Investigation of Keyes Skin Biopsy Instrument for Intestinal Biopsy Versus a Standard Biopsy Technique

Successful clinical management of canine intestinal lipogranulomatous lymphangitis through exclusive medical and nutritional treatment: four cases (2018-2023)

OBJECTIVES

To describe clinical, ultrasonographic, pathological features and response to medical therapy of four dogs with intestinal lipogranulomatous lymphangitis.

METHODS

Retrospective review of medical records of dogs with an ultrasonographic evidence of focal or multifocal intestinal wall thickening and a histological diagnosis of lipogranulomatous lymphangitis. Only dogs that did not undergo surgical resection of the lesions were included. The clinical response to medical treatment, consisting of low-fat or hydrolysed diet along with immunosuppressive agents was assessed; clinicopathological and ultrasonographic abnormalities were re-evaluated over time, with a median follow-up period of 16.5 months.

RESULTS

Four dogs met the inclusion criteria. The main historical complaints were diarrhoea (three of four dogs), vomiting (three of four dogs) and abdominal pain (two of four dogs). Clinicopathological abnormalities comprised hypoproteinaemia, hypoalbuminaemia and mild/moderate increase in C-reactive protein levels (three of four dogs). Abdominal ultrasound revealed focal (two of four dogs) or multifocal (two of four dogs) intestinal wall thickening involving distal jejunum, ileum and ileocolic junction. Histopathology of full thickness intestinal biopsies revealed granulomatous enteritis and lymphangitis with lymphangiectasia. Nutritional and medical treatment allowed complete clinical remission in all four dogs within a month of therapy. Improvement of ultrasound abnormalities was noted in three of the four dogs over a 3- to 12-month period.

CLINICAL SIGNIFICANCE

Intestinal lipogranulomatous lymphangitis is a rare form of canine chronic enteropathy characterised by focal or multifocal intestinal lesions due to the presence of transmural intestinal lipogranulomas. This is the first case series describing successful management of intestinal lipogranulomatous lymphangitis through medical treatment alone.

Modified circumferential preputioplasty using a Keyes biopsy punch for treatment of type I phimosis in two kittens

Case series summary

Medical records of two kittens diagnosed with type I phimosis were reviewed. Clinical signs on presentation, investigations, description of the surgical technique, and short- and long-term follow-up were reported. Type I phimosis was diagnosed in both kittens based on the clinical, radiographic and surgical exploration findings. Modified circumferential preputioplasty using 4 and 6 mm Keyes biopsy punches was performed by the same surgeon in each case. The biopsy punch was centred over the existing narrowed preputial orifice and rotated clockwise and anticlockwise to obtain a sharp circumferential cut through the skin and submucosa of predictable diameter. The underlying mucosa was resected with micro curved scissors and mucocutaneous apposition was achieved with simple interrupted sutures placed circumferentially. Minor protrusion of the tip of the penis was recorded in the short-term follow-up (2 weeks) but resolved on the long-term follow-up (10 and 72 months). No evidence of urinary tract infection, strictures or clinical signs associated with phimosis were recorded at long-term follow-up.

Relevance and novel information

This short case series describes the surgical correction of type I phimosis by circumferential preputioplasty implemented using a Keyes biopsy punch in two kittens. The technique described in this case series can be considered alongside other reported surgical techniques, and appears to provide a reliable, rapid and accurate removal of preputial skin in the two reported cases.

Feline gastrointestinal surgery: principles and essential techniques

PRACTICAL RELEVANCE

Gastrointestinal (GI) surgical procedures are performed commonly in cats in general practice for both diagnostic and treatment purposes. It is essential that the surgeon understands and adheres to the principles of GI surgery in order that postoperative morbidity and mortality are kept to a minimum.

AUDIENCE

This review is aimed at feline and general practitioners wanting to update their core skills in GI surgery. It discusses anatomical considerations and surgical principles, and aims to familiarise the surgeon with techniques (some well established, others newer) that will help to promote surgical success.

EQUIPMENT

Standard general surgical equipment is required, together with the facilities to provide adequate pre-, intra- and postoperative patient care.

EVIDENCE BASE

The author draws on clinical experience and evidence from the literature, where appropriate, in reviewing the guidance and techniques under discussion.

Diagnostic laparoscopy in the cat: 2. Common procedures

PRACTICAL RELEVANCE

Minimally invasive techniques are becoming increasingly available in both first opinion and referral veterinary surgeries. Clients may be reluctant to pursue open surgery for the collection of biopsy samples in a sick cat but may be more open to a laparoscopic approach. Furthermore, a laparoscopic approach provides excellent visualization of the abdominal organs and enables high quality biopsies to be taken that are invariably more diagnostic than percutaneous needle biopsies. Although the feline patient is small in size, its distensible abdomen allows more room for surgical manipulation than afforded by a similar sized canine patient.

CLINICAL CHALLENGES

Clinical challenges for the most part relate to mastering laparoscopic technique. Familiarity with the use of long instrumentation viewed on a two-dimensional screen is essential. Hemostasis is an important consideration and suitable instrumentation for achieving hemostasis should be available at all times. Insufflation of the abdomen carries its own challenges with regard to anesthesia and this is covered in an accompanying article in this Special Issue series.

AIM

This article introduces the feline practitioner to basic techniques required to effectively utilize diagnostic laparoscopy within feline medical investigations. It focuses on the common procedures of liver biopsy, cholecystocentesis, pancreatic biopsy, kidney biopsy and laparoscopic-assisted intestinal biopsy.

EVIDENCE BASE

Information provided in this article is drawn from the published literature and the authors' own clinical experience.