Intussusception in Cats (Felis) | Vetlexicon
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Intussusception

ISSN 2398-2950

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Introduction

  • Suspect in any young animal with history consistent with intestinal obstruction.
  • Invagination of a portion of gastrointestinal tract into a posterior or preceding segment of intestine.
  • Most common in young animals, located near the ileocolic valve.
  • Cause: intestinal irritation  →  vigorous contraction of a segment of intestine into the lumen of the adjacent relaxed segment.
  • Diagnosis: palpation, radiography.
  • Treatment: usually require surgical correction.
  • Prognosis: good (but depends on underlying disease).

Presenting signs

  • Anorexia.
  • Abdominal pain.
  • Vomiting Vomiting.
  • Weight loss.
  • Chronic diarrhea.

Age predisposition

  • Old cats associated with intestinal neoplasm.
  • Young cats.

Cost considerations

  • Surgery costs.

Pathogenesis

Predisposing factors

General

Pathophysiology

  • A portion of the gastrointestinal tract invaginates into a posterior or preceding segment of intestine.
  • Circulatory embarassment  →  ischemic necrosis and localized peritonitis.
  • Results in partial or complete intestinal obstruction Intestine: obstruction.
  • Vigorous contraction of a segment of intestine into the lumen of the adjacent relaxed segment.
  • The blood supply to the intussuscepted piece of gut is compromized due to its inclusion in the invagination.
  • Initially, venous occlusion is present, resulting in edema of the bowel; if prolonged, can eventually cause arterial occlusion and necrosis.
  • Eventually, fibrinous adhesions can form, making spontaneous or surgical reduction of the intussusception less likely.
  • Results in partial or complete intestinal obstruction Intestine: obstruction.

Timecourse

  • Days to weeks.

Diagnosis

Presenting problems

  • Anorexia.
  • Depression.
  • Abdominal mass.
  • Abdominal pain.
  • Vomiting Vomiting.

Client history

  • Signs may be intermittent with sliding intussusception.
  • Anorexia.
  • Depression.
  • Scant feces, principally of blood and mucus.
  • Vomiting.
  • Chronic diarrhea.

Clinical signs

  • Abdominal pain.
  • Abdominal mass.
    Raise forequarters to make ileocecal area slide out from behind ribs which may make intussusception more readily palpable
  • Dehydration.

Diagnostic investigation

Radiography

  • See abdominal radiography Radiography: abdomen.
  • Dilated gas and fluid-filled loops of bowel proximal to obstruction Intestine: chronic obstruction - lateral radiograph .
  • Soft tissue mass of the intussusception in the central abdomen.
  • Gas bubbles lying between the intussuscepted segment and its surrounding bowel.

Contrast radiography

  • See gastrography Radiography: gastrography.
  • Outline of mucosal folds in the intussusceptus.
    Oral administration of barium sulfate is inferior to a barium enema in outlining the lesion.In most cases sufficient evidence on plain radiography to make contrast radiography unnecessary.
  • Fluoroscopy: outline of mucosal folds in the intussusception.
    Barium enemas may reduce the intussusception which may then recur at a later time. For this reason, fluroscopy is recommended at the time of the barium enema if possible.

Biochemistry

Other

2-D Ultrasonography

Confirmation of diagnosis

Discriminatory diagnostic features

  • History and clinical signs.
  • Plain radiography.

Definitive diagnostic features

  • Contrast radiography.
  • Laparotomy.

Differential diagnosis

Treatment

Initial symptomatic treatment

Standard treatment

  • Attempt to reduce intussusception surgically Intussusception: surgical procedure .
  • If reducible and no obvious cause then intestine must be plicated to prevent recurrence.
  • May require surgical excision if chronic and bowel devitalized or neoplasia present.
  • A multiple enteropexy procedure that apposes the serosal surface of the small intestine extending from the proximal jejunum to the ileocolic valve may be indicated.
  • Gastroesophageal intussusception may require gastropexy to prevent recurrence.

Monitoring

  • Electrolyte levels Blood biochemistry: overview (potassium often low and may  →  ileus).
  • Encourage early feeding with low fat, low fiber diet (may require tube feeding if anorexic).

Subsequent management

Monitoring

  • For development of peritonitis (abdominal pain, vomiting, pyrexia) post-surgery Peritonitis.
  • For ileus Ileus (vomiting, lack of intestinal sounds).
  • For leakage or wound dehiscence.

Prevention

Outcomes

Prognosis

  • Regardless of the intra-operative findings and subsequent surgical manipulation, the most problematical aspect of therapy is to prevent recurrence.

Expected response to treatment

  • Cessation of clinical signs.

Reasons for treatment failure

  • Underlying cause not treated.

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Borgarelli M, Biller D S, Goggin J M & Bussadori C (1998) Ultrasonographic examination of the gastrointestinal system. Part 2 - Ultrasonographic identification of gastrointestinal disease. JSAP (2), 57.
  • Culvenor J A (1997) Peritonitis following intestinal anastomosis and enteroplication in a kitten with intussusception. Aust Vet J 75 (3), 175-177 PubMed.
  • Williams J, Reichle J (1993) What is your diagnosis? Ileocecocolic intussusception. JAVMA 203 (12), 1671-1672 PubMed.
  • Lansdown A B, Fox E A (1991) Colorectal intussusception in a young cat. Vet Rec 129 (19), 429-430 PubMed.
  • Lewis D D, Ellison G W (1987) Intussusception in dogs and cats. Comp Cont Ed (5), 523-532 VetMedResource.
  • Davies T D (1985) Intussusception in the cat. Vet Rec 117 (8), 191 PubMed.
  • Bellenger C R, Middleton D J, Ilkiw J E et al (1982) Double intussusception followed by reintussusception in a kitten. Vet Rec 110 (14), 323-324 PubMed.
  • Kavanagh M F (1981) Intussusception in Siamese cats. Vet Rec 109 (8), 165 PubMed.