A Case Report: Successful Resection of Intussusception in a Golden Retriever

A two-month-old male Golden Retriever, “Youyou,” weighing 4.5 kg, was presented to our hospital after a three-day course of intravenous fluid therapy at another facility for severe diarrhea failed to improve his condition. Prior to referral, the presence of adult parasites in his stool was noted. Upon arrival, Youyou exhibited severe anemia and dehydration, was unable to ambulate, and presented with multiple sausage-shaped masses palpable in his abdomen, highly suggestive of intussusception. Given the advanced stage of the disease, the dog’s poor condition, and the owner’s financial constraints, a decision was made to proceed with exploratory laparotomy.

I. Intussusception: An Overview

Intussusception is a condition characterized by the invagination of one portion of the intestine into an immediately adjacent segment. This can occur anywhere along the gastrointestinal tract, but it most commonly affects the ileum, cecum, and jejunum. The invaginating segment is termed the intussusceptum, while the receiving segment is the intussuscipiens. The direction of invagination aligns with the normal peristaltic movement of the bowel. Importantly, multiple intussusceptions often occur simultaneously, sometimes involving two segments invaginating into a single receiving section.

The initial stage of intussusception results in partial obstruction. As the condition progresses, complete obstruction develops. The compromised blood supply to the intussusceptum, due to compression of the mesenteric vessels by the increased intraluminal pressure, can lead to ischemia, vascular disruption, and ultimately, necrosis. Intestinal wall edema, hemorrhage, and inflammation ensue. Serosanguinous fluid may accumulate within the intestinal lumen and peritoneal cavity. Fibrin deposition may lead to adhesion formation between intestinal layers, potentially containing localized peritonitis. In advanced cases, intestinal necrosis may cause widespread peritoneal contamination, becoming a life-threatening condition. It’s crucial to note that intussusception can be a terminal event in moribund animals, with less pronounced inflammatory changes and a lack of extensive adhesion formation.

II. Pathophysiology and Etiology

The etiology of intussusception is multifactorial. While it can occur sporadically, predisposing factors often include parasitic infections, viral or bacterial enteritis, dietary indiscretions, intestinal masses, or the presence of other systemic diseases. In young animals, parasitic infestations and enteritis are frequently implicated. In adult dogs, intestinal thickening or neoplastic masses may play a significant role. The severity and clinical presentation of intussusception are determined by factors including the location and duration of the intussusception, the completeness of the obstruction, and the integrity of the vascular supply to the affected intestinal segment.

III. Clinical Presentation

Intussusception is more prevalent in certain breeds, with Golden Retrievers being somewhat predisposed. Classical clinical signs include intermittent or persistent hematochezia (bloody diarrhea), vomiting, abdominal pain, and the palpable abdominal mass characteristic of the intussusceptum. Chronic cases may present with subtle or intermittent diarrhea, hypoalbuminemia, lethargy, and weight loss. The intensity and nature of clinical signs vary depending on the aforementioned factors (location, duration, completeness, and vascular compromise).

IV. Case Analysis of Youyou

Youyou’s presentation was consistent with severe intussusception. His complete blood count revealed significant anemia, reflecting the blood loss associated with intestinal ischemia. His severe dehydration further compounded his compromised state. The multiple, palpable, sausage-shaped abdominal masses confirmed the clinical suspicion of intussusception. Routine infectious disease testing (Canine Distemper Virus, Canine Parvovirus, Canine Coronavirus) was negative.

Exploratory laparotomy revealed four distinct sites of intussusception, with relatively long segments of bowel involved. The intussusceptions were manually reduced. At one site, a rupture of the serosal layer of the intussusceptum, with minimal hemorrhage, was observed, highlighting the advanced ischemic changes. Because the intussusceptions were not accompanied by significant adhesion formation at the neck of the intussusceptum or the sheath, and the intestinal function appeared intact post-reduction, resection was not required. However, the risk of recurrence was acknowledged to the owner. Had intestinal necrosis been present, resection and end-to-end anastomosis would have been necessary. Extensive resection, potentially leading to short bowel syndrome, would have been a significant concern.

V. Post-operative Management and Prognosis

Post-operative management involved careful monitoring of Youyou’s hydration status, electrolyte balance, and pain management. As is standard practice following gastrointestinal surgery, he was kept NPO (nothing by mouth) for approximately three days, after which a gradual reintroduction of food, starting with clear liquids and advancing to a bland diet, was implemented under veterinary supervision. The transition to a normal diet was gradual and closely monitored for signs of complications.

Given Youyou’s advanced condition at presentation, his prognosis was guarded. While the intussusceptions were successfully reduced, the risk of recurrence remained, and ongoing monitoring for signs of complications was essential. His initial severe dehydration and anemia contributed to a prolonged recovery period. Long-term management focused on preventative care, including appropriate parasite control and a well-balanced diet to minimize the risk of future gastrointestinal issues. The case highlights the importance of early diagnosis and intervention in cases of suspected intussusception to improve the chances of a favorable outcome.

VI. Conclusion

This case report underscores the complexities of managing canine intussusception. While manual reduction was successful in this case, the severity of the presentation emphasized the potential for life-threatening complications. Early detection, prompt surgical intervention when indicated, and meticulous post-operative care are crucial for optimizing the prognosis in these challenging cases. The owner was thoroughly educated on the potential for recurrence and the importance of regular veterinary check-ups for ongoing monitoring.