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Diagnosis andTreatment ofIntussusceptions in DogsVeterinary Surgical Group of the Southwest, PC, Houston, TX

Aric A. Applewhite, DVM

University of Georgia

Karen K. Cornell, DVM, PhD, DACVSBarbara A. Selcer, DVM, MS, DACVR

ABSTRACT: Intussusceptions occur primarily in dogs younger than 1 year of age and are mostcommonly found at the ileocecocolic junction. Intussusceptions may, however, occur at otherlocations within the gastrointestinal tract, including the gastroesophageal junction and pyloro-gastric region. Gastroesophageal and pylorogastric intussusceptions result in more acute, severeclinical signs than do intussusceptions within the small intestine. Radiographic studies, includingcontrast-enhanced and non–contrast-enhanced radiographs, and ultrasonograms are extremelyhelpful in making a diagnosis of intussusception. Immediate systemic stabilization of the patient,followed by surgical correction of the intussusception, is critical to a successful outcome.Enteroplication techniques used to prevent recurrence of intussusception are not withoutpotential complications and should be performed in accordance with specific guidelines.

An intussusception is strictly defined as the taking up or receiving of onepart within another, especially in reference to the invagination of onesegment of intestine within another segment of intestine.1 The portion of

the gastrointestinal (GI) tract that is displaced into the lumen of anothersegment of the GI tract is referred to as the intussusceptum, whereas the outer orreceiving portion is referred to as the intussuscipiens. Intussusceptions usuallyoccur in the direction of normal peristalsis (aborally); these are referred to asdirect or normograde intussusceptions (Figure 1).2 Intussusceptions that occuragainst the direction of normal peristalsis are referred to as indirect orretrograde intussusceptions.2 Intussusceptions are named by citing theintussusceptum followed by the intussuscipiens. For example, an enterocolicintussusception is a normograde intussusception in which the small intestine(i.e., entero-) has invaginated into the large intestine (i.e., colic).

Intussusceptions in dogs have been identified in numerous locations withinthe GI tract. Many factors are reported to predispose dogs to intussusception

CE

110 Vol. 24, No. 2 February 2002

n Gastroesophagealintussusceptions occur mostfrequently in dogs younger than 3 months of age with underlyingesophageal problems.

n Clinical signs and electrolyteabnormalities are more severe and, in some cases, life-threatening in dogs withintussusceptions that involve theproximal gastrointestinal tract.

n Ultrasonography is a reliablediagnostic modality for theidentification of intestinalintussusceptions.

n Enteroplication, performed toprevent the potential recurrenceof intestinal intussusception, can have serious long-termcomplications.

Compendium February 2002 Intussusceptions in Dogs 111

formation. This article describes the proposed etiologiesand mechanisms of intussusception formation andoutlines appropriate diagnostic tests and therapeuticoptions for intussusceptions in dogs.

MECHANISMS OF INTESTINALINTUSSUSCEPTION FORMATION

The formation of an intestinal intussusception isproposed to be the result of a lack of homogeneity ofthe bowel wall. This inhomogeneity may be caused byany abnormality within the bowel wall that alters localintestinal motility or pliability. As the intussusception isformed, longitudinal and circular contractions of thenormal bowel wall adjacent to an area of local inhomo-geneity cause displacement of that portion of theintestine and a “kink” or fold in the intestine is formed(Figure 2). The fold is then propagated circumferen-tially, and longitudinal muscle contraction completesthe invagination.3,4 Once formed, intussusceptionsprogress by the same basic mechanism.

An intestinal intussusception may also formsecondary to a mechanical linkage between nonadjacentsegments of bowel.3,4 In this model of intussusceptionformation, longitudinal peristalsis generates a force oneach end of the linkage between bowel segments (Figure3). Contraction of circular muscle fibers within thebowel wall results in a small displacement and kinkformation. As in the inhomogeneity model, the kink isthen propagated and the bowel wall invaginates aslongitudinal contraction continues. Many local factorssuch as mesenteric attachments and bowel-wall pliabilityplay a role in the development of intussusception in anaboral or oral direction.

GASTROESOPHAGEAL INTUSSUSCEPTIONS Etiology

Gastroesophageal intussusceptions (GEIs) are rare indogs, with only 26 cases reported in the literature.5–9 AGEI is a retrograde invagination of the stomach intothe esophagus without displacement of the gastro-esophageal junction.5

The etiology of GEIs is not well understood. Thepresence of esophageal abnormalities, includingmegaesophagus, abnormal esophageal motility, andlaxity of the esophageal hiatus, may predispose dogs tothis type of intussusception. The active, retrogrademotility initiated during vomiting may also play a rolein invagination of the stomach into the esophagus.

