History: Presented after being at referring DVM, who was concerned about a possible GDV. The mucous membranes are pale, and the pulse is weak. Patient is a known diabetic.
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The abdomen is distended. The stomach is markedly distended with gas. There is diffuse, severe small intestinal dilation with stippled gas and fluid opacity luminal contents. Serosal contrast is diminished. The kidneys and urinary bladder are not clearly defined. Spondylosis deformans is present. Anomalous vertebrae compatible with patient breed are also present. No other significant findings are noted.
1.There is diffuse, marked, small intestinal dilation. Given the extent of involvement and size of the affected intestinal loops, mesenteric root torsion is the most likely diagnosis. Distal small intestinal obstruction is less likely due to the degree of intestinal distension and the distension of the stomach. Infarction of the cranial mesenteric artery with secondary paralytic ileus cannot be ruled out.
2.Dysautonomia is unlikely given the lack of other common signs, such as dysuria, mydriasis, absent pupillary light response, decreased tear production, dry mucous membranes and decreased anal tone.
3.The reduction in serosal contrast is most likely due to crowding. A small amount of abdominal fluid is not ruled out; this would not be unexpected.
4.The volvulus likely had no association with the diabetes mellitus.
An exploratory laparotomy is indicated as soon as possible.
Mesenteric volvulus usually results in occlusion of the cranial mesenteric artery and vein, leading to vascular obstruction and venous congestion of the bowel. Complete mesenteric volvulus is an emergency and a laparotomy is indicated. Death is usually due to shock and endotoxemia. Patients can survive if surgery is initiated early in the disease; 5 of 12 patients in one report survived (1). A chronic partial mesenteric volvulus associated with a 4-month history of gastrointestinal signs has been reported in a dog. In radiographs of this dog, there was initially marked gas distension of the small intestine compatible with an obstruction. 24 hours later the obstructive gas pattern had resolved (2).
1.Junius G, Appeldoorn AM, Schrauwen E. Mesenteric volvulus in the dog: A retrospective study of 12 cases. J Small Anim Pract. 2004;45:104–107.
2.Spevakow AB, Niblett BMD, Carr AP, Linn KA. Chronic mesenteric volvulus in a dog. Can Vet J 2010;51:85-88.