Intussusception

What is it?

Intussusception is when one intestinal segment invaginates into the lumen of an adjacent intestinal segment. Initially, this invagination causes partial intestinal obstruction which eventually progresses to complete obstruction as the length of the affected intestine increases. Eventually, the blood supply to the invaginated portion of intestine will be compromised and the cells of the gastrointestinal tract will die and slough off leading to intestinal perforation. The toxins may gain access to the bloodstream and cause multi-organ damage, failure and sepsis. This condition can occur anywhere in the gastrointestinal tract and there can be more than one site affected at a time. It is often associated with patients that have enteritis due to common differentials such as parasitism, bacterial/viral infections, foreign bodies, dietary indiscretion and masses. It can also occur in patients with systemic illness or idiopathically (no known identifiable cause). This condition usually affects young dogs; however, we also see them in older patients and cats.

Surgery involves manual reduction of the intussusceptions by gentle traction. In severe cases where there is irreversible intestinal damage and/or intestinal perforation, an intestinal resection and anastomoses may need to be performed. The entire abdominal cavity and its contents are also explored to assess for other abdominal abnormalities.

This condition is life-threatening and some mild cases may be manually reduced without surgery. However, because recurrence is common, surgery for correction is indicated and biopsies may be recommended at the time of surgery to help identify the cause of the intussusception.

Waiting to decide on surgical intervention can increase the chances of complication and even patient death. Anesthetic deaths can occur due to being in shock (low blood pressure, high then low heart rates).

Clinical Signs

The clinical signs vary depending on the location, completeness and duration of intestinal obstruction. Below are the possible clinical signs you may see in your pet:

  • Scant bloody diarrhea
  • Vomiting, drooling, lip licking
  • Abdominal pain
  • Depression
  • Anorexia/Emaciation

Aftercare

  • Patients recovering from intussusceptions surgery will spend on an average of two to seven days in the hospital before being discharged depending on how severe the intussusceptions surgery was.
  • Restricted activity for 14 days. Short leash walks only to go to the bathroom. No running, jumping or rough plays during this time.
  • Patient is monitored closely for the first week for reduced appetite, abdominal pain and swelling, lethargy, fever and vomiting.
  • Pain medications and a more frequent, smaller volume feeding schedule will be implemented during recovery.
  • An Elizabethan (E) collar (“cone”) is provided and must be worn at all times to prevent self-trauma of the surgical site. A loose-fitting breathable T-shirt or post-surgical onesies may also be considered.
  • Daily monitoring of the surgical site. Complications include oozing, a foul smell, swelling or pain at the surgical site. A bandage may be applied to the surgical site to be kept on for the first day (and removed thereafter) after surgery to minimize leaking from the incision.

Prognosis and Complications

Prognosis depends on the cause, location, completeness and duration of intussusceptions. In cases of uncomplicated intussusceptions, the prognosis can be excellent. Whereas in severe cases where there are severe obstruction(s) and intestinal perforation(s) the patient can die acutely during or within 3-4 days post-operation.

Complications such as wound dehiscence, peritonitis occurs more frequently in debilitated patients due to inadequate nutrition for optimum wound healing. Short bowel syndrome can occur when huge sections of intestines are required to be removed and may render these animals needing lifelong medical and/or dietary management.