• 1. Duell JR, Thieman Mankin KM, Rochat MC, et al. Frequency of dehiscence in hand-sutured and stapled intestinal anastomoses in dogs. Vet Surg 2016;45:100103.

    • Search Google Scholar
    • Export Citation
  • 2. Wylie KB, Hosgood GH. Mortality and morbidity of small and large intestinal surgery in dogs and cats: 74 cases (1980–1992). J Am Anim Hosp Assoc 1994;30:469474.

    • Search Google Scholar
    • Export Citation
  • 3. Grimes JA, Schmiedt CW, Cornell KK, et al. Identification of risk factors for septic peritonitis and failure to survive following gastrointestinal surgery in dogs. J Am Vet Med Assoc 2011;238:486494.

    • Search Google Scholar
    • Export Citation
  • 4. Applewhite AA, Hawthorne JC, Cornell KK. Complications of enteroplication for the prevention of intussusception recurrence in dogs: 35 cases (1989–1999). J Am Vet Med Assoc 2001;219:14151418.

    • Search Google Scholar
    • Export Citation
  • 5. Morello E, Martano M, Squassino C, et al. Transanal pull-through rectal amputation for treatment of colorectal carcinoma in 11 dogs. Vet Surg 2008;37:420426.

    • Search Google Scholar
    • Export Citation
  • 6. Hayes G. Gastrointestinal foreign bodies in dogs and cats: a retrospective study of 208 cases. J Small Anim Pract 2009;50:576583.

  • 7. Church EM, Mehlhaff CJ, Patnaik AK. Colorectal adenocarcinoma in dogs: 78 cases (1973–1984). J Am Vet Med Assoc 1987;191:727730.

  • 8. Birchard SJ, Couto CG, Johnson S. Nonlymphoid intestinal neoplasia in 32 dogs and 14 cats. J Am Anim Hosp Assoc 1986;22:533537.

  • 9. Frost D, Lasota J, Miettinen M. Gastrointestinal stromal tumors and leiomyomas in the dog: a histopathologic, immunohistochemical, and molecular genetic study of 50 cases. Vet Pathol 2003;40:4254.

    • Search Google Scholar
    • Export Citation
  • 10. Levitt L, Bauer MS. Intussusception in dogs and cats: a review of 36 cases. Can Vet J 1992;33:660664.

  • 11. Joy CL, Patterson JM. Short bowel syndrome following surgical correction of a double intussusception in a dog. Can Vet J 1978;19:254259.

    • Search Google Scholar
    • Export Citation
  • 12. Kim JM, Kang SS, Kim G, et al. Double intussusception in a Shih-Tzu puppy: the triple-circle sign. Pak Vet J 2012;32:292294.

  • 13. Marks A. Torsion of the colon in a rough Collie. Vet Rec 1986;118:400.

  • 14. Shinozaki JK, Sellon RK, Tobias KM, et al. Tubular colonic duplication in a dog. J Am Anim Hosp Assoc 2000;36:209213.

  • 15. Clark GN, Wise LA. Stapled typhlectomy via colotomy for treatment of cecal inversion in a dog. J Am Vet Med Assoc 1994;204:16411643.

    • Search Google Scholar
    • Export Citation
  • 16. Bright RM, Burrows CF, Goring R, et al. Subtotal colectomy for treatment of acquired megacolon in the dog and cat. J Am Vet Med Assoc 1986;188:14121416.

    • Search Google Scholar
    • Export Citation
  • 17. Nemeth T, Solymosi N, Balka G. Long-term results of subtotal colectomy for acquired hypertrophic megacolon in eight dogs. J Small Anim Pract 2008;49:618624.

    • Search Google Scholar
    • Export Citation
  • 18. Yoon HY, Mann FA. Bilateral pubic and ischial osteotomy for surgical management of caudal colonic and rectal masses in six dogs and a cat. J Am Vet Med Assoc 2008;232:10161020.

    • Search Google Scholar
    • Export Citation
  • 19. Sarathchandra SK, Lunn JA, Hunt GB. Ligation of the caudal mesenteric artery during resection and anastomosis of the colorectal junction for annular adenocarcinoma in two dogs. Aust Vet J 2009;87:356359.

    • Search Google Scholar
    • Export Citation
  • 20. Ralphs SC, Jessen CR, Lipowitz AJ. Risk factors for leakage following intestinal anastomosis in dogs and cats: 115 cases (1991–2000). J Am Vet Med Assoc 2003;223:7377.

    • Search Google Scholar
    • Export Citation
  • 21. Allen DA, Smeak DD, Schertel ER. Prevalence of small intestinal dehiscence and associated clinical factors: a retrospective study of 121 dogs. J Am Anim Hosp Assoc 1992;28:7076.

    • Search Google Scholar
    • Export Citation
  • 22. Radlinsky MG. Surgery of the digestive system. In: Fossum TW, ed. Small animal surgery. 4th ed. St Louis: Mosby Elsevier, 2012;386583.

