Intermittent Gastroesophageal Intussusception in a Kitten Resolved with a Percutaneous Gastropexy

Abstract

Gastroesophageal intussusception is a rare pathology characterized by an acute or intermittent invagination of the stomach into the lumen caudal to the thoracic esophagus, the pathogenesis is not well understood, although it is likely multifactorial. The mortality is high, associated with a late diagnosis and a rapid deterioration. A 4-month-old male domestic shorthair kitten presented for evaluation of intermittent respiratory distress and abdominal discomfort with two weeks of evolution. Based on clinical history, clinical sings and imaging studies a diagnosis of intermittent gastroesophageal intussusception was established. The reduction of the intussusception was performed with endoscopy maneuvers and with medical and nutritional management for some days, but this failed and fi nally was reduced with a percutaneous gastropexy tube to prevent recurrence with a good long-term outcome. Gastroesophageal intussusception in cats is associated with megaesophagus or hiatal hernia, and should be considered as a differential diagnosis in patients with chronic vomiting, regurgitation or respiratory disease. Survey and contrasted thoracic radiographs can be used to identify gross anatomical abnormalities, but the defi nitive diagnosis should be made by esophagogastroscopy with the possibility of reducing the intussusception. The use of percutaneous gastropexy provides other possible option to conventional surgery for the management of this pathology in cats.

Successful management of gastroesophageal intussusception in an adult puma (Puma concolor)

“…GEI is a rare disease but has been reported in cats and dogs, especially male German shepherd dogs younger than 6 months old. [6][7][8][9][10] In the literature, two types of GEI have been described: an acute, persistent type that presents as acute oesophageal obstruction and respiratory discomfort and a chronic, recurrent form more commonly reported in cats that causes intermittent gastrointestinal signs. 9,11,12 To the best of the authors' knowledge, this is the first report of GEI in a puma.…”

“…10 Furthermore, enteral nutrition is a possibility, and incision complications, hospitalisation days and costs are minimised. 10 However, this is difficult in wild felids because patients are often not handleable without anaesthesia, and the tube gastropexy would be difficult to manage. 2 There are contraindications to consider for laparoscopic/open surgery reduction of GEI such as gastric wall compromise, which increases the risk of gastric penetration.…”

“…2 There are contraindications to consider for laparoscopic/open surgery reduction of GEI such as gastric wall compromise, which increases the risk of gastric penetration. 10,18 Subsequently, the mild and intermittent nature of the condition made us attempt conservative treatment, which was not successful. In contrast, the puma recovered quickly and completely after gastropexy was performed.…”

“…After reducing the intussusception by using endoscopy, a tube gastropexy was used to fix the stomach to the abdominal wall 11 . It is a simple technique, and there are many advantages of this method, including reduced invasiveness due to a smaller number and size of incisions, decreased time under general anaesthesia and a minimised degree of postoperative pain and analgesic needs 10 . Furthermore, enteral nutrition is a possibility, and incision complications, hospitalisation days and costs are minimised 10 .…”

“…It is a simple technique, and there are many advantages of this method, including reduced invasiveness due to a smaller number and size of incisions, decreased time under general anaesthesia and a minimised degree of postoperative pain and analgesic needs 10 . Furthermore, enteral nutrition is a possibility, and incision complications, hospitalisation days and costs are minimised 10 . However, this is difficult in wild felids because patients are often not handleable without anaesthesia, and the tube gastropexy would be difficult to manage 2 .…”