Nonsurgical Treatment of Gastroesophageal Intussusception in a Puppy

Abstract

A 7-week-old, female Siberian husky was presented to Murdoch University Veterinary Hospital with an acute onset of respiratory distress and regurgitation. Thoracic imaging identified an intraluminal esophageal mass with concurrent aspiration pneumonia. Esophagoscopy identified the mass as stomach, and a diagnosis of gastroesophageal intussusception was made. The intussusception was reduced endoscopically, and fixation of the stomach to the abdominal wall was performed using a tube gastropexy. Gastroesophageal intussusception is an uncommon disease in small animals and traditionally has been managed surgically. This case report describes an alternative method of treatment associated with a good outcome in this puppy.

Intermittent Gastroesophageal Intussusception in a Kitten Resolved with a Percutaneous Gastropexy

“…GEI has been rarely reported in animal species such as the dog [10,11], cat [4][5][6][7][8], leopard (Panthera pardus) [12], cheetah (Acinonyx jubatus) [9] and hedgehog (Atelerix albiventris) [13]. Some authors have categorized GEI as a sliding hiatal hernia as it is defi ned as a transposition of the abdominal part of the esophagus, gastroesophageal junction and a portion of stomach through the esophageal hiatus of the diaphragm [10,11]; however, this is different than GEI because the gastroesophageal junction does not move cranially into the thorax [7,10].…”

“…Some authors have categorized GEI as a sliding hiatal hernia as it is defi ned as a transposition of the abdominal part of the esophagus, gastroesophageal junction and a portion of stomach through the esophageal hiatus of the diaphragm [10,11]; however, this is different than GEI because the gastroesophageal junction does not move cranially into the thorax [7,10]. Occasionally, the spleen, duodenum, pancreas, and omentum may be trapped within the invagination [10].…”

“…Some authors have suggested a relation with diverse esophageal abnormalities such as megaesophagus [8,10,12], incompetence of the lower esophageal sphincter which often occurs secondary to sliding hiatal hernias, different causes of increased intrabdominal pressure such as chronic vomiting or blunt trauma, and negative intrathoracic pressure from inspiratory dyspnea due to chronic upper airway obstruction or severe respiratory disease [6,10].…”

“…The use of endoscopic percutaneous gastropexy for the treatment of GEI in dogs was reported in two clinical cases with good results [10,11]. The placement of a percutaneous gastropexy is a simple procedure, which can be performed using endoscopy [14,15] or a gastrostomy tube device [16].…”

“…According to different authors, the benefi ts of percutaneous tube gastropexy include: being a minimally invasive procedure as it minimizes the number and size of surgical incisions, with a shorter anesthesia procedure; and less degree of postoperative pain and requirements for analgesia; incidence of incision complications, days of hospitalization, and cost [15]; and also the possibility of enteral nutrition [10,11]. However, a relative disadvantage is the limitation of to do only a unilateral gastropexy (left-side); contraindications of performing a percutaneous gastropexy for this case would include situations where the gastric wall is compromised or adhesions are formed, which increase the risk of gastric perforation, other limitation is that the assessment and correction of esophageal hiatal abnormalities is not possible with this method [10,11].…”