Abstract
BackgroundIleoscopy is increasingly performed in dogs and cats with gastrointestinal signs, but iatrogenic ileocecocolic (ICC) perforations have not been described.Hypothesis/ObjectivesTo characterize endoscopic ICC perforations in dogs and cats.AnimalsThirteen dogs and 2 cats.MethodsThis 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.ResultsSix 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 ImportanceIatrogenic 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.
Highlights
Endoscopy is used routinely to visualize the gastrointestinal mucosa and procure biopsy specimens from dogs and cats with a chronic history of gastrointestinal disease.[1]
Despite the increased frequency with which lower gastrointestinal endoscopy is performed, neither ileal nor cecal perforations have been reported, and none of the 4 reported colonic perforations occurred near the ileocecocolonic (ICC) valve.[6,7]
Ileocecocolonic perforations occur in 0.01%-0.16% of people undergoing diagnostic endoscopy.[8,9,10,11]
Summary
Endoscopy is used routinely to visualize the gastrointestinal mucosa and procure biopsy specimens from dogs and cats with a chronic history of gastrointestinal disease.[1] Performance of ileoscopy is increasingly common because of discrepancies between duodenal and ileal histopathologic results.[2,3,4,5] Despite the increased frequency with which lower gastrointestinal endoscopy is performed, neither ileal nor cecal perforations have been reported, and none of the 4 reported colonic perforations occurred near the ileocecocolonic (ICC) valve.[6,7]. Ileoscopy is increasingly performed in dogs and cats with gastrointestinal signs, but iatrogenic ileocecocolic (ICC) perforations have not been described. 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. Perforation should be considered in the differential diagnosis for animals with clinical deterioration after endoscopy
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