Signalment and Clinical SignsSeventy-six percent of GEIs reported were in dogs

younger than 3 months of age.5–9 The largest retro-spective study of GEIs reported a higher incidence inmales than females,5 but with the addition of recentcase reports this trend is not supported. In the 16 casesin which gender was reported, 9 were male and 7 werefemale.5–9 Fifty-four percent of the 26 GEI casesreported occurred in German shepherds.5–9

GEIs may be acute in onset, resulting in severerespiratory compromise, or chronic in nature, withintermittent episodes of regurgitation and vomiting.5–9

The presence of the stomach and other abdominalorgans within the caudal thoracic esophaguscompressing the caudal lung lobes can producerespiratory distress in dogs with acute GEI.6,9

Respiratory compromise is made more severe by thepresence of concurrent aspiration pneumonia. Dogswith intermittent or chronic, recurrent GEI presentwith chronic regurgitation or vomiting.7,8 The chronicform of GEI is thought to be secondary to a slidingintussusception.7

Vomiting and regurgitation are the most commonclinical signs associated with GEI and have been

Figure 1—Illustration of an intussusception showing theinvaginated intussusceptum (blue) and the invaginatingintussuscipiens (red). (A) A direct or normograde intussus-ception occurs in the direction of normal peristalsis. (B) Anindirect or retrograde intussusception occurs against thenormal direction of peristalsis.

112 Small Animal/Exotics Compendium February 2002

Figure 3—Mechanical linkage model of intussusceptionformation. Lack of homogeneity of the bowel wall caused byan abnormality within the bowel wall alters intestinalmotility or pliability. (A) Longitudinal peristalsis generates aforce (F) on each end of the linkage between bowel segments.(B) Longitudinal and circular contractions of the normalbowel wall adjacent to the area of inhomogeneity (S) result inbowel wall displacement and kink formation. (C) Aslongitudinal muscle contraction continues, the kink ispropagated and the intussusception is formed.

Figure 2—Inhomogeneity model of intussusception formation.(A) A focal area of inhomogeneity (I) is present within the wall ofthe bowel. (B) Longitudinal (F) and circular contraction of thebowel wall occurs adjacent to the area of inhomogeneity, creatinga kink. (C) Continued longitudinal force causes complete invagi-nation of the area of inhomogeneity. (D) The kink is propagatedcircumferentially, and longitudinal muscle contraction completesthe formation of the intussusception.


reported in 65% (17 of 26) of affected dogs,5–9 withhematemesis (n = 7) and dyspnea (n = 7) reported lessfrequently.5–9 Clinical signs may also include nonspecificsigns of gastroenteritis or abdominal discomfort. 5–9

GEIs are occasionally described as a type of hiatal herniabecause of the associated laxity of the esophageal hiatusreported in several dogs diagnosed with GEI.6,7,9

The majority of dogs (15 of 26) had evidence ofesophageal disease, including megaesophagus, enlargedesophageal hiatus, and abnormal esophageal motility.5–9

The increased incidence of GEI in German shepherdsmay be secondary to the increased incidence ofcongenital megaesophagus and esophageal abnormalitieswithin this breed.10

DiagnosisGEIs are diagnosed by identification of the

invaginated stomach within the caudal esophagus.Plain thoracic radiographs may reveal a soft tissue masswithin the esophagus and lack of a gastric gas bubble orpylorus within the cranial abdomen (Figure 4).5–9

Frequently, the esophagus is dilated. Aspirationpneumonia is often present and may be secondary tounderlying esophageal disease or GEI. Contrast esopha-gography demonstrates a mass lesion within the caudalesophagus without failure of contrast media to enterthe stomach.5–9 The risk of aspiration during contrast-enhanced diagnostic imaging should be consideredsignificant in animals with vomiting and regurgitationand, therefore, should not be performed unlessabsolutely necessary for diagnosis.

Esophagoscopy has also been used to diagnose

GEI,5–9 and this tool aids in differentiation of GEI froman esophageal foreign body. Typically, esophagoscopyreveals a soft tissue mass within the caudal esophagus.Rugal folds may also be identified within the

Figure 4A Figure 4B

Figure 4—GEI lateral esophagograms. (A) The esophagus is dilated throughout its length (megaesophagus). A soft tissue mass(stomach) in the caudal esophagus obstructs aboral flow. The stomach is not seen in the cranial abdomen (lack of gastric gasbubble). (B) Megaesophagus is present. There is a filling defect (stomach) in the caudal thoracic esophagus. Barium is seenbetween gastric rugal folds.


esophagus. In some cases, it may not be possible to passthe endoscope into the stomach.

Treatment and PreventionSuccessful treatment of GEI has been reported in

only 5 of 26 cases.5–9 Factors associated with successfultreatment include early diagnosis; aggressivestabilization of the patient in shock with oxygen,intravenous fluids, and correction of electrolyteabnormalities; and accurate identification of concurrentdiseases. Following stabilization, immediate surgicalexploration, with replacement of the stomach and otherinvolved organs to their normal anatomic location, isindicated.5–9 Rapid surgical reduction of the intussus-ception decreases the likelihood of vascularcompromise of the invaginated organs and relievesrespiratory compromise. A variety of permanentgastropexy techniques, including gastropexy of theright, left, or both sides of the stomach to anchor thestomach in a normal anatomic position, have beendescribed to prevent recurrence of GEI.5–9 Treatment ofconcurrent aspiration pneumonia and esophagealabnormalities is necessary for a successful outcome.Recurrence of GEI has not been reported.

