Pulse - January 2022 - 12

extending orad to the pylorus throughout
the entire antrum and terminating roughly
aborad to the fundus. A gastrotomy was
performed, which revealed no evidence of
foreign material or gastric masses. A biopsy
of the gastric mucosa was obtained. The
stomach was closed in a two-layer Cushing
pattern with 3-0 PDS. A type I (sliding)
hiatal hernia was identified on inspection
of the esophageal hiatus. A left-sided incisional
gastropexy was performed in addition
to a duodenocolonic enteroplication
using the descending duodenum and the
transverse colon to prevent recurrence
of the hiatal hernia and intussusception,
respectively. The remainder of the abdomen
was inspected and appeared grossly normal.
Intraoperatively the patient developed poor
oxygen saturation;
thoracic radiographs
taken after recovery were performed with
no abnormal findings.
Over a period of four days of hospitalization,
the patient was persistently
anorexic, lethargic and uncomfortable on
abdominal palpation despite medical management.
A nasogastric tube was placed two
days after surgery, however gastric residuals
remained elevated despite placement.
When the patient began regurgitating on
the fourth day of hospitalization, a recheck
abdominal ultrasound was recommended.
Abdominal ultrasound revealed a severely
distended, fluid-filled stomach. The walls of
the gastric body were diffusely thickened,
measuring 0.51-0.72 cm. What was suspected
to be the greater curvature of the
stomach and a portion of the pylorus was
extremely thickened, with an oval-shaped
protuberance into the lumen measuring
6.14 cm in greatest diameter (Figure 2).
The duodenum, remaining intestines and
pancreas appeared normal. Given the severity
of gastric distension and the patient's
persistent signs, an abdominal exploratory
surgery was recommended.
Re-exploration of the abdomen revealed
the gastric antrum had intussuscepted into
the fundus of the stomach (Figure 3). Once
the pylorogastric intussusception was manually
reduced, the antrum appeared healthy
at previous gastrotomy site. The previous
left-sided gastropexy was intact and the
hiatal hernia remained reduced. The bruising
noted previously over the duodenum
was resolved and thickening of the antrum
was subjectively improved compared to
previously noted. Two right-sided incisional
gastropexies were performed: one
parallel to the previous gastrotomy site
12
Figure 2. The stomach is severely distended. What is suspected to be the greater curvature of the stomach
and a portion of the pylorus is extremely thickened, with an oval-shaped protuberance into the lumen
measuring 6.14 cm in greatest diameter.
cranially, and another caudally on the dorsal
aspect of the antrum, the region that
intussuscepted dorsally. The remainder of
the abdominal organs, including the intestines
and pancreas, appeared grossly normal.
Anesthetic recovery was smooth and
uneventful. The patient was hospitalized
for 7 days post-original surgery and discharged
when appetite was improved, and
gastric residuals were minimal. The patient
was sent home with gabapentin (10 mg/
kg PO q8), maropitant (1 mg/kg PO q24),
and metoclopramide (2 mg/kg PO q8hr).
Histopathology of the gastric mucosa was
consistent with benign hyperplastic polypoid
gastritis with edema. There was no
evidence of malignancy or neoplasia. The
patient was reevaluated 9 days post-surgery
for abdominal distension and lethargy after
eating a large meal and drinking a large
amount of water. Abdominal radiographs
revealed a fluid distended stomach likely
due to a functional ileus, and less likely
obstructive based on a normal gas-filled
pylorus seen on the left lateral view. The
patient proceeded to have intermittent gastrointestinal
signs and gastritis; however, no
evidence of recurrence has been reported
within the time period.
Reports of retrograde intussusceptions
are scarce in the veterinary literature.1-2,4,6
While
more commonly
intussusceptions occur in the direction of
peristalsis (aborad),
infrequently invagination
can occur in the orad direction,
opposing normal peristalsis.1-2,5-6,7-8
Large
breed dogs greater than 1 year of age have
a higher reported incidence of retrograde
intussusceptions.5
In contrast to normograde
intussusceptions, which more commonly
occur in dogs less than 1 year of
age.1
pathic,
Although majority of cases are idioseveral
etiologies and predisposing
factors for intussusceptions have been
reported including enteritis
Clinical signs are typi(particularly
in
young animals with parasitism, viral or
immune-mediated disease), gastritis, general
anesthesia, foreign body obstruction
and neoplasia.1-2,5,8
cally acute and include vomiting, diarrhea,
lethargy, inappetence and abdominal
pain.1,5
Studies have shown a direct association
between the onset and severity of
clinical signs related to the location within
the gastrointestinal tract and tissue viability.1
A
recent study suggested severe vomiting
due to underlying gastritis could have
incited an alteration in gastric motility that
ultimately increased the risk for development
of a pylorogastric intussusception.5
The chronic nature of clinical signs in this
patient could have caused a severe enough
gastritis to alter gastrointestinal motility in
a similar way.
JANUARY 2022
PULSE

Pulse - January 2022

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