SMALL BOWEL INTUSSUSCEPTION SECONDARY TO
PARVOVIRUS INFECTION IN A DOG : CASE REPORT
Endang Yuli A., Royama Sari,
Herlina, Cucu K. Sajuthi
24 HRS Veterinary Clinic Drh. Cucu K. Sajuthi and Associate
Ruko Nirwana Sunter Asri Tahap III Blok J-1 no.2 Sunter, North Jakarta-Indonesia
Keywords: Dog, Intussusception, Parvovirus, Small Bowel
INTRODUCTION
Intussusception is a telescoping of one intestine segment into an adjacent segment. Intussusception is associated with active enteritis, especially in young animals5. The exact cause is unknown. It is considered a sign of underlying disorder, such as parvovirus infection, severe intestinal parasitism, and intestinal obstruction2. Diagnosis of intussusception was based most often on clinical signs of bowel obstruction in association with the palpable abdominal mass3.
Intestinal intussuception is the most serious sequela that may develop during treatment for viral gastroenteritis. Altered intestinal motility is implicated. Careful abdominal palpation for the presence of an abdominal mass should be performed daily. Persistent vomiting after apparent clinical recovery should prompt a careful search for intussusception6.
MATERIALS AND METHODS
The observation was done to a three-month-old female dog of mixed race. The dog was diagnosed of gastroenteritis due to parvovirus infection. Signalment and medical history were evaluated. Physical examination, diagnostic test (including plain abdominal radiograph, complete blood count, and serum biochemical profile), laparotomy exploration of the abdominal cavity and blood transfusion were performed. The dog died 7 days after surgery and the case was reviewed.
RESULTS AND DISCUSSION
A three-month-old female dog of mixed race was examined at the 24 HRS Veterinary Clinic Drh. Cucu K. Sajuthi and Associate. The dog was presented with a pale mucous membrane, abdominal pain, anorexia, depression, nausea, severe vomiting, and diarrhea to bloody diarrhea. A parvovirus test kit revealed positive result. The dog was diagnosed with gastroenteritis due to parvovirus infection and hospitalized for intensive treatment but the symptoms were prolonged. The treatment consisted of intravenous (IV) Lactated Ringer’s solution , enrofloxacin , ampicillin, ondansetron and sucralfate.
After a week of treatment, the dog showed clinical recovery, but began to vomit again the next five days. Persistent vomiting after apparent clinical recovery should prompt a careful search for intussusception6. Abdominal palpation of the dog evinced pain and revealed a firm tubular mass (sausage-like mass) inside. Diagnosis of intussusception was based most often on clinical signs of bowel obstruction in association with the palpable abdominal mass3. Plain abdominal radiograph showed gas accumulation and were suggestive of intussusception (Fig. 1). Plain abdominal radiographs allow the diagnosis of intussusceptions because they usually cause minimal intestinal gas accumulation. Intussusception must be treated surgically5. The dog was premedicated with atropine sulphate (0.025 mg/kg body weight SC) and diazepam (0.5 mg/kg body weight). Anesthesia was induced and maintained with isoflurane. Laparotomy exploration of the abdominal cavity revealed intussusception of the jejuno-jejunal segment (Fig. 2). The intussuception could not be reduced manually and the intestinal segment was not viable. The non-viable intestinal segment was resected (Fig. 3) and an end-to-end anastomosis of the viable segments was performed.
After surgery, the blood test was performed. Complete blood count (CBC) revealed severe leukocytosis, severe anemia, and thrombocytosis, and serum biochemical profile (SBP) revealed severe hypoproteinemia and hypoalbuminemia, as shown in Table 1. Whole blood transfusion was administered to treat severe anemia. The dog survived for 7 days after surgery and died because of serious complication.
