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Stacy N. Soulsby Stoney Creek Animal Hospital, 626 W Mallard Creek Church Rd, Charlotte, NC 28262.

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 DVM
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Jason M. Balara Carolina Veterinary Specialists, 12117 Statesville Rd, Huntersville, NC 28078.

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 DVM, DACVS
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Suzanne N. LeGrange Carolina Veterinary Specialists, 12117 Statesville Rd, Huntersville, NC 28078.

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 DVM, MS, DACVIM

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History

A 6-year-old neutered male Labrador Retriever was evaluated for chronic weight loss, flatulence, borborygmus, and intermittent diarrhea. Serum total thyroxine concentration, CBC, and serum biochemical analysis results were within reference limits. No parasite ova were seen on fecal floatation. The dog had serum trypsin-like immunoreac-tivity and pancreatic lipase immunoreactivity concentrations within reference limits, a low serum folate concentration (7.2 μg/L; reference range, 7.7 to 24.4 μg/L), and a serum cobalamin concentration within reference limits. His-tologic examination of endoscopic biopsy specimens of the stomach and duodenum revealed lymphocytic enteritis. A diagnosis of inflammatory bowel disease was made, and treatment was started with prednisone, metronidazole, a probiotic,a vitamin B12, and a limited ingredient diet.b

Following 18 days of treatment, the dog was reevaluated for a 12-hour history of vomiting, anorexia, tenesmus, restlessness, and signs of abdominal pain. Physical examination revealed continued weight loss of 3.6 kg (8 lb), panting, and mild signs of pain on abdominal palpation. Results of venous blood gas and serum biochemical analyses performed with a portable clinical analyzer were unremarkable. Abdominal radiographs were obtained (Figure 1).

Figure 1—
Figure 1—

Left lateral (A), ventrodorsal (B), and right lateral (C) radiographic views of the abdomen of a 6-year-old neutered male Labrador Retriever with a 12-hour history of vomiting, anorexia, tenesmus, restlessness, and signs of abdominal pain.

Citation: Journal of the American Veterinary Medical Association 237, 8; 10.2460/javma.237.8.907

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Radiographic Findings and Interpretation

Gaseous distention of the small and large intestinal tract is evident, allowing for good serosal detail. Most notable is the severe dilation of a segment of intestine resulting in caudal displacement of the small intestines. Granular, soft tissue opacity material appearing consistent with feces can be seen within the lumen of the distended segment of intestine, suggesting that it is the colon. However, the cecum cannot be readily identified among the gas-dilated loops of intestines. In addition, because the caudal portion of the abdomen is not included on the radiographs as a result of limitations from the size of the dog, neither the distal portion of the colon as it enters the pelvic canal to become the rectum nor the urinary bladder is visualized, making it difficult to definitively conclude that the distended segment is the colon. Therefore, the granular material in the dilated intestine could also represent porous foreign material or accumulated ingesta in a segment of distended small intestine. A paper clip is located in the normally positioned stomach (Figure 2). Differential diagnoses based on radiographic findings include colonic volvulus, foreign body obstruction, volvulus of the small intestine, and adynamic ileus.

Figure 2—
Figure 2—

Same radiographic images as in Figure 1. Notice the generalized increase in gas in the gastrointestinal tract. The colon (c) is identified as the markedly dilated segment of intestine in the cranial and middle portions of the abdomen causing caudal displacement of the small intestines (s). Material consistent with feces (f) can be seen within the lumen. A paper clip (p) is evident in the stomach in all images.

Citation: Journal of the American Veterinary Medical Association 237, 8; 10.2460/javma.237.8.907

Comments

Exploratory celiotomy was performed in this dog, and colonic volvulus was identified. The ascending, transverse, and descending portions of the colon had undergone 180° counterclockwise rotation. After the colon was repositioned, an orogastric tube was used to eliminate fluid and gas from the gastrointestinal tract. A gastrotomy was performed to remove the paper clip. A right-sided incisional gastropexy along with a left-sided colopexy and gastrocolopexy were performed to prevent future gastric dilatation-volvulus and colonic volvulus. Full-thickness biopsy specimens of the duodenum, jejunum, and ileum were taken, and inflammatory intestinal disease was confirmed on histologic evaluation. The dog recovered well after surgery and was discharged with instructions to continue all current medications for inflammatory bowel disease.

Volvulus of the colon has been previously reported in young to middle-aged dogs of medium and large breeds, many of which have a history of gastrointestinal tract dis-ease.1–4 The most common clinical signs of this disease are vomiting and abdominal discomfort, although depression, diarrhea, tenes-mus, and anorexia have also been described.1–4

Although a definitive diagnosis of colonic volvulus could not be made from the radiographic images obtained from the dog of this report, the radiographic findings were highly suggestive of the disease. The shape and degree of dilation of the segment of intestine, lack of any other structure resembling a normally positioned colon in the radiographs, and appearance of material consistent with feces within the distended intestine were indicative of the colon. Differentiating between adynamic ileus and mechanical obstruction can be difficult.3 A barium contrast study may have been helpful in ruling out differential diagnoses, but based on the clinical signs of the dog of this report and the degree of dilation of the segment of the intestine observed on radiographs, this was not performed. Exploratory celiotomy was indicated and confirmed the suspected colonic volvulus.

Unfortunately, 1 month following surgery, the dog of this report sustained further weight loss, borborygmus, and episodes of vomiting and regurgitation despite continual medical management of the inflammatory bowel disease. As a result of further clinical deterioration, the dog was euthanatized.

a.

Purina Veterinary Diets Fortiflora, Nestlé Purina PetCare Co, St Louis, Mo.

b.

Royal Canin Veterinary Diets Potato and Rabbit Formula, Royal Canin USA Inc, St Charles, Mo.

  • 1.

    Halfacree ZJBeck ALLee KCL, et al Torsion and volvulus of the transverse and descending colon in a German Shepherd Dog. J Small Anim Pract 2006; 47:468-470.

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  • 2.

    Carberry CAFlanders JA. Cecal-colic volvulus in two dogs. Vet Surg 1993; 22:225-228.

  • 3.

    Bentley AMO'Toole TEKowaleski MP, et al Volvulus of the colon in four dogs. J Am Vet Med Assoc 2005; 227:253256.

  • 4.

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

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