Ch 92 - Small Intestine Flashcards
Gill JAVMA 2019
Factors associated with dehiscence and mortality rates
following gastrointestinal surgery in dogs
Univariate analyses revealed that preoperative plasma lactate concentration increased with increasing ASA status, and lactate concentrations were significantly higher for nonsurvivors (mean ± SD, 4.6 ± 3.7 mmol/L) than for survivors (2.4 ± 1.7 mmol/L).
dogs with an ASA status ≥ 3 were more likely to develop dehiscence after gastrointestinal surgery than were dogs with a lower ASA status (OR, 17.77; 95% confidence interval, 2.17 to 144.06).
Multivariate analysis also revealed that dogs with an ASA status ≥ 3 or high lactate concentration were less likely to survive than were other dogs.
CONCLUSIONS AND CLINICAL RELEVANCE These findings regarding ASA status and preoperative plasma lactate concentration and their associations with outcome may help clinicians to determine and provide optimal perioperative care to dogs requiring gastrointestinal surgery as well as to inform owners about prognosis
Strelchik JAVMA 2019
Intestinal incisional dehiscence rate following enterotomy for foreign body removal in 247 dogs
8 of the 247 (3.2%) dogs had preoperative septic peritonitis, and all 8 dogs survived to hospital discharge.
Incisional dehiscence occurred following 5 of the 247 (2.0%) enterotomies, and only 2 dogs in the dehiscence group did not survive to hospital discharge.
Duration of hospitalization was longer for dogs in the dehiscence group than for dogs in the nondehiscence group.
CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that enterotomy for intestinal foreign body removal had a lower rate of dehiscence in dogs during the study period, compared with rates previously reported; however, the low rate should not be used as a reason to perform an enterotomy rather than an enterectomy when needed. Surgeons should thoroughly evaluate the bowel and perform an enterotomy only when indicated.
Lopez JAVMA 2021
Comparison of patient outcomes following enterotomy
versus intestinal resection and anastomosis
for treatment of intestinal foreign bodies in dogs
RESULTS
Dehiscence rates were 3.8% (7/183) for enterotomy
Dehiscence rate was 18.2% (8/44) for IRA,
Overall dehiscence rate was 6.6% (15/227).
The odds of intestinal dehiscence for IRA were 6.09 times (95% CI, 1.89 to 19.58) the odds for enterotomy.
An American Society of Anesthesiologists score > 3 (OR, 4.49; 95% CI, 1.43 to 14.11) and an older age (OR, 1.02 [95% CI, 1.01 to 1.02] for each 1-month increase in age) were significantly associated with greater odds of intestinal dehiscence, regardless of surgical procedure.
Chu Vet Surg 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
Objective: To determine the ability of functional side-to-side small intestinal anastomoses (FSS-SIA) created with an electrothermal bipolar vessel sealing (EBVS) device to resist leakage.
Study design: Experimental, ex vivo. Sample population: Jejunal segments (n = 130) from 10 healthy canine cadavers. Methods: Four types of anastomoses were created (two segments/construct and 15 constructs/group): EBVS (group A), EBVS + transverse stapling (group B), stapled (group C), and EBVS + suture augmentation (group D). Initial leakage pressure (ILP), initial leakage location (ILL), and maximal intraluminal pressure were compared between groups, and five group A constructs were analyzed histologically.
Results: Initial leakage pressure was greater in group D than in groups A, B, and C (P < .011). There was a difference in ILL among groups (P = .003).
Leakage occurred at the side-to-side intestinal anastomosis fusion line in 13 of 15 (87%) constructs for groups A and B and in nine of 15 (60%) constructs for group D.
Maximal intraluminal pressure was greater in group C than in groups A, B, and D (P < .004).
Histological examination was consistent with collagenous fusion without cavitation defects.
Conclusion: Functional side-to-side small intestinal anastomosis was consistently achieved with an EBVS device.
Augmentation of EBVS anastomoses with simple interrupted sutures along the anastomotic fusion line increased ILP compared with stapled anastomoses.
