Distended Small Intestine Research Articles

SummaryA 4‐year‐old Thoroughbred gelding was presented with a history of severe colic signs that were non‐responsive to non‐steroidal anti‐inflammatory drugs. During initial evaluation, distended small intestine was observed, together with continued colic signs and a serosanguinous abdominocentesis sample. It was therefore elected to perform an exploratory laparotomy to ascertain and resolve the source of colic. Intraoperatively, a 2 cm horizontal defect was located at the junction between the diaphragm and the left 12th rib, midway between the dorsal and ventral body walls. One metre of small intestine was entrapped within the thoracic cavity. The diaphragmatic defect was digitally extended to 6 cm to allow safe exteriorisation of the intestine. The resulting defect extended from just left of midline to the body wall; the defect was sutured closed using 4 M polyglactin 910 in a simple continuous pattern, utilising forwarder and Aberdeen self‐locking knots. Subsequently, the horse also underwent a jejunoileostomy. The horse progressed well post‐operatively, with the exception of an incisional infection. Repeat thoracic evaluation 2 weeks post‐operatively and again 6 months post‐operatively revealed no evidence of reoccurrence.

SummaryBackgroundPancreatitis is a poorly understood condition in the horse. The DGGR‐lipase assay has recently been validated for horses.ObjectivesTo evaluate serum DGGR‐lipase concentrations in equids presented to an equine hospital in the United Kingdom with gastrointestinal disease.Study designProspective descriptive.MethodsBlood samples were obtained by convenience sampling of horses and donkeys presented for evaluation of gastrointestinal disease.ResultsSerum pancreatic (DGGR‐) lipase concentrations were measured in 205 equids with gastrointestinal disease, of which 147 survived, 47 were euthanised and 11 died. The median serum pancreatic lipase concentration in all animals was 17 U/L (IQR 14–27; range 1–3484). The lipase concentration was categorised as normal in 124 animals (60.5%) and elevated in 81 (39.5%). There was a statistically significant difference in the disease category and pancreatic lipase concentration (p < 0.001), with colic cases having higher lipase concentrations than colitis and peritonitis cases. There was strong evidence (p = 0.01) of an association between pain severity and lipase values, with higher lipase concentrations in horses with more severe pain. Of 12 horses with severely increased pancreatic lipase concentration (>200 U/L), 3/12 had spontaneous nasogastric reflux and 6/10 had distended and/or thickened small intestine on abdominal ultrasonography; 7/12 survived to hospital discharge and 5/12 died or were euthanised.Main limitationsWe were unable to confirm the presence of pancreatitis in any of the horses with elevated serum DGGR‐lipase concentrations by post‐mortem examination or histopathology.ConclusionsSome equids with gastrointestinal disease have increased serum pancreatic (DGGR‐) lipase concentrations, especially those with colic. This suggests that a degree of pancreatitis may be present in many colic cases, although this does not indicate causation.

A 68-year-old man presented at Pacific institute of medical sciences emergency department in May 2023 with pain in the epigastric region. Physical examination revealed no pertinent findings. Blood and urine tests were normal, and erect abdominal x-ray revealed a distended small intestine. CT scan shows ileo-colic intussusception. During laparotomy a large mass of 5x5 cm in size was detected in the caecum. It is very important to do CT scan for patients with long- standing abdominal pain and vomiting to achieve a definitive diagnosis of intussusception.

Marine toxin C17-SAMT causes major structural damage to vital organs in mice following subchronic toxicity trials

