at enterotomy sites in 3 dogs at mean time of 44 hr after surgery
Overall survival rate 96.1% (320/333)
2 dogs presented with another linear FB that was attached to the staples in the lumen at postop days 24 and 42
The risk factors SA with incisional dehiscence included multiple GI incisions in 1 surgery, and presence of linear FB
No associations between dogs age, sex, weight, surgery tx, indication for sx, location in GIT, or experience and dehiscence rate
(0 dogs had pre-op septic peritonitis; 5 dogs had postop septic peritonitis and had a 2nd surgery (2/5 had intact incisions with no evidence of dehiscence)
Patient outcomes were NOT associated with anesthesia time, WBC or RBC count, or albumin
Patients were hospitalized longer if leukocytopenia and thrombocytopenia present)
Duell VSURG 2016 PQ
Frequency of Dehiscence in Hand-Sutured and Stapled Intestinal Anastomoses in Dogs
29/205 dogs (0.14, 95% CI 0.10-00.19) had dehiscence, including 21/134 dogs (0.16, 0.11-0.23) undergoing hand-sutured anastomosis and 8/71 dogs (0.11, 0.06-0.21) undergoing stapled anastomosis.
There was no significant difference in the frequency of dehiscence across anastomosis methods (χ(2), P = .389). The mean (95% CI) surgery duration of 140 minutes (132-147) for hand- sutured anastomoses and 108 minutes (99-119) for stapled anastomoses was significantly different (t-test, P < .001).
Conclusion: No significant difference in frequency of dehiscence was noted between hand- sutured and stapled anastomoses in dogs but surgery duration is significantly reduced by the use of staples for intestinal closure.
Rosenbaum JSAP 2016 PQ
The use of disposable skin staples for intestinal resection and anastomosis in 63 dogs: 2000 to 2014
overall mortality rate of patients undergoing intestinal resection and anastomosis was 12·7% (8/63). The most common indication for resection and anastomosis was neoplasia (20/63 [31·7%]), followed by foreign body removal (19/63 [30·2%]). The overall dehiscence rate was 4·8% (3/63). No difference in mortality associated with indication for surgery, whether multiple procedures were performed, surgeon qualifications, or evidence of peritonitis at the time of surgery was identified.
fyi pq
Lit questions about septic abdomens
- Dehiscence rate if it is second time
- Some others
- duffy
