Intussusception

Question 1

Intussusception

Answer 1

Young animals and >6 years: Siamese and German Sheperds
Dog: ileocecal colic
Cat: jejunal
Segments: Intussusceptum (apex), intussuscipiens (neck)
6 layers.
Direct: proximal part invaginates into the distal.
Indirect

Question 2

Etiology and clinical signs

Answer 2

Hypermotility, distemper, parvo, intestinal parasites, bowel manipulation
Inappetence, vomit, tenesmus, melena

Question 3

Pathophysiology

Answer 3

Incoordinated motor activity. Mechanical linkage of nonadjacent segments (FB and adhesions).

Question 4

Radiography/US

Answer 4

Small intestinal dilation. Mass right cranial abdomen. Gas may outline apex. Lack of gas in the cecum. Rarely perforate.
Bull’s eye in ultrasound is pathognomonic

Question 5

Surgical management

Answer 5

Manual reduction. 
Resection and anastomosis
Enteropexy
Enteroplication
Recurrence

Question 6

Enteropexy

Answer 6

No significant difference in recurrence. Higher complication rate.
DON’T ALWAYS DO THIS

Question 7

Intestinal Volvulus

Answer 7

GSD. Jejunum twists on the mesentery.
Peracute CV collapse. Bloody stools.
Etiology: EPI
Dilated loops of bowel. Fluid in abdomen
Prognosis: Grave. Survivors- short bowel syndrome.

Question 8

Intestinal Phycomycosis

Answer 8

Mucormycosis- pythiosis
Invade GI tract. Intramural granulomatous inflammation. Partial obstruction. Treatment- resect and amphotericin B.
Grave prognosis.

Question 9

Rectal Polyps

Answer 9

Hyperplastic polyps, papillary adenoma, papillotubular adenoma
Electrocoagulation, submucosal resection, rectal pull through- anastomosis

Question 10

Rectal Prolapse

Answer 10

Double layer evagination of rectum through anus.
Young animals
Enteritis, parasitism, parvovirus.
Secondary to perineal hernia repair, dystocia, prostatic disease.
Differential: Locate fornix.
1cm- prolapsed rectum
5-6cm prolapsed intussusception

Question 11

Rectal eversion

Answer 11

Edematous protrusion of rectal mucosa.
Rectal muscularis stays reduced.
Sometimes reduce spontaneously.

Question 12

Rectal prolapse treatment

Answer 12

Mucosal edema: osmotic dessicator. Reduction and purse string.
Mucosal necrosis: submucosal resection. Complete amputation.
Recurrence: colopexy
Resolve primary cause

Question 13

Tissue viability

Answer 13

Color, hemorrhage, temperature, fluoroscein dye

Question 14

Reduce edema

Answer 14

20% mannitol
50% dextrose
Warm saline
massage

Question 15

Anal pursestring

Answer 15

Viable, reducible.

1st or 2nd occurrence. Place at the anocutaneous line loosely. Retain 5- days

Question 16

Colopexy

Answer 16

Viable, recurrent, non-digitally reducible, cats.

Mattress suture tech. Permanent adhesion

Question 17

Amputation

Answer 17

Devitalized tissue. Multiple recurrences. Potential for stricture.

Question 18

Post op

Answer 18

Local hypertonic solutions.
Local anesthetic. Epidural analgesia
High fiber diet.