Extrahepatic biliary duct obstruction secondary to duodenal foreign bodies in 2 dogs

Two dogs, a 5-year-old neutered male boxer dog and a 2-year-old neutered male Australian cattle dog, were evaluated for vomiting and inappetence. Both dogs were icteric on physical examination, and had hyperbilirubinemia, elevated liver enzymes, and inflammatory changes on diagnostic blood analysis. A proximal duodenal obstruction causing extrahepatic biliary duct obstruction (EHBDO) was suspected in both cases after diagnostic imaging was performed. Exploratory laparotomy confirmed duodenal foreign bodies in both cases. This case report defines duodenal foreign body as a differential diagnosis for EHBDO in dogs.

Catastrophic gastric rupture in a horse secondary to psyllium pharmacobezoars

A mare was euthanized because of gastric rupture secondary to complete duodenal obstruction by 2 bezoars located in the pylorus and proximal duodenum. Infrared spectroscopy showed that the bezoars were composed of psyllium. The mare had been receiving treatment with a pelleted psyllium product at 4 times the recommended dosage. Veterinarians should be aware that treatment of colic in horses with pelleted psyllium products could be associated with gastric impaction.

Ultrasonographic findings in 2 cows with duodenal obstruction

Two cases where clinical findings suggestive of proximal ileus resulting in hypokalemic and hypochloremic alkalosis are presented. Ultrasonographs showed distension of the sigmoid flexure along the ventral border of the liver and between the serosal lamellae of the greater omentum in the flank, allowing exact preoperative obstruction localization.

Duodenal obstruction caused by malposition of the gallbladder in a heifer

A heifer with clinical findings suggesting obstruction of the proximal portion of the intestine was admitted for diagnostic evaluation. Ultrasonographic examination of the abdomen failed to locate the gallbladder in its normal anatomic position. Exploratory laparotomy and manual examination of the proximal portion of the intestine revealed obstruction of the duodenum caused by abnormal positioning of the gallbladder. The obstruction was relieved by replacing the gallbladder to its normal position; however, relapse occurred within 2 days. To resolve and prevent the recurrence of the obstruction without compromising gallbladder function, a novel surgical technique to provide fixation of the gallbladder to the liver was performed. The heifer recovered rapidly, proceeded to develop normally during the following year, and became pregnant.

Gravel obstruction in the abomasum or duodenum of two cows

Two Holstein cows from dry lot dairies were evaluated because of clinical signs of depression, anorexia, and decreased milk production. Bilateral abdominal distention and decreased fecal output were found on physical examination. Results of serum biochemical analyses indicated that the cows had severe hypochloremic, hypokalemic metabolic alkalosis. On the basis of physical examination and laboratory findings, an obstruction of the abomasum or cranial portion of the small intestine was suspected in these cows and abdominal exploratory surgery was performed. A mass of gravel was found in the pyloric antrum of the abomasum of 1 cow and the descending duodenum of the other cow. The duodenal obstruction was removed by enterotomy, and the pyloric mass was manually reduced during surgery. The cows were treated with antibiotics and isotonic saline solution (NaCl) supplemented with potassium chloride and recovered quickly after surgery.

Ultrasonographic examination of the small intestine of cows with ileus of the duodenum, jejunum or ileum

The small intestine of 35 heifers and cows with an ileus of the duodenum, jejunum or ileum was examined ultrasonographically. After a clinical examination, the animals were examined from the right flank and thorax with a 3.5 MHz linear transducer, and the findings were verified by a right flank laparotomy or post mortem. Dilated loops of small intestine with a diameter of more than 3.5 cm were visible in at least one location in all the animals; they were seen predominantly in cross-section or longitudinally. The number of loops of dilated intestine visible from the flank or intercostal spaces was markedly influenced by the site of the ileus. In animals with an ileus of the duodenum, only one intestinal loop was usually visible from the flank or from the 12th, 11th or 10th intercostal spaces. In contrast, more than five dilated loops of intestine were usually visible in animals with an ileus of the jejunum or ileum. The largest diameter of intestine measured from the 12th intercostal space was between 6.5 and 9.9 cm in animals with an ileus of the duodenum, between 3.5 and 9.8 cm in animals with an ileus of the jejunum, and between 4.4 and 5.5 cm in animals with an ileus of the ileum. In the majority of the cows, the contents of the intestines were predominantly echogenic, but in the others they were anechoic. The cause of the ileus could be identified by ultrasonography in only a few cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Use of a modified Roux-en-Y procedure for treatment of pyloroduodenal obstruction in a horse

A modification of the Roux-en-Y anastomosis procedure was used to bypass a pyloroduodenal mass in a 12-year-old Arabian stallion. Clinical signs had consisted of a 4-week progression of ventral and hind limb edema, hypoproteinemia, fecal occult blood, intermittent abdominal pain, weight loss, and gastric reflux. On exploratory celiotomy, an obstructive mass was found in the pylorus and proximal portion of the duodenum. Gastrojejunostomy and duodenojejunostomy were performed by use of stapled side-to-side anastomosis techniques. Inaccessibility of the obstructed pyloric region prevented resection of the affected area.