Background: Equine gastrointestinal colic cases represent one of the diseases with higher morbidity and mortality. Short and long term survivals are commonly correlated with the colic causes, being considered 50% the survival rate of horses referred to surgery because of small intestine strangulative causes. The jejuno-caecostomy technique is recommended in cases of ileum necrosis or ischemia that indicates ileum removal. The survival rate after this procedure is low, being even lower than others common terminal-terminal enteroanastomoses. This study reports a case of jejuno-caecostomy followed by tiflopexy and tiflostomy performed in a colic horse.Case: A 12-year-old mare, mangalarga breed, with a history of acute abdomen during 18 h was referred to the FZEA-USP equine hospital. According to the owner, the animal suffered previous episodes of colic that had been solved without treatment. On this occasion, the owner, without veterinary advice, had administered 10 mL of flunixin meglumine, but the animal did not show improvement. During the examination, the patient presented tachycardia, tachypnea, toxemic mucosa, a large amount of enterogastric reflux, and it was possible to observe distended small intestine during rectal palpation. The horse was referred to surgery; it was possible to identify necrosis of the ileum and 30 cm of the aboral segment of the jejunum, caused by strangulation due to a pedunculated lipoma localized in the medial band of the caecum. Latero-lateral jejuno-caecostomy was performed between the medial and dorsal bands of the caecum, using polyglactin 910, nº 2.0, potassium penicillin 30.000 IU / kg, every 6 h, gentamicin 6.6 mg / kg, every 24 h, flunixin meglumine 1.1 mg / kg, every 12 h and maintenance fluid therapy were performed post operatively. The animal had ileus and severe enterogastric reflux for five days postoperatively, showing severe signs of endotoxemia, and parenteral hydration seemed to be not enough. So it was decided to hydrate the animal through the caecum. It was performed a tiflostomy and the implantation of a Foley catheter, nº 24, followed by tiflopexy. During this procedure, it was possible to diagnostic, via intra-abdominal palpation, a significant type I cecal impaction. Immediately after the procedure, the animal presented no more enterogastric reflux and started to defecate pasty manure. Two days after the procedure, the animal died. During necropsy, the anastomoses region showed a great healing process, without folds or stenosis and the functional test of the region was performed, showing no leakage, ensuring the success of the anastomosis technique; the tiflopexy was adequate, and the other intestinal segments presented normal.Discussion: In this report it was possible to observe several postoperative complications such as enterogastric reflux, type I caecum impaction, ileus, and endotoxemia, which was determinant for the death of the animal. Probably the cecal impaction was responsible for the enterogastric reflux and ileus, contributing with the endotoxemia and hydro electrolytic imbalance. These facts evidenced the necessity of faster and more efficient actions in future cases with similar complications, such as the accomplishment of a tiflostomy more precociously avoiding the impaction of caecum and minimizing the electrolytic imbalances of the patients. It was concluded that the delay in the patient referral, followed by the advanced hydro electrolytic imbalance and endotoxemia were the main factors responsible for the treatment failure.

A 38-year-old woman presented at Orotta National Referral Hospital emergency department in May 2017 with pain in the epigastric region and vomiting. Physical examination revealed no pertinent findings. Blood and urine tests were normal, and erect abdominal x-ray revealed a distended small intestine with multiple layers of “air-fluid levels”. CT scan and MRI were not done due to their temporary unavailability. During laparotomy a large mass of 20x20 cm in size was detected in the mid-jejunum of the small intestine. This leading tumor caused intussusception and coiling of the small intestine. As there are no typical symptoms of intussusception, it is very important to do CT scan for patients with long-standing abdominal pain and vomiting to achieve a definitive diagnosis of intussusception.

Colonic torsion is a life-threatening condition in dogs and radiographic findings for this condition have not been well described. The purpose of this retrospective case series was to describe radiographic findings and clinical signs in a group of dogs with colonic torsion. Inclusion criteria were dogs presenting during the period of 2006 and 2016, and that had abdominal radiography and a surgically confirmed or presumed diagnosis of colonic torsion. For each dog, clinical data were recorded from medical records and imaging findings were recorded from retrieved plain radiographs and positive contrast radiographs in which barium enema was performed. Fourteen dogs met inclusion criteria. Of these, nine dogs had colonic torsion confirmed at surgery, with five dogs having surgical confirmation of colonic congestion or mesenteric torsion. Radiographic findings included segmental distention of the colon (14/14), focal narrowing of the colon (11/14), displacement of cecum (11/14), displacement of descending colon (14/14), and mild to no small intestinal distention (14/14). In cases where barium enema was performed, focal narrowing of the colon and longitudinal striations that course in a helical pattern were identified, termed the "torsion sign." Vomiting was the most common clinical sign observed (12/14), followed by abdominal pain in a small majority of cases (8/14). Severe abdominal pain and hypovolemic shock were uncommon in the patients reported (3/14). Colonic torsion should be considered as a differential diagnosis for dogs with radiographic segmental colonic distention with displacement of the descending colon and cecum. Barium enema is recommended for more definitive diagnosis.

