“Always expect the unexpected” would be a good motto for any veterinarian. It was certainly the case for me last Monday.
The run-up to Christmas is a weird time in veterinary practice. People are busy preparing for the festivities and spend money on things other than a trip to the vet. Therefore it’s usually a quiet time of year with gaps in the clinic schedule during which to draw breath.
This Monday evening, I was rostered on at a branch surgery, which looked even more sleepy than usual. In anticipation, I’d taken in a backlog of veterinary journals to read. I really should know better, because expecting things to be quiet is guaranteed to bring in an emergency.
Sweet and Sour
True enough, my first patient was an adorable Cocker Spaniel puppy, with a not-so-sweet 3-week history of diarrhea.
I had a cuddle with the puppy and started my exam in full expectation of having a run-of-the-mill chat about diarrhea management. However, everything changed when I felt the puppy’s belly.
Toward the front of the puppy’s tummy, I could feel a firm, sausage-like swelling. Immediately, alarm bells sounded in my head. I had another feel to confirm. Yep — definitely a swelling that shouldn’t be there.
The reason for my concern was that the puppy’s history of tummy upsets and a firm swelling was suspicious of an intussusception. This involves part of the intestine telescoping inside itself, blocking the gut like a foot on a hosepipe. Untreated, the blood supply to the gut dies off; the patient becomes toxic and, without corrective surgery, dies.
There are some conditions that just can’t be left with a question mark hanging over them — it was clear that this pup needed an urgent workup. But the branch surgery had no X-ray or ultrasound machines.
So my quiet Monday evening suddenly became very busy.
The pet’s guardians were distraught after I gently broke the news. Let’s face it — no one wants to be told their gorgeous, 12-week old bundle of fluff may be seriously ill and needs surgery. But after their initial distress, they were magnificent and hurried the pup over to the main clinic — with me in hot pursuit.
The out-of-hours vet tech and I X-rayed the pup, and the results were inconclusive. There was a suspicious buildup of gas in the intestine and a stomach that was fuller of food than it should have been. But there was no smoking gun — no radiographic image of a blocked bowel.
This is one of those step-through moments: Do you keep digging or leave things and check again in the morning? We decided to keep digging — and it’s a jolly good thing we did. An ultrasound scan revealed a classic picture of layers of bowels sitting inside each other, like a collapsed telescope.
Surgery it was.
The dog’s humans gave consent and, after putting the dog on intravenous fluids, we performed surgery on him.
There it was: a portion of bowel that had slide inside itself, not once, not twice, but 3 times. The only way to save the dog was to surgically remove that portion of bowel.
This surgery involves removing the intussusception and then suturing the ends of bowel back together again. The complication rate is high, though, because swelling occurs as part of the natural healing process, and there’s a tendency for sutures to “cheesewire” through the gut. If this happens, gut contents can leak into the abdomen and cause a serious infection called peritonitis.
Not Out of the Woods Yet
A quiet Monday evening turned into a late-night operating session, but it was all worth it. Now, 5 days later, the pup is doing well, eating and pooping like a hero.
Which leaves this question: What caused the diarrhea in the first place? Intussusceptions occur when the gut goes into spasm, such as with a tummy upset. To avoid a repeat performance, it’s essential to get to the bottom of the puppy’s diarrhea, which is a whole new story….
This pet health content was written by a veterinarian, Dr. Pippa Elliott, BVMS, MRCVS. It was last reviewed Jan. 6, 2017.