Acute gastroesophageal intussusception in a juvenile Australian shepherd dog: endoscopic treatment and long-term follow-up

Abstract

BackgroundCanine gastroesophageal intussusception (GEI) is a rare and potentially fatal disease usually affecting puppies or young dogs < 3 months of age and of medium to large breeds. Surgical intervention has been advocated as the therapy of choice by most authors. Endoscopic treatment may offer an advantageous or alternative method of treatment.Case presentationGEI was diagnosed in a nine-week-old Australian Shepherd dog with an acute onset of vomiting and regurgitation and compatible radiographic findings on thoracic radiography. Treatment consisted of endoscopic gastric repositioning and placement of a percutaneous endoscopic gastrostomy (PEG) tube to prevent repeated dislocation of the stomach, and to allow for nutritional supplementation During a follow- up period of eight months, thoracic radiographs were obtained showing persistent esophageal dilatation in the absence of compatible clinical signs.ConclusionEndoscopic intervention is an effective, alternative in selected canine GEI- cases, allowing for rapid, minimally invasive confirmation of diagnosis and therapy. After initial treatment, radiographic long-term follow-up seems prudent even in asymptomatic patients.

Intermittent Gastroesophageal Intussusception in a Kitten Resolved with a Percutaneous Gastropexy

“…Some authors have categorized GEI as a sliding hiatal hernia as it is defi ned as a transposition of the abdominal part of the esophagus, gastroesophageal junction and a portion of stomach through the esophageal hiatus of the diaphragm [10,11]; however, this is different than GEI because the gastroesophageal junction does not move cranially into the thorax [7,10]. Occasionally, the spleen, duodenum, pancreas, and omentum may be trapped within the invagination [10].…”

“…GEI has been rarely reported in animal species such as the dog [10,11], cat [4][5][6][7][8], leopard (Panthera pardus) [12], cheetah (Acinonyx jubatus) [9] and hedgehog (Atelerix albiventris) [13]. Some authors have categorized GEI as a sliding hiatal hernia as it is defi ned as a transposition of the abdominal part of the esophagus, gastroesophageal junction and a portion of stomach through the esophageal hiatus of the diaphragm [10,11]; however, this is different than GEI because the gastroesophageal junction does not move cranially into the thorax [7,10].…”

“…Potential disadvantages include a prolonged surgical procedure, hemodynamically compromised patients, an extended convalescence period and possible post-surgical complications. In addition to potential congenital esophageal abnormalities resulting in a guarded prognosis, this may infl uence the decision leading to euthanasia of a patient with a potentially controllable condition [11].…”

“…According to different authors, the benefi ts of percutaneous tube gastropexy include: being a minimally invasive procedure as it minimizes the number and size of surgical incisions, with a shorter anesthesia procedure; and less degree of postoperative pain and requirements for analgesia; incidence of incision complications, days of hospitalization, and cost [15]; and also the possibility of enteral nutrition [10,11]. However, a relative disadvantage is the limitation of to do only a unilateral gastropexy (left-side); contraindications of performing a percutaneous gastropexy for this case would include situations where the gastric wall is compromised or adhesions are formed, which increase the risk of gastric perforation, other limitation is that the assessment and correction of esophageal hiatal abnormalities is not possible with this method [10,11].…”

“…The use of endoscopic percutaneous gastropexy for the treatment of GEI in dogs was reported in two clinical cases with good results [10,11]. The placement of a percutaneous gastropexy is a simple procedure, which can be performed using endoscopy [14,15] or a gastrostomy tube device [16].…”