A Furioso-North Star mare, aged 8 years, was examined for colic signs. The mare had a history of dystocia andpost partumvaginal lacerations, acute endometritis and laminitis approximately one year before the admission for colic. Signs of persistent abdominal pain, moderate distended abdomen, non-passage of manure, fever, tachycardia, tachypnoea, congested mucus membranes, and “toxic line” were recorded. No intestinal borborygmi were present in the four quarters of the abdomen. On rectal examination, the colon, the ventral band of the caecum, the right ovary and the uterine horn were palpated on the right side of the abdomen. The spleen, the nephrosplenic ligament, the left ovary and a firm, distended and painful small intestine (SI) loop were palpated on the left side. The left uterine horn and the adjacent broad ligament were not detectable. Percutaneous abdominal ultrasound evaluation revealed a large amount of fluid in the abdominal cavity, SI distention and absence of peristalsis. Abdominocentesis yielded approximately 20 ml of red-tinged peritoneal fluid with increased mean protein concentration (5.2 mg/dl), white blood cell count (12,550 cells/μl), and lactate (14 mmol/dl). A presumptive diagnosis of SI strangulation was made. Surgical resection of the affected intestinal loops was recommended. Due to poor prognosis and financial limitations, the mare was euthanized.Post mortemmacroscopic diagnosis was a herniation of 3 metres of the mid-jejunum through the left mesometrium, resulting in a complete and complicated strangulation. To prevent this type of SI strangulation, we recommend transrectal palpation of the urogenital tract (including the broad ligament) after foaling. If a defect is identified, we recommend flank laparoscopy for correction.

In an effort to identify novel high density lipoprotein (HDL) receptors expressed by the liver, a bacteriophage library expressing liver cDNA fragments was used to screen for clones that bind to HDL. The gene DENND5B showed significant enrichment for HDL binding over 3 cycles of biopanning, with negative selection against low density lipoprotein binding. Although little is known about the recently described DENN-domain containing family of proteins, some members act as guanine nucleotide exchange factors involved in the activation of Rab proteins and membrane trafficking. To examine the influence of DENND5B on HDL physiology, a DENND5B knockout mouse was generated using a custom zinc finger nuclease. DENND5B -/- mice had decreased plasma total cholesterol (-30.9%, p < 0.0001) and phosphatidylcholine (-31.4%, p < 0.0001). When plasma was analyzed by size-exclusion chromatography, the lipid effects were attributed entirely to decreased HDL. When fed western diet for 4 months, DENND5B -/- mice showed significantly smaller increases in plasma lipids and body weight compared to wild type mice. After sacrifice, DENND5B -/- mice were found to have a distended small intestine that was whitish in color. To evaluate fat absorption, mice were given an oral gavage of vegetable oil (10 uL/gram body weight) and plasma lipids were measured at 0, 2, and 4 hours post-gavage. DENND5B -/- mice had significantly reduced plasma triglyceride (p < 0.05) and free fatty acids (p < 0.01) in response to oil gavage compared to wild type mice. To identify a possible role for this gene in human lipoprotein metabolism, we examined gene expression data from 5,458 participants in the Framingham Heart Study. Consistent with the mouse data, a significant negative relationship exists between DENND5B expression and plasma HDL-C (p = 4.82 x 10 -5 ). In summary, using a phage display screening approach, we have identified a novel gene associated with circulating HDL levels in mice and humans. Additionally, in a homozygous knockout mouse model, a defect in intestinal fat absorption is present. Future studies will be aimed at evaluating the influence of this gene on HDL function, fat absorption, and atherosclerotic disease burden.

