Author

Stephen J. Birchard DVM, MS, Diplomate ACVS

Thursday, November 14, 2013

Case Outcome: German Shepherd With Chronic Diarrhea (Did you get it right?)

Fig. 1: note intraluminal soft tissue mass in the colon in the lateral abdominal radiograph
Fig. 2: Note filling defect in the colon in the barium study

Diagnosis 

Cecal inversion (or cecal intussusception). The cecum is "inside out" and what you see on the surgical photo is the cecal mucosa.

Treatment

Typhlectomy (removal of the cecum) 

After exposing the cecum via a colotomy it was excised at its base and the colotomy closed routinely in one layer. (simple continuous, 4-0 PDS) Michael did well and made a full recovery.

Discussion

Cecal inversion, or ceco-colic intussusception, is a rare disorder that is characterized by hematochezia and occasionally, diarrhea. It is more common in young dogs. A palpable abdominal mass is present and the primary differential diagnoses are foreign body, ileo-ceco-colic intussusception, and neoplasia. Typhlitis, such as that associated with whipworm infestation, may predispose to the condition. Definitive diagnosis is by plain film and contrast radiographs, or abdominal ultrasound


Fig. 3: Pneumocologram in a dog with cecal inversion. Note intraluminal soft
tissue mass.(arrows)  (from: Leah A. Cohn, DVM, PhD, DACVIM; Jimmy C. Lattimer, DVM, MS, DACVR; and Laura D. Dvorak, DVM. What’s your diagnosis? JAVMA, Vol 220, No. 2, pg 169, January 15, 2002.)
Pneumocologram (Fig. 3) or colonoscopy can also be used to confirm the diagnosis. Treatment is surgical removal of the cecum. Removal of the cecum, also called typhlectomy, can be done by first performing a colotomy to exteriorize the cecum, then removing the cecum at its base. Closure of the resultant colonic incision is routine. Alternatively, resection of the ileo-ceco-colic junction can be performed. However, removal of only the cecum, preserving the ileo-ceco-colic valve, is preferable. Attempts to un-invert the cecum are fruitless because of the severe inflammation and edema of the tissue. Be sure to treat associated parasitic infestations.