Another challenging aspect of this case was the postoperative management. We think that the dog's recovery from an already
severe condition was hindered by its respiratory disease (aspiration pneumonia), leading to a state of hypoxemia. Thoracic
radiographs taken five days after surgery showed patterns consistent with bronchopneumonia. There was no obvious gross evidence
of pneumonia on necropsy, but it was not ruled out by a histologic examination. We think that aspiration pneumonia was present
based on clinical and radiographic signs. If a transtracheal wash or bronchoalveolar lavage had been performed, the results
of the cytology and culture would have helped rule pneumonia in or out. A pulmonary thromboembolism could have caused the
radiographic changes as well.10
Another differential diagnosis for the dog's postoperative clinical signs could have been esophageal leakage. If leakage through
the esophageal incision had been suspected, another surgery could have been performed to repair the esophagus. Although leakage
of the thoracic esophagus was considered, the expected pleural effusion was not seen radiographically. The fluid may have
been difficult to see if it was contained in the caudal mediastinal space, as noted at necropsy. If negative culture results
had been attained after a transtracheal wash or bronchoalveolar lavage, esophageal leakage would have been more strongly considered.
CONCLUSION
Gastroesophageal intussusception is a relatively rare condition, but this case demonstrates the importance of considering
esophageal disease when confronted with a history of chronic vomiting. The outcome depends on being able to recognize possible
esophageal disease promptly so that appropriate diagnostic steps are taken to arrive at an early and correct diagnosis. ?
Ralph P. Millard, DVM*
Brenda Jo Salinardi, DVM, MS, DACVS**
Department of Clinical Sciences
College of Veterinary Medicine
Kansas State University
Manhattan, KS 66506
Current addresses:
*Department of Veterinary Clinical Sciences
College of Veterinary Medicine
University of Minnesota
St. Paul, MN 55108
**Department of Clinical Sciences
College of Veterinary Medicine
Oregon State University
Corvallis, OR 97331
REFERENCES
1. Washabau RJ, Holt DE. Esophageal pathophysiology. In: Slatter D, ed. Textbook of small animal surgery. 3rd ed. Philadelphia, Pa: WB Saunders Co, 2003;530-533.
2. Graham KL, Buss MS, Dhein CR, et al. Gastroesophageal intussusception in a Labrador retriever. Can Vet J 1998;39:709-711.
3. Leib MS, Blass CE. Gastroesophageal intussusception in the dog: a review of literature and a case report. J Am Anim Hosp Assoc 1984;20:783-790.
4. Clark GN, Spodnick GJ, Rush JE, et al. Belt loop gastropexy in the management of gastroesophageal intussusception in a pup.
J Am Vet Med Assoc 1992;201:739-742.
5. von Werthern CJ, Montavon PM, Fluckiger MA. Gastro-oesophageal intussusception in a young German shepherd dog. J Small Anim Pract 1996;37:491-494.
6. Greenfield CL, Quinn MK, Coolman BR. Bilateral incisional gastropexies for treatment of intermittent gastroesophageal intussusception
in a puppy. J Am Vet Med Assoc 1997;211:728-730.
7. Applewhite AA, Cornell KK, Selcer BA. Diagnosis and treatment of intussusceptions in dogs. Compend Contin Educ Pract Vet 2002;24:110-125.
8. Fossum TW. Surgery of the stomach. In: Small animal surgery. 2nd ed. St. Louis, Mo: Mosby, 2002;337-368.
9. Gowen GF, Stoldt HS, Rosato FE. Five risk factors identify patients with gastroesophageal intussusception. Arch Surg 1999;134:1394-1397.
10. Johnson LR, Lappin MR, Baker DC. Pulmonary thromboembolism in 29 dogs: 1985-1995. J Vet Intern Med 1999;13:338-345.
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