SummarySmall intestine strangulation by pedunculated lipomas is a common cause of acute colic in horses. However, diagnosis of this condition prior to surgery may be difficult due to the poor specificity of the clinical signs. We describe the ultrasonographic findings of 2 horses presented for acute colic with a diagnosis of strangulating lipoma confirmed in surgery. Lipomas were identified as rounded and well‐defined, homogeneous hyperechoic structures, surrounded by distended small intestine loops and peritoneal fluid. Ultrasonographic identification of lipomas should be attempted during an abdominal scan, especially in horses with evidence of small intestinal ileus and/or obstruction.

Will rapid abdominal ultrasound help you to decide whether to take a colic to surgery?

A prospective randomized controlled study of erythromycin on gastric and small intestinal distention: Implications for MR enterography

Acute appendicitis mimicking intestinal obstruction in a patient with cystic fibrosis

SummaryA gelding was referred for colic and inguinal wound evaluation. Abdominal ultrasound showed distended, oedematous and immotile small intestine abaxial to the spleen. An exploratory laparotomy revealed jejunal incarceration through a rent in the gastrosplenic ligament (GSL). The rent in the GSL was opened and surgical correction (resection and anastomosis of nonviable jejunum) performed. The GSL was left open. The horse recovered uneventfully and one year after surgery no further episodes of colic have been observed.

A 78-year-old man who had malnutrition and Parkinson’s disease vomited. Abdominal X-ray showed a distended stomach, small intestine and colon. Abdominal computed tomography (CT) indicated ascites, hepatic portal venous gas (HPVG), thickened intestinal wall and pneumatosis cystoides intestinalis (PCI) in the wall of the small intestine. Because there was no sign of peritoneal irritation, we decided to use conservative therapy. Neither HPVG nor PCI was observed on the abdominal CT scan taken 14 days after the onset of failure. Oral intake was started and the patient took a 1400-kilocalorie diet daily. The levels of serum alanine aminotransferase (ALT), aspartate aminotransferase (AST) and lactate dehydrogenase (LDH) were increased on the 40th day after the onset of failure. On the 46th day, respiratory and cardiac arrest occurred. His blood sugar level was below 20mg/dl. Intravenous hyperalimentation was started. Hypoglycemia was not present from the next day. The cause of the hypoglycemia was supposed to be malabsorption and liver insufficiency, which might have been caused by HPVG and PCI. It is supposed that patients with HPVG and PCI with malnutrition need careful observation for a long period after recovery from HPVG and PCI.

Studies were undertaken to evaluate the clinical, gross, histopathological and some biochemical parameters in broiler birds suffered from E. necatrix infection in a local broiler farm in the Aizawl district. Clinically, 20 birds out of 100 no. (aged between 4-6 weeks) showed loss of appetite, unthriftiness and bloody diarrhoea with mucus. Postmortem examination revealed anaemic pale musculature, distended small intestine with petechial haemorrhages. Similar changes were also observed in some areas of th e large intestine and caecum. Histopathological examination showed severe haemorrhagic enteritis with necrosis and disintegration of glandular epithelial cells. Several schizonts were observed in the epithelial cells along with merozoites, infiltrating neutrophils and eosinophils. Biochemically, the infected broilers presented hypoglycaemia associated with a reduction in liver glycogen level. Biochemical serum analysis of coccidia infected chickens also showed a significant increase (p<0.01) in alanine amino transferase levels (2.9-245.2) and there were also changes in total protein and cholesterol level in the serum.

Postmortem radiographic examinations of animals are commonly performed in judicial investigations to rule out gunshot and fractures. However, there was no available data on radiographic postmortem changes of animals. Forty-one sets of abdominal radiographs of feline cadavers made within 12 h of death were evaluated for postmortem changes. Intravascular gas was detected in 11 of 41 (27%) cadavers. The most common site of intravascular gas was the liver. Intravascular gas was also present in the aorta, femoral artery, celiac and cranial mesenteric arteries, and caudal superficial epigastric artery. Intrasplenic gas was detected in two cadavers. Only two cadavers had distended small intestine. One cadaver had pneumatosis coli. The changes detected were most likely due to putrefaction.