Cholelith causing duodenal obstruction in a horse

A 10-year-old Appaloosa stallion was referred for evaluation of colic. At admission, the heart rate, capillary refill time, respiratory rate, and rectal temperature were high. Fifteen liters of reflux was obtained by nasogastric intubation. Palpation of an abdominal mass per rectum elicited signs of pain. At exploratory laparotomy, a mass was palpated in the ascending portion of the duodenum. The small intestine ruptured at the site of obstruction during manipulation. The horse was euthanatized. A large cholelith was the cause of the duodenal obstruction. At necropsy, multiple choleliths of various sizes were found in the pancreatic and common bile ducts and in the stomach.

Experimental model of hypochloremic metabolic alkalosis caused by diversion of abomasal outflow in sheep

Hypochloremic metabolic alkalosis accompanied by hypokalemia and hyponatremia was induced experimentally in 7 adult sheep by diversion (loss) of gastric contents through an Ivan and Johnston cannula placed in the cranial part of the duodenum just distal to the pylorus. Cannula placement was easily accomplished, and cannulae were tolerated well by the sheep. Volume of effluent produced during the 60- to 120-hour period of diversion ranged from 7.7 to 14.9 L and tended to be greatest during the first 24 hours. All sheep became dehydrated, with mean PCV and plasma total protein concentration increases of 94.2 and 61.7%, respectively. Plasma chloride concentration decreased in linear fashion from a prediversion mean of 113 mEq/L (range, 111 to 117 mEq/L) to an end-point mean of 54 mEq/L (range, 45 to 65 mEq/L). Plasma sodium and potassium concentrations also decreased, though potassium concentration increased terminally. There were rapid increases in arterial blood pH and bicarbonate and base excess concentrations during the first 48 hours after diversion. However, during the final stages of diversion, sheep developed superimposed metabolic acidosis with increased plasma lactate concentration and high anion gap.

Surgical management of duodenal obstruction in an adult horse

A 3-year-old Standardbred stallion was admitted for treatment of acute enterocolitis. The horse improved in response to empiric treatment, but subsequently developed ventral edema, scrotal abscessation, and severe laminitis. Improvement again was seen, but on day 29 of hospitalization, the horse developed rapid heart rate and signs of abdominal pain. Exploratory celiotomy revealed complete obstruction of the descending portion of the duodenum, 20 cm caudal to the duodenal sigmoidal flexure. Three-tier duodenojejunostomy and jejunojejunostomy were performed to bypass the duodenal obstruction.

Hepaticojejunostomy for treatment of common hepatic duct obstructions associated with duodenal stenosis in two foals

Two female Standardbred foals 2 and 3 months of age were presented with signs of gastroduodenal obstruction that was confirmed with contrast radiography and exploratory surgery. Ventral midline celiotomy was performed, showing stenosis of the duodenum proximal and distal to the hepatopancreatic ampulla. The common hepatic duct, the pancreatic duct, and the sigmoid section of the duodenum proximal to the stenosis were greatly dilated. To bypass the intestinal obstruction, a side-to-side duodenojejunostomy was performed. Obstruction of the common hepatic duct was relieved by side-to-side hepaticojejunostomy. In addition, jejunojejunostomy was performed distal to the other anastomoses. Both foals recovered. On admission, the foals' total bilirubin, aspartate aminotransferase, and gamma glutamyl transferase levels were greatly elevated. During the subsequent 6 to 8 months, they returned to normal. Six months after the first surgery, one foal was readmitted with an acute abdominal crisis. At surgery, there was greater than 360 degrees clockwise rotation of the mesenteric root involving most of the jejunum. At necropsy, the previously created stomas were patent. The liver and bile duct were grossly and histologically normal. The second foal continues to progress normally 12 months after surgery.

Effects of experimental duodenal occlusion on electrical activity of the proximal duodenum in cattle

An electromyographic study of the proximal duodenum in cattle is presented. Changes of motility patterns were studied after induced mechanical obstruction of the descending duodenum in five healthy cows. Special attention was paid to the ratio of antegrade and retrograde motility. Induced duodenal obstruction of which the duration was at most 48 hours, resulted in abrupt disorganisation of the migrating myoelectric complexes; the phases of regular spiking activity disappeared completely or reappeared in a disorganised pattern, and the phases of irregular spiking activity consisted of repetitive groups of spike bursts with prolonged duration and increased propagation velocity. Retrograde peristaltic contractions in the proximal duodenum were observed. Relief of obstruction resulted in a rapid reorganisation of the cyclic pattern of the migrating myoelectric complexes, which indicates normalisation of intestinal activity.

Small intestinal obstruction associated with wood chewing in two horses

Although wood chewing by horses is recognised as a common vice, there are few reports of specific disease associated with the habit. Two cases of acute obstruction of the small intestine by solid aggregations of wood splinters are described in horses which were both habitual wood chewers. Details are presented of the clinical findings in these cases, including the surgical treatment of acute colic. Both horses returned to full working fitness. The authors review the syndrome of enterolithiasis in horses, and discuss the causes and significance of wood chewing as a stable vice.