    • Search Google Scholar
    • Export Citation
  • 23. Buchs NC, Gervaz P, Secic M, et al. Incidence, consequences, and risk factors for anastomotic dehiscence after colorectal surgery: a prospective monocentric study. Int J Colorectal Dis 2008;23:265270.

    • Search Google Scholar
    • Export Citation
  • 24. Soeters PB, de Zoete JP, Dejong CH, et al. Colorectal surgery and anastomotic leakage. Dig Surg 2002;19:150155.

  • 25. Graf W, Glimelius B, Bergström R, et al. Complications after double and single stapling in rectal surgery. Eur J Surg 1991;157:543547.

    • Search Google Scholar
    • Export Citation
  • 26. Lustosa SA, Matos D, Atallah A, et al. Stapled versus hand-sewn methods for colorectal anastomosis surgery. Cochrane Database Syst Rev 2001;3:CD003144.

    • Search Google Scholar
    • Export Citation
  • 27. Goligher JC, Graham NG, De Dombal FT. Anastomotic dehiscence after anterior resection of rectum and sigmoid. Br J Surg 1970;57:109118.

    • Search Google Scholar
    • Export Citation
  • 28. Akyol AM, McGregor JR, Galloway DJ, et al. Anastomotic leaks in colorectal cancer surgery: a risk factor for recurrence? Int J Colorectal Dis 1991;6:179183.

    • Search Google Scholar
    • Export Citation
  • 29. Snowdon KA, Smeak DD, Chiang S. Risk factors for dehiscence of stapled functional end-to-end intestinal anastomoses in dogs: 53 cases (2001–2012). Vet Surg 2016;45:9199.

    • Search Google Scholar
    • Export Citation
  • 30. Stoloff D, Snider TG, Crawford MP, et al. End-to-end colonic anastomosis a comparison of techniques in normal dogs. Vet Surg 1984;13:7682.

    • Search Google Scholar
    • Export Citation
  • 31. Richardson DC, Duckett KE, Krahwinkel DJ Jr, et al. Colonic anastomosis: evaluation of an end-to-end crushing and inverting technique. Am J Vet Res 1982;43:436442.

    • Search Google Scholar
    • Export Citation
  • 32. Jung B, Påhlman L, Nyström PO, et al. Multicentre randomized clinical trial of mechanical bowel preparation in elective colonic resection. Br J Surg 2007;94:689695.

    • Search Google Scholar
    • Export Citation
  • 33. Mahajna A, Krausz M, Rosin D, et al. Bowel preparation is associated with spillage of bowel contents in colorectal surgery. Dis Colon Rectum 2005;48:16261631.

    • Search Google Scholar
    • Export Citation
  • 34. Irvin TT. Collagen metabolism in infected colonic anastomoses. Surg Gynecol Obstet 1976;143:220224.

  • 35. Ho YH, Ashour MA. Techniques for colorectal anastomosis. World J Gastroenterol 2010;16:16101621.

  • 36. Agren MS, Andersen TL, Mirastschijski U, et al. Action of matrix metalloproteinases at restricted sites in colon anastomosis repair: an immunohistochemical and biochemical study. Surgery 2006;140:7282.

    • Search Google Scholar
    • Export Citation
  • 37. Krarup PM, Eld M, Heinemeier K, et al. Expression and inhibition of matrix metalloproteinase (MMP)-8, MMP-9 and MMP-12 in early colonic anastomotic repair. Int J Colorectal Dis 2013;28:11511159.

    • Search Google Scholar
    • Export Citation
  • 38. Hesp FL, Hendriks T, Lubbers EJ, et al. Wound healing in the intestinal wall: a comparison between experimental ileal and colonic anastomoses. Dis Colon Rectum 1984;27:99104.

    • Search Google Scholar
    • Export Citation
  • 39. Martens MF, Hendriks T. Postoperative changes in collagen synthesis in intestinal anastomoses of the rat: differences between small and large bowel. Gut 1991;32:14821487.

    • Search Google Scholar
    • Export Citation
  • 40. Ellison GW. Wound healing in the gastrointestinal tract. Semin Vet Med Surg (Small Anim) 1989;4:287293.

  • 41. Koruda MJ, Rolandelli RH. Experimental studies on the healing of colonic anastomoses. J Surg Res 1990;48:504515.

  • 42. Mouat EE, Davis GJ, Drobatz KJ, et al. Evaluation of data from 35 dogs pertaining to dehiscence following intestinal resection and anastomosis. J Am Anim Hosp Assoc 2014;50:254263.

    • Search Google Scholar
    • Export Citation
  • 43. Harvey HJ. Complications of small intestinal biopsy in hypoalbuminemic dogs. Vet Surg 1990;19:289292.

  • 44. Aroch I, Klement E, Segev G. Clinical, biochemical, and hematologic characteristics, disease prevalence, and prognosis of dogs presenting with neutrophil cytoplasmic toxicity. J Vet Intern Med 2005;19:6473.

