Pulse - January 2024 - 10

DIMENSIONS IN SURGERY + CRITICAL CARE
DIMENSIONS IN SURGERY + CRITICAL CARE
ANIMAL SPECIALTY & EMERGENCY CENTER
ANIMAL SPE
TY & EMERGENCY CENTER
Figure 2. Intraoperative images of the exploratory laparotomy. Segment of the jejunum with evidence of noticeable adhesions (left). Congested segmental
intestinal volvulus with normal jejunum for comparison (right).
abdomen was closed in routine fashion.
The patient recovered post-operatively with gabapentin (12mg/
kg PO q8h), cefazolin (22mg/kg IV q8h), hydromorphone
(0.1mg/kg IV q6h), and LRS at maintenance fluid rates. She was
discharged one day post-surgery with cefpodoxime 100mg PO SID
and gabapentin 100-200mg PO q8-12h for 5 days. The patient was
re-evaluated two weeks post-surgery for suture removal and owners
reported she was clinically normal at home.
Median age for dogs with intestinal volvulus is 2.6 years, and
it predominantly affects large breed dogs.1
Clinical signs include
vomiting, diarrhea, abdominal distension and pain. Blood work
is often nonspecific and can be often secondary to dehydration,
characterized by hemoconcentration, mild azotemia, and mild
electrolyte derangements. Obtaining a diagnosis is challenging
without imaging due to the non-specific clinical signs and laboratory
findings. Distinct populations of bowels may be appreciated
on abdominal radiographs, raising concerns for a possible foreign
body obstruction. An abdominal ultrasound is recommended to
further characterize the abnormality. If suspicion of a volvulus is
raised, an exploratory laparotomy should be performed.
Intestinal volvulus, when left untreated, can be fatal.2,3
The vascular
obstruction causing intestinal hypoxia to anoxia can result in
circulatory shock and endotoxemia. Patients should be monitored
post-operatively for reperfusion injury, as this can worsen clinical
outcomes despite uneventful surgical correction. Historically, small
intestinal volvulus managed surgically carried a poor prognosis.1-3
Large intestinal volvulus was associated with a better prognosis
than the small intestinal counterparts.2
Recent case reports have
documented an improved prognosis for patients with intestinal volvulus,
for both dogs and cats.4,5
Prognosis appears to be associated
with the quantity of intestines subjected to volvulus, where prognosis
worsens with the percentage of bowel involvement. Treatment
is often more challenging when larger intestinal segments affected,
as the pathological changes at diagnosis may be irreversible, and
consequences can be fatal.3
The case highlights intestinal volvulus as a differential for gastrointestinal
distress. Previous gastrointestinal surgery appears to
be a risk factor for developing intra-abdominal adhesions, reit10
JANUARY
2024
PULSE
5. Hadala A, Lavallée J. Partial volvulus, entrapment, and extraluminal
obstruction of the jejunum in a cat. Can Vet J 2023;64:742-746.
erating the importance of gentle tissue handling and meticulous
hemostasis to minimize these occurrences. Independent case
reports have been published in dogs and one cat with intestinal
volvulus. All these patients were young and had historic gastrointestinal
surgery prior to the exploration for their intestinal
volvulus.4,5
is crucial in the diagnosis. P
References
1. Shealy PM, Henderson RA. Canine intestinal volvulus. A report of nine new
cases. Vet Surg 1992;21:15-19.2. Davis E, Townsend FI, Bennett JW, et al.
Comparison of Surgically Treated Large Versus Small Intestinal Volvulus
(2009-2014). J Am Anim Hosp Assoc 2016;52:227-233.
3. Cairó J, Font J, Gorraiz J, et al. Intestinal volvulus in dogs: a study of four
clinical cases. J Small Anim Pract 1999;40:136-140.
4. Di Cicco MF, Bennett RA, Ragetly C, et al. Segmental jejunal entrapment,
volvulus, and strangulation secondary to intra-abdominal adhesions in a
dog. J Am Anim Hosp Assoc 2011;47:e31-35.
The diagnostic process, including imaging techniques,

Pulse - January 2024

Table of Contents for the Digital Edition of Pulse - January 2024