To determine prevalence, clinical findings, and long-term survival rate after surgery associated with incarceration of the small intestine through the gastrosplenic ligament (ISIGL) in horses. Retrospective case series. 14 horses with ISIGL. Medical records of horses with ISIGL examined between January 1994 and December 2006 were reviewed. Signalment, initial physical examination findings, results of abdominal fluid analysis, and clinical laboratory values were recorded, along with surgical findings, including segment of incarcerated intestine and surgical procedures performed. Long-term survival data were obtained through client interviews. Clinical findings included small intestinal distention identified via rectal palpation (10/14 horses) or transabdominal ultrasonography (8/11), nasogastric reflux (4/14), and abnormal abdominal fluid (9/9). All horses required intestinal resection and anastomosis. Postoperative complications included adynamic ileus (5/14 horses), incisional infection (4/14), diarrhea (3/14), and laminitis (1/14). No breed or age predilection was detected, although geldings were at increased risk for ISIGL. Long-term survival rate was 79% (11/14 horses). ISIGL was an uncommon cause of colicin this hospital population. With appropriate surgical intervention and postoperative management, the long-term prognosis for surgically treated horses was fair to good.

To evaluate the historical data, signalment, clinical signs, results of laboratory analyses, treatment, and outcome of horses with small intestinal (SI) volvulus. Retrospective study. One hundred and fifteen client-owned horses, aged 1 month to 21 years. Clinical signs, laboratory data, surgical or necropsy findings, and outcome for horses with SI volvulus were obtained from medical records, identified by computer search and manual review. There was no statistical difference in signalment between cases and the hospital population. Seventy-four percent of horses were >/=3 years. There were considerable variations in clinical signs on admission; high heart rate and signs of severe pain were not consistent features. Examination per rectum identified distended small intestine in only 69% of horses. One hundred horses had surgery, and small intestine resection was performed in 25. Eighty-four horses were recovered from surgery, and 67 horses survived to hospital discharge (80% of horses recovered from surgery, 58% of 115 horses). Forty-eight percent that were ultimately discharged had a post-operative complication and these horses had a longer average stay than horses with no complication (11 days versus 8.9 days). We identified 115 horses with primary SI volvulus over a 12-year period. We found that the population of horses with this lesion was older than has previously been reported and that the prognosis for post-operative survival to hospital discharge is good (80%). Post-operative complications were common, and affected approximately half the horses that were ultimately discharged from the hospital. This information may aid diagnosis and prognosis and guide decision making for horses with this condition.

To report the history, clinical findings, and outcome of horses with idiopathic focal eosinophilic enteritis associated with acute small intestinal obstruction. Retrospective study. Six horses with idiopathic focal eosinophilic enteritis. Retrospective review of medical records of horses with idiopathic focal eosinophilic enteritis, with acute abdominal pain and small intestinal obstruction, associated with a focal region of eosinophilic enteritis of unknown cause. Information retrieved from the medical records included signalment, physical examination, laboratory findings, surgical procedure, histologic diagnosis, and postoperative management. Outcome was determined by telephone communication with owners. Six horses met the selection criteria. Horses had persistent pain, distended small intestine, and nasogastric reflux. Idiopathic focal eosinophilic enteritis lesions associated with a small intestinal obstruction were treated surgically by intestinal resection and anastomosis or wedge resection. There were no observed complications associated with extension of the disease from the lesion site. Five horses were alive at follow-up 5 to 60 months after surgery. Although the cause of these focal eosinophilic enteritis lesions is unknown, the long-term outcome after lesion resection was favorable. Small intestinal obstruction associated with a focal eosinophilic enteritis lesion may be a cause of acute abdominal pain in horses. Horses apparently have a good prognosis after lesion resection.