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
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.
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