Gastroesophageal intussusception

From Dog
Jump to: navigation, search
Radiographic appearance of a gastroesophageal intussusception, showing occlusion of the cranial esophagus due to caudal obstruction by the stomach[1]

Gastroesophageal intussusception is a rare gastrointestinal disease of primarily young dogs characterized by invagination of the stomach into the caudal esophagus.

Although the stomach is primarily involved in the intussusceptum, other organs such as the duodenum or spleen can also be involved[2].

Young dogs appear to be less clinically affected, but in older dogs, this is usually a life-threatening condition that requires an accurate, swift diagnosis with immediate surgical intervention.

A breed predisposition has been noted in the German Shepherd but any breed may be affected, and male are more commonly involved. A predisposition to this disease in dogs is more common with megaesophagus[3][4], and has been reported following pneumonectomy[5] and respiratory distress syndrome[6].

This disease is frequently diagnosed in puppies from 8 weeks of age which present with recurrent regurgitation[7] or acute onset fever and respiratory dyspnea.

Initial symptoms may include vomiting, abdominal discomfort, hematemesis, dyspnea. Marked deterioration coincides with acute gastric ischemia and esophageal distension leading to pulmonary compression, hypotension, shock and cardiac arrest[8].

In other cases, only mild intermittent vomiting may be evident prior to diagnosis[9].

Depending on clinical severity, chest radiographs may reveal aspiration pneumonia and blood tests often show a leukocytosis characterized by neutrophilia, lymphopenia and monocytosis.

In young pups, radiographs may not show any abnormality and endoscopic examination is required for definitive diagnosis.

Diagnosis is based on barium-meal radiographs or CT scans, showing invagination of the anterior pylorus into the esophagus without other abdominal organs present in the deficit. The cranial esophagus is often dilated with gas while the caudal esophagus is distended with a soft-tissue dense mass.

A differential diagnosis would include megaesophagus, Spirocerca lupi infection, esophageal diverticula, hiatal hernia or diaphragmatic hernia[1].

Temporary alleviation of esophageal distention can be achieved via nasogastric tubing, allowing time to institute aggressive intravenous fluid therapy, correction of metabolic alkalosis and any fluid deficits[10].

Surgical intervention usually requires general anesthesia followed by open-surgical belt-loop gastropexy[11], bilateral incisional gastropexy (attaching the gastric fundus and body to the left and right body walls)[12] or endoscopic gastropexy.

References

  1. 1.0 1.1 McGill SE et al (2009) Nonsurgical treatment of gastroesophageal intussusception in a puppy. J Am Anim Hosp Assoc 45(4):185-190
  2. Leib M & Blass C (1984) Gastroesophageal intussusception in the dog: A review of the literature and a case report. J Am Anim Hosp Assoc 20:783-790
  3. Masloski A & Besso J (1998) What is your diagnosis? Gastroesophageal intussusception with megaesophagus in a dog. J Am Vet Med Assoc 212(1):23-24
  4. Rowland MG & Robinson M (1978) Gastro-oesophageal intussusception in an adult dog. J Small Anim Pract 19:121-125
  5. Weekley LB et al (1997) Gastroesophageal Intussusception Associated with Pneumonectomy in a Dog. Contemp Top Lab Anim Sci 36(1):91-93
  6. Järvinen AK et al (1995) Lung injury leading to respiratory distress syndrome in young Dalmatian dogs. J Vet Intern Med 9(3):162-168
  7. Roach W & Hecht S (2007) What is your diagnosis? Gastroesophageal intussusception. J Am Vet Med Assoc 231(3):381-382
  8. Pietra M et al (2003) Intermittent gastroesophageal intussusception in a dog: clinical features, radiographic and endoscopic findings, and surgical management. Vet Res Commun 27(1):783-786
  9. Morris EL & Turnwald GH (1980) Gastroesophageal intussusception. J Am Vet Med Assoc 176(4):361-362
  10. Crowe DT (1986) Use of a nasogastric tube for gastric and esophageal decompression in the dog and cat. J Am Vet Med Assoc 188(10):1178-1182
  11. Clark GN et al (1992) Belt loop gastropexy in the management of gastroesophageal intussusception in a pup. J Am Vet Med Assoc 201:739-742
  12. Greenfield CL et al (1997) Bilateral incisional gastropexies for treatment of intermittent gastroesophageal intussusception in a puppy. J Am Vet Med Assoc 211(6):728-730