    • Search Google Scholar
    • Export Citation
  • 45. Smith GS. Neutrophils. In: Feldman BF, Zinkl JG, Jain NC, eds. Schalm's veterinary hematology. 5th ed. Philadelphia: Lippincott Williams & Wilkins, 2000;281296.

    • Search Google Scholar
    • Export Citation
  • 46. Latimer KS, Rakich PM. Clinical interpretation of leukocyte responses. Vet Clin North Am Small Anim Pract 1989;19:637668.

  • 47. Walters AM, O'Brien MA, Selmic LE, et al. Comparison of clinical findings between dogs with suspected anaphylaxis and dogs with confirmed sepsis. J Am Vet Med Assoc 2017;251:681688.

    • Search Google Scholar
    • Export Citation
  • 48. Hayes G, Mathews K, Doig G, et al. The acute patient physiologic and laboratory evaluation (APPLE) score: a severity of illness stratification system for hospitalized dogs. J Vet Intern Med 2010;24:10341047.

    • Search Google Scholar
    • Export Citation
  • 49. Tadros T, Wobbes T, Hendriks T. Blood transfusion impairs the healing of experimental intestinal anastomoses. Ann Surg 1992;215:276281.

    • Search Google Scholar
    • Export Citation
  • 50. Golub R, Golub RW, Cantru R Jr, et al. A multivariate analysis of factors contributing to leakage of intestinal anastomoses. J Am Coll Surg 1997;184:364372.

    • Search Google Scholar
    • Export Citation
  • 51. Beer KS, Silverstein DC. Controversies in the use of fresh frozen plasma in critically ill small animal patients. J Vet Emerg Crit Care (San Antonio) 2015;25:101106.

    • Search Google Scholar
    • Export Citation
  • 52. Dickinson AE, Summers JF, Wignal J, et al. Impact of appropriate empirical antimicrobial therapy on outcome of dogs with septic peritonitis. J Vet Emerg Crit Care (San Antonio) 2015;25:152159.

    • Search Google Scholar
    • Export Citation
  • 53. Proulx A, Hume DZ, Drobatz KJ, et al. In vitro bacterial isolate susceptibility to empirically selected antimicrobials in 111 dogs with bacterial pneumonia. J Vet Emerg Crit Care (San Antonio) 2014;24:194200.

    • Search Google Scholar
    • Export Citation
  • 54. Paul M, Shani V, Muchtar E, et al. Systematic review and meta-analysis of the efficacy of appropriate empiric antibiotic therapy for sepsis. Antimicrob Agents Chemother 2010;54:48514863.

    • Search Google Scholar
    • Export Citation
  • 55. Kumar A, Roberts D, Wood KE, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 2006;34:15891596.

    • Search Google Scholar
    • Export Citation

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Evaluation of short-term outcomes and potential risk factors for death and intestinal dehiscence following full-thickness large intestinal incisions in dogs

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  • 1 1Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN 37996.
  • | 2 2Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA 30602.
  • | 3 3Department of Small Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061.
  • | 4 4Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616.
  • | 5 5Martingale Consulting LLC, Media, PA 19063.

Abstract

OBJECTIVE

To determine complication rates for dogs in which full-thickness large intestinal incisions were performed, assess potential risk factors for death during hospitalization and for intestinal dehiscence following these surgeries, and report short-term mortality rates for these patients.

ANIMALS

90 dogs.

PROCEDURES

Medical records of 4 veterinary referral hospitals were reviewed to identify dogs that underwent large intestinal surgery requiring full-thickness incisions. Signalment, history, clinicopathologic data, medical treatments, surgical procedures, complications, and outcomes were recorded. Descriptive statistics were calculated; data were analyzed for association with survival to discharge (with logistic regression analysis) and postoperative intestinal dehiscence (with Fisher exact or Wilcoxon rank sum tests).

RESULTS

Overall 7-day postoperative intestinal dehiscence and mortality rates were 9 of 90 (10%) and 15 of 90 (17%). Dogs with preoperative anorexia, hypoglycemia, or neutrophils with toxic changes and those that received preoperative antimicrobial treatment had greater odds of death than did dogs without these findings. Preexisting colon trauma or dehiscence, preexisting peritonitis, administration of blood products, administration of > 2 classes of antimicrobials, positive microbial culture results for a surgical sample, and open abdominal management of peritonitis after surgery were associated with development of intestinal dehiscence. Five of 9 dogs with intestinal dehiscence died or were euthanized.

CONCLUSIONS AND CLINICAL RELEVANCE

Factors associated with failure to survive to discharge were considered suggestive of sepsis. Results suggested the dehiscence rate for full-thickness large intestinal incisions may not be as high as previously reported, but several factors may influence this outcome and larger, longer-term studies are needed to confirm these findings.

Contributor Notes

Dr. Latimer's present address is Carolina Veterinary Specialists, 12117 Statesville Rd, Huntersville, NC 28078. Dr. Benitez's present address is Dogwood Veterinary Surgical Care PLLC, PO Box 2473, Cornelius, NC 28031.

Address correspondence to Dr. Lux (clux@utk.edu).