Ins & Outs of Intussusception in Dogs

In the Literature

Larose PC, Singh A, Giuffrida MA, et al. Clinical findings and outcomes of 153 dogs surgically treated for intestinal intussusceptions. Vet Surg. 2020;49(5):870-878.

The Research …

Intestinal intussusception can lead to life-threatening sequelae; however, because the condition is uncommon, literature describing this condition has been limited to small groups of dogs, and strong recommendations for specific treatment strategies are lacking. 

This retrospective study of intestinal intussusception in 153 dogs describes important clinical findings and treatment options. Intussusception disproportionately affects younger dogs; the median age of patients in this study was 10 months. The most common clinical signs were vomiting, diarrhea, anorexia, lethargy, and hematochezia. Half of the dogs were presented with abdominal pain, and intussusception was palpable on physical examination in approximately one-third of dogs. 

Recent surgery was identified as a potential risk factor, as 18.9% of dogs had undergone surgery in the 30 days prior to presentation. Although a majority of the surgeries were abdominal, they did not exclusively involve the GI tract. During surgery, 19.6% of dogs had evidence of intestinal perforation prior to manipulation of the intussusception. 

Manual reduction of intussusception can cause serosal or full-thickness perforation but may be useful for resection planning. Surgical treatment options include manual reduction alone, manual reduction with enteroplication, manual reduction followed by resection and anastomosis or typhlectomy, and manual reduction followed by both resection and anastomosis and enteroplication, all of which were reported in this study. 

In total, resection and anastomosis were performed in 84.3% of dogs, and enteroplication was performed in 18.4% of dogs. Partial or complete enteroplication was performed in 54.2% of dogs treated with manual reduction alone. 

Intussusception was classified as idiopathic in 67% of dogs. Intestinal parasites, neoplasia, foreign material, chronic inflammatory disease, previous intestinal surgery, parvoviral enteritis, and Campylobacter spp enteritis were identified as uncommon underlying causes. 

Overall prognosis was good; 94% of dogs survived the 14-day postoperative period. Severe or life-threatening postoperative complications occurred in 14% of dogs. Intussusception recurred in 2.6% of dogs and developed within 72 hours postoperatively. Long-term complications (eg, mesenteric volvulus, mechanical obstruction due to adhesion formation, colonic torsion, colonic stricture) were uncommon. 

The study population was insufficient to evaluate whether etiology or surgical treatment affected recurrence or overall outcome. Thus, the recommendation of whether to resect viable tissue after manual reduction and the utility of partial and complete enteroplication remain unclear.

FIGURE 1

Jejunocolic intussusception in which the jejunum (left) is entering the colon (right). The intussusceptum in this patient included part of the jejunum, the ileum, and the cecum. Image courtesy of Michelle Oblak, DVM, DVSc, DACVS

FIGURE 2

Manual reduction of an intussusception via gentle traction on the intussusceptum. Image courtesy of Michelle Oblak, DVM, DVSc, DACVS

… The Takeaways

Key pearls to put into practice:

• Intussusception should be a differential diagnosis for patients presented with GI or nonspecific signs following recent surgery.

• Histopathology of GI biopsy sites and the intussusception site increases the likelihood of obtaining a histopathologic diagnosis of underlying nonneoplastic GI disease.¹

• Although surgical treatment of intestinal intussusception has a good prognosis and 94% survival rate, pet owners should be counseled that severe or life-threatening complications, including recurrence, occur postoperatively in ≈14% of cases.

• Manual reduction of intussusception alone may be sufficient for a good outcome. The therapeutic benefits of enteroplication are unclear.