Table 1
Result of blood test including complete blood count and serum biochemical profile
|
Parameter |
Result |
Unit |
Reference Range |
| CBC : | |||
| WBC |
58.2 |
109 /L |
6.0-17.0 |
| RBC |
2.93 |
106 //µL |
5.50-8.50 |
| Hemoglobin |
5.5 |
g/dL |
12.0-18.0 |
| HCT |
16.4 |
% |
37.0-55.0 |
| MCV |
56 |
fL |
60.0-77.0 |
| MCH |
18.8 |
Pg |
19.5-24.5 |
| MCHC |
33.5 |
g/dL |
32.0-36.0 |
| PLT |
869 |
109 /L |
200-500 |
| Lymphocyte |
17.4 |
% |
12.0-30.0 |
| Monocyte |
5.3 |
% |
3.0-10.0 |
| Eosinophil |
2.2 |
% |
2.0-10.0 |
| Granulocyte |
75.1 |
% |
60.0-80.0 |
| Lymphocyte |
10.1 |
109 /L |
1.0-4.8 |
| Monocyte |
3.1 |
109 /L |
0.15-1.35 |
| Eosinophil |
1.3 |
109 /L |
0.01-1.25 |
| Granulocyte |
43.7 |
109 /L |
3.5-14.0 |
| RDW |
14.7 |
% |
12.0-16.0 |
| PCT |
0.49 |
% |
0.00-2.90 |
| MPV |
5.6 |
fL |
6.7-11.0 |
| PDW |
16.0 |
% |
0.0-50.0 |
| SBP : | |||
| AST / SGOT |
70 |
U/L |
8.9-48.5 |
| ALT / SGPT |
37 |
U/L |
8.2-57.3 |
| Ureum (BUN) |
10 |
mg/dL |
10-20 |
| Creatinine |
0.4 |
mg/dL |
1-2 |
| Total Protein |
2.6 |
g/dL |
5.4-7.5 |
| Albumin |
0.8 |
g/dL |
2.6-4.0 |
| Total Bilirubin |
0.246 |
mg/dL |
0.07-0.61 |
| GGT |
3 |
U/L |
1.0-9.7 |
| ALP |
328 |
U/L |
10.6-100.7 |
Figure 1 – Plain abdominal radiograph revealed gas accumulation (arrow) : (A) Ventrodorsal; (B) Left lateral recumbent
Figure 2 – Laparotomy exploration of the abdominal cavity revealed intussusception of the jejuno-jejunal segment (arrow)
Figure 3 – The resected of non-viable intestinal segment
Intussusception is a telescoping of one intestine segment into an adjacent segment. Intussusception is associated with active enteritis, especially in young animals5. The exact cause is unknown. It is considered a sign of underlying disorder, such as parvovirus infection, severe intestinal parasitism, and intestinal obstruction2. Intestinal infection of canine parvovirus destroyed intestinal crypts and may produce villus collapse, diarrhea, vomiting, intestinal bleeding, and subsequent bacterial invasion5. Altered intestinal motility is implicated6. The common site in dogs is the ileocolic junction and jejuno-jejunal segments and dogs less than one year age were mostly affected4. Intussusception caused venous obstruction leading to necrosis of intestinal wall and variety of life threatening electrolyte disturbance; endotoxic and septic shock1.
REFERENCES
[1] Burrows CF, Merritt AM. 1992. Assessment of Gastrointestinal Function. In Anderson: Veterinary Gastroenterology. 2nd ed. Philadelphia: Lea and Febiger. p16-42.
[2] Harari J. 2004. Small Animal Surgery Secrets. 2nd ed. Philadelphia : Hanley & Belfus, Inc. p164.
[3] Levitt L, Bauer MS. 1992. Intussusception in Dogs and Cats: A Review of Thirty-Six Cases. J. Can. Vet. 33: 660-664.
[4] Lewis DD, Ellison GW. 1987. Intussusception in dog and cat, Comp Contin. 9: 523.
[5] Nelson RW, Couto CG. 2003. Disorder of The Intestinal Tract. In: Text Book of Small Animal Internal Medicine. 3rd ed. St. Louis: Mosby Inc. p433-434 and p455-456.
[6] Tams TR. 2003. Handbook of Small Animal Gastroenterology. 2nd ed. St. Louis: Saunders Elsevier Science. p204-205.
