A challenging case: Acute-on-chronic vomiting in a German shepherd - Veterinary Medicine
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A challenging case: Acute-on-chronic vomiting in a German shepherd
These clinicians discover that this dog's history of chronic vomiting was disguising a serious underlying problem.


VETERINARY MEDICINE


Five days after surgery, the dog became very depressed, tachypneic (120 breaths/min), remained febrile (104.5 F [40.3 C]), and began vomiting large amounts of bloody fluid. Thoracic radiography revealed no changes in appearance from the previous day. Results of an arterial blood gas analysis (sample obtained while the dog was receiving supplemental oxygen) indicated hypoxemia (PO2 = 60 mm Hg [normal = 90 to 100 mm Hg]; PCO2 = 25 mm Hg [normal = 36 to 40 mm Hg]; SPO2 = 91% [normal = 95% to 100%]). The owners elected euthanasia because of the poor prognosis associated with aspiration pneumonia and megaesophagus.


Figure 6
A gross necropsy was performed. The jejunostomy and gastropexy sites were intact. The stomach serosa was dark-red to black, but the mucosa appeared normal. The esophageal serosa and mucosa were dark-red to black, but the mucosa was intact. The sutures were intact in the esophagus; however, when tested, fluid leaked through a small portion of the suture line. The diaphragm incision was also intact. The mediastinum contained about 1 L of serosanguineous fluid. The esophagus was markedly dilated, measuring more than 16 cm in circumference (Figure 6). The cranial lung lobes were atelectatic. There was no gross evidence of aspiration pneumonia, but a histologic examination was not performed.

DISCUSSION

Gastroesophageal intussusception is a rare gastrointestinal emergency, and the cause is not completely understood. It seems to be more common in young dogs, usually less than 3 months of age. Males seem to be more commonly affected, as do large-breed dogs, especially German shepherds, possibly because of the higher incidence of hereditary megaesophagus.1-4 Esophageal disease is frequently associated with gastroesophageal intussusception, suggesting that abnormalities such as megaesophagus, abnormal esophageal motility, and esophageal hiatus laxity may be important contributing factors to gastroesophageal intussusception.2-6

Common clinical signs of gastroesophageal intussusception include regurgitation, vomiting, hematemesis, hypersalivation, abdominal discomfort, and dyspnea.3 Along with the stomach, other abdominal organs can invaginate into the esophagus, including the spleen, duodenum, pancreas, and omentum.3,5 In addition to obstructing the esophagus, gastroesophageal intussusception can cause respiratory and cardiovascular dysfunction by acting as a space-occupying mass in the thorax.2-4 The intussusception can impair caudal lung lobe expansion and compress the great vessels in the thorax, compromising perfusion to various organs and venous return to the heart, leading to a state of obstructive shock and death.3

Gastroesophageal intussusception can be diagnosed by obtaining plain or contrast radiographs. A soft tissue opacity mass may be located in the caudal thoracic mediastinal area. The gas bubble in the stomach's normal anatomical location will be absent. If contrast medium is used, it may show a filling defect in the caudal esophagus, with no contrast present in the normal anatomical location of the stomach.3-5 If the diagnosis is still questionable, esophagoscopy can be performed, although it may not be possible to pass the endoscope into the stomach or rugal folds may be viewed within the esophagus.2-5,7


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Source: VETERINARY MEDICINE,
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