Clinical significance: Despite the success and feasibility of creating an FSSSIA with an EBVS device, additional in vivo studies are required to determine the effectiveness of intestinal fusion prior to clinical implementation.
Larose Vet Surg 2020
Clinical findings and outcomes of 153 dogs surgically
treated for intestinal intussusceptions
Results: Dogs had a median age of 10 months (range, 2-156), and the most common location for intussusception was ileocolic (66/153 [43%]).
Most cases had no identifiable cause (104/155 [67%]).
Intestinal resection and anastomosis (IRA) was performed in 129 of 153 (84%) dogs; enteroplication was performed in 28 of 153 (18%) dogs, including 13 with and 15 without IRA.
Intraoperative complications occurred in 10 of 153 (7%) dogs, all involving intestinal damage during attempted manual reduction.
Postoperative complications occurred in 53 of 153 (35%) dogs, including 22 of 153 (14%) with severe (grade 3 or 4) events.
Diarrhea, regurgitation, and septic peritonitis were the most common postoperative complications; intussusception recurred in four of 153 (3%) dogs, all within 72 hours postoperatively.
Fourteen-day postoperative mortality rate was 6%.
Conclusion: Surgical treatment of intestinal intussusception was curative in most dogs, even when an underlying cause was not identified. Surgical complications were common, including a 14% risk of life-threatening short-term complications.
Clinical significance: Surgical treatment of intestinal intussusception offers an excellent prognosis, but the potential life-threatening complications should be considered.
Culbertson Vet Surg 2021
Intraoperative surgeon probe inspection compared to leak
testing for detecting gaps in canine jejunal continuous
anastomoses: A cadaveric study
Methods: Intestinal segments were randomly selected by four volunteers who
created six simple continuous anastomoses: two constructs using standard
technique with 2–3 mm suture spacing (ST, 8 total), and four constructs with
one 4-mm gap (IG, 16 total). All 24 anastomoses were examined with PT (1 volunteer)
prior to LT (3 volunteers). LT was performed within a maximal peristaltic
pressure range (34–54 cmH2O). The presence and location of
anastomotic leaks (LA) detected with LT were compared with gaps detected
with PT.
Results: Nineteen out of twenty-four (79.2%) samples had at least one probe
drop, and four out of twenty-three (17.4%) samples leaked. LT results from one
sample were excluded due to iatrogenic suture failure. PT was 100% sensitive
(95% CI: 51.01, 100%) with a 100% negative predictive value (95% CI: 56.55,
100%) at detecting gaps compared with LT. The location of all LA was accurately
identified with PT and confirmed during LT.
Conclusion: PT was highly sensitive at detecting gaps compared with LT. All
LA were accurately detected by PT. None of the segments negative during PT
leaked.
Clinical Significance: The diagnostic value of PT appears adequate to recognize
gaps in cadaveric small intestinal anastomoses. PT offers surgeons an
alternative to detect suture gaps that may contribute to postoperative dehiscence
of intestinal anastomoses.
Maxwell Vet Surg 2021
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
Surgical intervention was classified as immediate when it occurred within 6 hours of presentation and delayed when it occurred >6 hours after presentation.
Results: Outcomes did not differ between dogs treated immediately (n = 584) or over 6 hours after presentation (n = 210).
Intestinal necrosis and perforations were more common when surgery was delayed (P = .008; P = .019) but became nonsignificant after controlling for preoperative differences.
Risk factors for necrosis and perforations included duration of clinical signs, increased lactate, linear foreign material, and timing of surgery.
Enterectomies (P = .004) as well as the duration of surgery (P = .004) and anesthesia (P = .001) were increased when surgery was delayed.
Immediate surgery was associated with earlier return to feeding (P = .004) and discharge from the hospital (P < .001);
(5%) dogs in each group (n = 33 immediate; n = 11 delayed) either had a negative explore or the foreign body was milked aborally into the colon at the time of surgery.
