Share it:

section content

  • 7-year-old male castrated Maine Coone presented for evaluation of anorexia and lethargy of 4 days duration. Vomited 4 times 4 days ago but has not vomited since.
  • Physical examination was largely unremarkable aside from nausea on abdominal palpation.
  • Point of care bloodwork revealed hyperchloremia and hyperlactatemia. Otherwise unremarkable.

 

  • The stomach and almost all small intestinal segments are severely distended with echogenic fluid.
  • The fluid distension extends into the distal jejunum, which tracks into an intussusception.
  • Within the intussuseptum, there is a hyperechoic linear structure that continues to track aborad and results in severe intestinal (jejunal and ileal) plication. The intestinal plication extends to the ileocolic junction.
  • The fat adjacent to the plicated segments is hyperechoic and there are small pockets of anechoic fluid adjacent.
  • The muscularis layer of the plicated segments is thickened. The wall layering is maintained on all segments.
  • Test positive for an intestinal mechanical obstruction secondary to a linear foreign body anchored within a jejunal-jejunal intussusception, extending to the ileocolic junction.
  • There is moderate to severe adjacent peritonitis. Surgical intervention is recommended.

Surgical findings:

  • A ~3cm area of intestine mid-jejunum was intususscepted. The jejunum aboral to this location was mildly plicated with a palpable linear foreign body extending through the ileum and ending in the colon attached to a larger object in the colon. Jejunum orad to this location and duodenum were moderately fluid distended. The stomach was mild-moderately gas distended. No serosal tearing, palpable thinning, significant erythema, or localized peritonitis appreciated. Marked mesenteric lymphadenopathy was noted. The remainder of the abdominal explore was within normal limits. Normal structures included the liver, common bile duct, spleen, kidneys bilaterally, adrenals, colon and urinary bladder. A long 8Fr red rubber was passed orogastrically by a non-sterile assistant and guided intraabdominally by the surgeon. 35mL of air was retrieved.
  • The jejunum was isolated and packed off with moist laparotomy sponge‚Äôs extracoporally. A resection and anastomosis was performed without complication using an EndoGIA stapler with a 45mm purple cartridge and Proximate TA 60mm stapler with blue cartridge resulting in a functional end to end stapled anastomoses. Intestinal contents were contained with no gross contamination noted. The site was leak tested with a 12 ml syringe and 25 g needle infusing the lumen with sterile saline under pressure. Leakage was noted and the end was oversewn with 4/0 PDS in a simple continuous pattern following which, no leak was noted. The crotch was reinforced with twosimple interrupted sutures with 4/0 PDS on either side and one in the middle. A mesenteric lymph node biospy was performed by creating a ~5mm wedge with #15 blade and cutting out the wedge out with Metzenbaum scissors. The incision was closed with 4-0 PDS in a simple interrupted pattern. Sponge count confirmed. Gloves and instruments were changed prior to proceeding. The abdominal organs were replaced into the peritoneal cavity and the abdomen was flushed with warm sterile saline and suctioned.
  • Hair was noted within the intussuscepted tissue once reduced and opened.
  • The excised intestinal segments and the biopsied mesenteric lymph node were submitted for histopathology.

Discharge:

  • Discharged and no complications since the follow up examination.

Histopathology:

  • Ileum: There is chronic moderate to marked diffuse inflammation of lymphocytes, plasma cells, eosinophils and neutrophils. There is a segmental area of ulceration with suppurative inflammation and granulation tissue. There are colonies of bacteria There is no evidence of neoplasia. Inflammation in some areas is transmural.
  • Lymph node: The lymph node is reactive with enlarged follicles with prominent germinal centers along with increased medullary plasma cells and histiocytes. There is no evidence of overt neoplasia or infectious agents.MICROSCOPIC INTERPRETATION:
    – Ileum: Segmental ulcerative and suppurative ileitis with colonies of bacteria- removal appears complete (approximately 21 mm nearest resection margins)
    – Lymph node: Reactive
The above findings are morphologically consistent with the history of intussusception. Intussusception involves the telescoping of one segment of bowel into an outer sheath formed by another, usually distal, segment of the gut. Any level of the gut with sufficient mesenteric mobility may be involved. The cause is usually not apparent, though linear foreign bodies, heavy parasitism, previous intestinal surgery, enteritis and intramural lesions such as abscesses and tumors may be associated. They are most common in young animals. In dogs they are more frequently ileocolic. They are much less common in cats and moderately common in lambs, calves, and young horses were they may involve small intestine, cecum and colon.