Section: Veterinary Care In-depth
Diagnosis
Certain diagnostic tests are performed to diagnose an intussusception and to exclude other disease processes that may cause similar symptoms. Obtaining a complete description of clinical signs and a thorough physical examination are an important part of obtaining a diagnosis. In addition, the following tests may be recommended to confirm the diagnosis:
A complete blood count may be within normal limits. It may also reveal a low white blood cell count in cases of viral infections, or a high white blood cell count in cases associated with bacterial or inflammatory processes. The red blood cell count may be low if there is associated bleeding into the intestinal tract. The red blood cell count may be high in cases of severe dehydration.
A biochemical profile may show electrolyte abnormalities (changes in sodium, potassium, chloride), altered kidney function tests, and abnormalities associated with concurrent disease processes.
A urinalysis is useful to assess kidney function and the presence of any dehydration of the patient.
Fecal tests are performed to check for certain intestinal parasites that can cause or be associated with intussusceptions .
Abdominal X-rays may reveal the classic appearance of a tubular mass in the intestinal tract associated with distended loops of bowel. Additionally, abdominal X-rays may rule out other disorders that cause similar clinical signs such as tumors, foreign bodies.
Thoracic (chest) radiographs may be performed, especially in older patients in which cancer may be a factor, in order to rule out metastatic (spread of cancer) disease. Chest X-rays may also be indicated prior to anesthesia and surgery.
Abdominal ultrasonography is helpful in evaluating many of the abdominal organs, including the liver, kidneys, lymph nodes and spleen. It is equally important to rule out other disorders or diseases that may initially be difficult to differentiate from an intussusception. In many cases, it helps identify a cylindrical, sausage-like intestinal mass, very characteristic of an intussusception. Abdominal ultrasonography is a noninvasive test that utilizes specialized instrumentation. It may require that your dog be referred to a veterinary internal medicine specialist or a radiologist to perform the procedure.
Your veterinarian may recommend additional tests to exclude or diagnose concurrent conditions. These tests are not necessary in every case, although they may be of benefit in certain individuals, and are selected on a case-by-case basis. These include:
A fecal Elisa test for parvovirus is considered in dogs suspected of having parvovirus.
An ACTH stimulation test is performed in individuals suspected of having hypoadrenocorticism.
An upper gastrointestinal (GI) barium series may be considered in those patients with vomiting due to any underlying cause. It may help diagnose foreign objects or tumors that are not apparent on radiographs, confirm a diagnosis of GI ulceration, or directly outline an intussusception. A safe dye is given to the patient by mouth and is then watched as it travels through the GI tract. It is a non-invasive test that can often be performed by your regular veterinarian, although in some cases it may necessitate transfer to a specialty hospital.
Some cases of intussusception are only confirmed via surgical exploration of the abdomen.
Treatment
Patients with life-threatening clinical signs are hospitalized and treated aggressively. Clinical deterioration is often rapid and can be fatal. Successful treatment depends on medical stabilization of the patient with correction of fluid, electrolyte, and acid-base abnormalities. Once the animal is stabilized surgical correction is instituted as soon as possible. It is important to address each patient individually, as different underlying processes may warrant different recommendations regarding therapy and prognosis. Therapies that may be administered include the following:
Rapid intravenous fluid therapy is imperative in severely ill animals.
Surgical correction involves relieving the telescoping of the bowel, or resection (removal) of the affected segment of intestine. If the bowel is not resected, it may be folded and tacked upon itself, so the telescoping does not recur.
Water and food is withheld from most patients until 24 hours after surgery, or after all vomiting has stopped. The animal is then introduced to small amounts of water, followed eventually by small, frequent meals of an easily digestible food.
Injectable antibiotics are often given around the time of surgery to help prevent infection.
Follow-up
Optimal treatment for your pet requires a combination of home and professional veterinary care. Follow-up can be critical, especially if your pet does not rapidly improve.
Administer all prescribed medications and diets as directed. Alert your veterinarian if you are experiencing problems treating your pet.
Watch your pet closely for recurrence or worsening of signs post-operatively and contact your veterinarian at once.
The prognosis for these patients varies, depending on the severity of the blockage, the length of time the animal has been affected, and the underlying cause. Many patients have a full recovery, while others do not. Recurrence is seen in some cases, even with corrective surgery.
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