Multicenter retrospective evaluation of ileocecocolic perforations associated with diagnostic lower gastrointestinal endoscopy in dogs and cats

Abstract

Background Ileoscopy is increasingly performed in dogs and cats with gastrointestinal signs, but iatrogenic ileocecocolic (ICC) perforations have not been described. Hypothesis/Objectives To characterize endoscopic ICC perforations in dogs and cats. Animals Thirteen dogs and 2 cats. Methods This is a retrospective case series. Signalment, presentation, endoscopic equipment, colonic preparation, endoscopist's experience level, ileal intubation technique, method of diagnosis, perforation location, histopathology, management, and outcome data were collected and reviewed. Results Six ileal, 5 cecal, and 4 colonic perforations were identified between 2012 and 2019. Dogs weighed 2.4‐26 kg (median, 10.3 kg) and cats 4.6‐5.1 kg (median, 4.9 kg). Endoscopy was performed in dogs presented for vomiting (n = 4), as well as large (n = 5), mixed (n = 4), and small (n = 1) bowel diarrhea. Cats had large bowel diarrhea. Endoscopists included 1 supervised intern, 9 supervised internal medicine residents (2 first year, 6 second year, 1 third year), and 5 internal medicine diplomates. Diagnosis was delayed in 5 dogs, occurring 1‐5 days after endoscopy (median, 3 days); dogs were presented again with inappetence (n = 4), lethargy (n = 4), abdominal pain (n = 3), retching (n = 2), and syncope (n = 1). All animals underwent surgical correction. Histopathology did not identify lesions at the perforation site in any animal. Two dogs required a second surgery; 1 died 12 hours after surgery. Survival to discharge was 93%, with 78% surviving ≥8 months. Conclusions and Clinical Importance Iatrogenic endoscopic ICC perforation is not indicative of underlying disease and is associated with a good prognosis. Delayed diagnosis can occur. Therefore, perforation should be considered in the differential diagnosis for animals with clinical deterioration after endoscopy.

Concordance of the Histopathologic Diagnosis of Concurrent Duodenal and Ileal Biopsy Specimens in Dogs

“…For canine EATL-2, the small intestine is the favored anatomical location and studies have similarly demonstrated cases where EATL-2 has only been detected within the ileum, but this has not been firmly established as a predilection site [17,18]. Conflicting evidence exists as to whether increased perforation risk is seen in dogs with ulcerated or neoplastic intestinal disease [19,20]. If a high level of histopathologic diagnosis discordance is seen, with canine neoplastic cases favouring the ileum, including cases assessed via IHC and/or PARR analysis then this may provide evidence for the need to biopsy the thinner-walled ileum.…”

Feasibility of combined upper and lower gastrointestinal endoscopic biopsy in the common marmoset (Callithrix jacchus) to evaluate gastrointestinal diseases

“…In addition, endoscopic biopsies from the stomach, duodenum, and colon were successfully obtained from all marmosets, except for that one duodenum that could not be intubated. Blind biopsies (i.e., intubation of the duodenum with the biopsy instrument only and collection of biopsies without endoscopic visualization) were not attempted, given the risks associated with this technique [18].…”

“…Blind biopsies (i.e., intubation of the duodenum with the biopsy instrument only and collection of biopsies without endoscopic visualization) were not attempted, given the risks associated with this technique [18].…”

Relationship between serum cobalamin concentration and endoscopic ileal appearance and histology in dogs with chronic inflammatory enteropathy

“…According to a recent study, ileoscopy can be challenging and involve certain risks. Iatrogenic ileocecocolic perforation is a rare but serious complication that might occur, mainly when lower endoscopy is performed by a novice endoscopist 19 . This might be a deterrent to performing routine ileoscopy and could be a possible reason for the lack of knowledge on ileum appearance.…”