Comparison of naturally occurring proximal duodenal obstruction and abomasal volvulus in dairy cattle

Physical and clinicopathologic findings from six cows with proximal duodenal obstruction (PDO) and 58 cows with abomasal volvulus (AV) were compared retrospectively. Many of the physical signs were similar in cows with PDO and cows with AV, but the two conditions differed in the type of abdominal distention, and in the findings from rectal examination and abdominal auscultation. Cows with PDO had significantly lower mean values for serum sodium (Na+) and chloride ion (Cl-), and higher mean values for plasma bicarbonate [HCO3-], base excess, carbon dioxide pressure (pCO2), serum phosphate, urea nitrogen, and total protein than AV affected cattle. Cows with PDO showed hyperglycemia (range, 263-990 mg/dl; mean, 618 mg/dl) of unexplained etiology that was significantly higher than blood-glucose concentrations in AV cows (mean, 178 mg/dl). Although all AV cows with anion gap values greater than 32 mEq/l died;PDO cows with equally elevated anion gap survived. The anion gap elevations in PDO and AV cows resulted from accumulation of different anions. Although the site of obstruction of aborad flow of ingesta is similar in both disease conditions, the differences in physical and clinicopathologic findings appear to reflect differences in the degree of reticulo-omasal orifice obstruction and the degree of abomasal vascular compromise.

Duodenal impaction in a horse

An 8-cm compressed mass of dry cracked corn was found obstructing the duodenum of a horse with signs of colic. The mass was manipulated aborally and removed through jejunal enterotomy. The horse recovered and the impaction did not recur.

Intramural intestinal hematoma causing obstruction in three dogs

Intramural hematoma of the intestine caused intestinal obstruction in three dogs. Two dogs were examined because of vomiting and anorexia of several weeks' duration. In one of these, an intramural hematoma of the duodenum was associated with chronic pancreatitis. A cause was not found in the second dog. The third dog, which had clinical and radiographic evidence of gastric dilatation, was found at surgery to have hemoperitoneum associated with a ruptured intramural intestinal hematoma. In 1 dog, the hematoma was evacuated through a serosal incision. In the other 2 dogs, the problem was resolved by resection of the involved segment of intestine, followed by anastomosis. All 3 dogs recovered without complications.

Functional stenosis of the sigmoid curve of the duodenum in cattle

The symptoms and treatment of 18 cattle suffering from functional stenosis of the sigmoid curve of the duodenum are described. Side to side anastomosis between the proximal part of the duodenum and the descending duodenum is the most successful treatment for this previously undescribed syndrome.

Congenital duodenal stenotic diaphragm in the foal

A two-month-old female foal with duodenal stenosis is described. The foal was in poor condition and showed an abnormal stable behaviour. She stood preferably with her head stretched out and reposing on the mare's back or on the stable ridge. Salivation was an important symptom. Clinical and radiological examination of the oral cavity, the pharynx, and the oesophagus showed no abnormalities, except for the antiperistaltic wave along the oesophagus. Because of her bad condition the filly was euthanized. At post mortem examination, apart from leukoplakia, an erosive ulcerative inflammation was found in the oesophagus and the oesophageal part of the stomach. The stomach was severely dilated, as was the proximal part of the duodenum. A diaphragm in the duodenum with a small perforation was found nine cm distally from the pyloric canal.

Experimentally induced intestinal obstruction in sheep: paradoxical aciduria in metabolic alkalosis

Ewes with surgically prepared obstruction of the duodenum were used as a model in the study of ruminant metabolic alkalosis and paradoxical aciduria. Metabolic alkalosis occurred as a result of irreversible chloride loss, presumably into the abomasum and forestomachs. Analysis of data on serum and urinary electrolye concentrations provided limited support for the explanation of paradoxical aciduria in terms of chloride and potassium deficiencies. The accumulation undetermined anions in the serum indicated that the decreased urinary pH was due to the excretion of titratable acid.

Intestinal surgery in the foal

Intestinal surgery in the foal is seldom necessary but some conditions in which it is essential are well recognized. The foal is a good surgical subject but success depends mainly on operating promptly before irreversible degenerative changes take place. Exploratory laparatomy is recommended whenever mechanical obstruction is suspected. Indications fall broadly into two main categories: 1. Cases arising from congenital defects. These form a miscellaneous group and present considerable difficulties in diagnosis and effective treatment. 2. Cases related to acute onset of obstruction, mainly due to volvulus or torsion. By far the most important condition in this category is volvulus of the ileum close to the ileocaecal valve. Aetiological factors are discussed, and the value of resection of affected small intestine and creation of a new jejuno-caecal opening is indicated. It is suggested that with improvement of such techniques it will be possible to save a higher proportion of foals suffering from mechanical intestinal obstruction.