Conclusion: Although outcomes were not associated with surgical timing, the unadjusted prevalence of gastrointestinal injury and, thus, the requirement for complex surgical procedures was higher in the delayed group. Clinical significance: Earlier surgical treatment of stabilized dogs with GIFBO may involve fewer complex procedures and accelerate recovery.
Quitzan Vet Surg 2022
Influence of staple line number and configuration on the
leakage of small intestinal functional end-to-end stapled
anastomosis: An ex vivo study
Jejunal segments (N = 72) from 10 mature, canine cadavers. Methods: Jejunal segments (10 cm) were randomly assigned to a control group (8 segments) and 4 FEESA groups (16 segments/group (8 constructs/ group)), according to the number of rows of staples used in the vertical (V) and transverse lines (T), respectively: Control, 2-row V/2-row T (2V/2T), 2-row V/3-row T (2V/3T), 3-row V/2-row T (3V/2T), 3-row V/3-row T (3V/3T). Initial leak pressure (ILP), maximum intraluminal pressure (MIP), and initial leakage location (ILL) were compared.
Results: The ILP (mean ± SD) for control segments, 2V/2T, 2V/3T, 3V/2T and 3V/3T were 321.38 ± 34.59, 32.88 ± 7.36, 50.13 ± 10.46, 34.38 ± 11.78, 69.88 ± 21.23 mmHg, respectively.
All FEESAs initially leaked at lower pressures than intact segments. The only other differences detected between groups consisted of ILPs that were higher when FEESAs were closed with 3V/3T (69.88 ± 21.23 mmHg) than 2V/2T (32.88 ± 7.36, P < .001).
Initial leakage occurred predominantly from the transverse staple line rather than the anastomotic crotch (P < .001).
Conclusion: 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. Clinical significance: The addition of a third row of staples in the transverse line (with or without a third row in the vertical staple line) in FEESAs should be further investigated as a strategy to reduce intestinal leakage clinically.
Brand Vet Surg 2019
Effects of needle gauge and syringe size on small intestinal
leakage at injection sites
Fresh porcine intestines were divided into 5-cm or 10-cm segments and randomly assigned to the one of nine treatment groups: 25-gauge, 22-gauge, and 20-gauge needles attached to full 12-mL, half-full 20-mL, and full 20-mL syringes (n = 20/group). The jejunal segments were occluded with Rochester- Carmalt forceps prior to injection of diluted India ink. Injection time and leakage were noted by a blinded observer.
Results: Leakage occurred in 36% of 5-cm and 15% of 10-cm segments and was immediate without palpation in 33.8% and 11% of segments, respectively.
Protective effects were seen for 22-gauge needles in both 5-cm (P = .002) and 10-cm (P = .001) segments,
whereas injection of 20 mL had a higher odds ratio of leakage compared with injection of 10 mL and 12 mL in 5-cm segments (P = .003).
Conclusion: Injections with 22-gauge needles reduced the frequency of leakage, while 20 mL instilled in 5-cm segments increased the frequency of leakage in intact segments of porcine jejunum.
Clinical significance: Injection with a smaller syringe size attached to a 22-gauge needle through a 10-cm segment of small intestine may lower the frequency of leakage from the injection site, but influence on the detection of surgical site leakage remains unknown.
Coeuriot JFMS 2022
Ultrasound appearance of the
duodenal papilla in clinically
healthy cats
The dimensions of the DP were a mean ± SD width of 3.13 ± 0.68 mm and height of 2.47 ± 0.63 mm in the transverse section, and
length of 3.98 ± 1.27 mm and height of 2.44 ± 0.57 mm in the longitudinal section.
