Hospital Cases

Intestinal Strangulation

Mac, a 2 year old pointer, had just returned from a weekend on the farm. His owner noticed he was vomiting everything he ate and drank and was very quiet.

On examination, his gums were nice and pink and filled up with blood quickly when pressed by a finger (capillary refill time). His temperature was ok and heart and breathing rates ok. 

Mac was very uncomfortable when palpating his abdomen, even with a heavy pain killer sedation. We were concerned he may have a foreign body in his stomach or intestines or had some kind of blockage in his intestines. Blood tests showed healthy organs but his white blood cell count was elevated indicating infection and/or inflammation.

X-rays showed a lot of gas building up in his intestines but no real evidence of a solid foreign body.

The fact that he had severe vomiting and marked pain in his abdomen and gas building up in his intestines was enough to warrant us having a look inside straight away.

Mac was placed on an IV drip and anaesthetised with IV Alfaxan before being placed on Isoflurane gas. Upon opening the abdomen, there was fresh blood lying around and a very nasty looking section of bleeding and dying small intestine.

On close examination, approx. 50cm of his small intestine had slipped through a naturally occurring small hole in some tissue called the mesentery, and then twisted around and cut its own blood supply off.

The mesentery is a transparent tough “cling wrap” like which lines the abdominal contents. Unfortunately, it has a small hole (foramen) in it as part of its normal structure. Very rarely in dogs, but more so in horses, a piece of intestine slips into this hole. Once it slips through, the intestine twists around on itself and cuts its own blood supply off. This is very painful, and it is not long before the intestine dies and leaks all the food and bacteria it contains into the abdomen causing sudden death.

We removed the dead piece of small intestine and then joined (anastomosed) the 2 fresh edges together. Luckily, there was 1.5cm of normal small intestine to work with before the junction of small and large intestines was involved (where the appendix is). If we had had to remove this junction, there was a very high risk of chronic diarrhoea issues and breakdown of the surgery site as we would be trying to join a narrow “tube” (small intestine) to a wide “tube” (large intestine).

The whole area was flushed several tines with saline and then Cephalexin antibiotic was sprayed over the operating site. We then wrapped the anastomosis in some tissue called omentum which has great at healing powers and is good at sealing any small leaks.

Mac stayed on a drip of 48 hours and was offered water after 36 hours which he kept down. After 36 hours, we fed him on hourly small amounts of tin food made into slurry. He went home 3 days after the surgery looking a whole lot brighter and stronger. At stitches out 10 days post-op, he was bouncing up our stairs eager to get his special treat before having his stitches removed.

All in all, a very tricky surgery with great results.

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