Author

Stephen J. Birchard DVM, MS, Diplomate ACVS

Friday, October 4, 2013

"Beetle": A Jack Russell Terrier With An Unusual Intussusception


Fig. 1: Beetle
Beetle is a 10-year-old male neutered Jack Russell Terrier (Fig. 1) who had been lethargic and anorexic for the past 2-3 days. On physical examination Beetle was quiet but alert and had pale mucous membranes, 5% dehydration, 3/6 systolic cardiac murmur, and dark tarry stool on rectal examination. His right eye was very small and avisual with chronic corneal changes. His abdomen was tense and painful with a possible cranial abdominal mass present. Thoracic auscultation revealed a 3/6 systolic murmur. Rectal examination revealed dark, tarry stool.

Complete blood count and serum chemistry profile revealed of PCV of 18% and serum albumin 2 g/dl. A coagulagram was performed and was within normal limits.

Because of the possible abdominal mass and melena an abdominal ultrasound was performed and showed evidence of an intussusception. (Fig. 2)
Fig. 2: Ultrasound of a dog with an intussusception (not Beetle but similar). In this cross section of the affected
intestine note the layered intestinal walls  creating a target appearance. (arrows)
Abdominal exploratory was recommended to the owner. (Fig. 3)
Fig. 3: Beetle being aseptically prepared for abdominal exploratory.
A ventral midline abdominal exploratory was performed and revealed a duodenal intussusception and nodular fibrotic changes in the pancreas. (Fig. 4) 
Fig. 4: Duodenal intussusception in Beetle
The intussusception was easily reduced manually. A movable intraluminal mass was palpated and was exposed with a longitudinal incision in the antimesenteric aspect of the duodenum. (Fig. 5) 
Fig. 5: Duodenal enterotomy revealed an intraluminal mass. 
The pedunculated mass was 2cm in length and was locally excised by removing the full thickness area of bowel to which the mass was attached. (Fig. 6-7) 
Fig. 6: The duodenal mass was localized and pedunculated.
Fig. 7: The excised duodenal mass and attached intestine.
The intestinal incision was closed with 4-0 PDS in a simple continuous pattern.(Fig. 8)
Fig. 8: The closed duodenal incision. 
 The abdominal incision was closed routinely.

Beetle did well and was discharged from the hospital 2 days postoperatively. Skin staples were removed 10 days postoperatively. Histopathology of the duodenal mass showed a leiomyoma that was completely excised. Beetle was seen by referring veterinarian 1 year later and was doing very well.

Discussion

This is a very unusual case because the intussusception was in the duodenum rather than the more common (in dogs) ileo-ceco-colic area and it was secondary to a benign neoplasm. Also, Beetle did not present for vomiting but was anorexic and anemic due to bleeding from the duodenal mass. We performed a more conservative local full thickness tumor resection rather than a full intestinal resection and anastomosis because of the location of the mass (duodenum) and our suspicion that it was a benign tumor.

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