The DP
was homogeneous, subjectively isoechoic to fat and had a round and oval shape in the transverse and longitudinal
sections, respectively
Fealey Vet Surg 2020
Initial leak pressures of four anastomosis techniques in cooled cadaveric canine jejunum
Methods: Eight-centimeter cooled canine cadaveric jejunal segments were randomly assigned to a control group (six segments) and four treatment groups (16 segments each [two segments/anastomotic construct]): (1) handsewn anastomosis (HSA), (2) barbed suture anastomosis (B-HSA), (3) stapled functional end-to-end anastomosis (SFEEA), and (4) stapled functional end-to-end anastomosis with an oversew (SFEEA-O). Control segments and anastomotic constructs were infused intraluminally to the point of leakage. Initial leak pressures were recorded and compared. Results: Initial leak pressures (median + range) for jejunal control segments, HSA, B-HSA, SFEEA, and SFEEA-O were 331.88 mmHg (range, 315.34– 346.64), 35.17 (20.29–56.24), 24.99 (6.08–38.64), 28.77 (18.80–85.09), and 35.92 (12.05–80.71), respectively. No difference was detected between leak pressures of anastomosed segments (P = .35), all of which were more variable and lower than those of intact segments. Conclusion: No difference in initial leak pressures was detected between the four anastomosis techniques tested in cooled canine cadaveric jejunum. Clinical significance: All four anastomosis techniques evaluated in this study may be suitable in dogs.
Fruehwald JAVMA 2024
Association of mesenteric volvulus
in police working dogs with and without
a prior prophylactic laparoscopic gastropexy
3 cases of mesenteric volvulus were noted in this patient population. Two (2.4%) of the 82 PWDs that had undergone prophylactic laparoscopic gastropexy developed MV, whereas 1 (0.3%) of the 288 PWDs that had not undergone a gastropexy procedure developed MV.
Police working dogs with PLG were estimated to be at 7.2 times greater odds of MV (point estimate OR, 7.18; 95% CI, 0.642 to 80.143); however, the low incidence of MV in this population limited statistical power, and thus this effect did not achieve statistical significance.
Gollnick JFMS 2023
Retrospective evaluation of surgical
treatment of linear and discrete
gastrointestinal foreign bodies
in cats: 2009–2021
A total of 56 cats were included in this study; 38 cats had a DFB and 18 had an LFB.
No cats developed postoperative septic peritonitis, and all cats survived.
The likelihood of postoperative septic peritonitis or mortality in an additional cat was estimated to be <5.2%.
Cats with an LFB were found to have a significantly higher body condition score (P = 0.047), albumin (P = 0.025), American Society of Anesthesiologists status (P = 0.027), surgery length (P <0.001) and total cost of visit (P = 0.006) when compared with cats with a DFB.
Cats with LFBs were more likely to develop a surgical site infection (SSI; P = 0.007) and be administered postoperative antibiotics (P = 0.017).
Conclusions and relevance Cats undergoing surgery for gastrointestinal FBs had a low incidence of postoperative complications. Cats with LFBs had longer surgeries and were more likely to develop postoperative SSIs.
Hiebert JFMS 2022
Intestinal dehiscence and mortality
in cats undergoing gastrointestinal
surgery
In total, 126 cats were included. One cat developed GI dehiscence following complete resection of a jejunal adenocarcinoma.
Twenty-three cats (18.2%) died within 10 days of surgery.
Cats with PSP (P = 0.0462) (13.5% had PSP)
or that developed hypothermia 25–72 h postoperatively (P = 0.0055) had higher odds of mortality in multivariate analysis.
Cats with PSP had 6.7-times higher odds of mortality than cats not diagnosed with PSP.
Conclusions and relevance In cats receiving GI surgery, the incidence of GI incisional dehiscence was <1%.
Cats with PSP had a higher likelihood of mortality.
SIRS was a common finding in cats with septic peritonitis, but was not associated with mortality.
Postoperative mortality during the home recovery period might be significant in cats. Future studies evaluating postoperative mortality in cats should consider extending the research period beyond the date of discharge.
Demars JSAP 2023
Surgical removal of intestinal FB using a lap-assisted endoscopic approach in dogs and cats and comparison with enterotomy
Crino JSAP 2023
Conservative mgmt of metallic pointed FB in dogs and cats 17 Cases
Lozano JSAP 2023
Evaluation of acid base and electrolyte status in dogs with upper GI obstruction