PrognosisThe prognosis for recovery from GEI is guarded to

poor. A mortality rate of 95% was reported in a seriesof 22 cases described in 1984.5 However, recent casereports document successful treatment and long-termsurvival in dogs diagnosed promptly and treated aggres-sively.6–9 Management of esophageal abnormalities andaspiration pneumonia is also critical for long-termsurvival.6–9 Only one case report documents resolutionof megaesophagus after correction of GEI.6

PYLOROGASTRIC INTUSSUSCEPTIONSEtiology

Pylorogastric intussusceptions (PGIs), also describedas duodenogastric or gastrogastric intussusceptions, areretrograde intussusceptions that have rarely beenreported in veterinary medicine. To date, only four casesof PGI in dogs have been reported.11–14 The infrequentoccurrence of this type of intussusception in veterinarymedicine precludes speculation on its etiology.

Signalment and Clinical SignsThe four reported cases of PGI were in adult, large-

breed dogs.11–14 No obvious sex or breed predilectionwas noted. All dogs diagnosed with PGI were presentedfor acute, severe vomiting.11–14 Marked dehydration,tachycardia, and abdominal pain were consistentphysical examination findings.11–14

Figure 5—Ventrodorsal survey radiograph of the cranialabdomen of a dog with PGI. The fundus of the stomach isdistended with gas. A soft-tissue mass is present within thebody of the stomach.

DiagnosisA diagnosis of PGI is difficult to confirm without an

exploratory celiotomy.11–14 Electrolyte and biochemicalabnormalities (i.e., azotemia, hypochloremia, hypona-tremia, hypokalemia, isosthenuria) are consistent withacute gastric outflow obstruction and hypovolemia.11–14

Radiographic findings are consistent with a soft-tissueopacity mass in the gastric fundus but are not specificfor PGI (Figure 5).11–14 Positive-contrast radiographyand abdominal ultrasonography have not been provento be beneficial in differentiating PGI from othercauses of gastric outflow obstruction.

Treatment and PreventionSuccessful treatment of PGI was reported in two of

the four affected dogs.13,14 Fluid resuscitation withcorrection of electrolyte abnormalities is recommendedprior to exploratory celiotomy. Intussusception

correction should be performed as soon as possiblefollowing normalization of cardiovascular parametersand electrolyte abnormalities.13,14 Evaluation of thevascular supply of the associated tissue is critical toavoid subsequent gastric necrosis or perforation. Agastrotomy is indicated to rule out the presence of agastric foreign body or mass lesion predisposing tointussusception formation. If gastric or duodenalnecrosis is present, resection and anastomosis may berequired. At that time, the decision to perform a gastro-duodenostomy or gastrojejunostomy is based on theextent of devitalized tissue.

In the two successfully treated cases of PGI, manualreduction of the intussusception was achieved withoutcomplication.13,14 Reduction of the intussusception inone of these successful cases was followed by a Y-Upyloroplasty to relieve the remaining outflowobstruction caused by profound pyloric edema.14 TheY-U pyloroplasty increases the diameter of the pyloricoutflow tract by making a full-thickness, Y-shapedincision over the pylorus and advancing the stomachwall such that the incision is closed as a U-shapedincision.15 A duodenopexy was also performed in thereported animal to prevent recurrence of PGI.14 It isunknown whether a duodenopexy is necessary, as norecurrent case of PGI has been reported.

PrognosisThe prognosis for PGI is unknown due to the

infrequent occurrence of this type of intussusception inveterinary medicine.

INTESTINAL INTUSSUSCEPTIONS Etiology

Intestinal intussusception is the most common formof intussusception seen in dogs.16 The most frequent siteis the ileocecocolic junction, but intussusception mayoccur at any area along the intestinal tract.16–21 Intestinalintussusceptions may be single or multiple andnormograde or retrograde and frequently involve a largepercentage of the intestine.16–21 Agonal intussusceptionsare occasionally noted on postmortem examination andcan be differentiated from antemortem intussusceptionsby the lack of adhesion and inflammation of theinvolved intestine. Although the majority of intestinalintussusceptions reported in dogs are idiopathic innature, many conditions reportedly predispose dogs totheir formation, including intestinal parasitism, viralenteritis, intestinal foreign bodies, and intraluminal andextraluminal mass lesions.16–21

Signalment and Clinical SignsSeventy-five percent of dogs diagnosed with

intestinal intussusceptions are younger than 1 year ofage.17–21 Although an early study20 suggested thatGerman shepherds may be predisposed to intestinalintussusception, subsequent retrospective studies havenot identified a breed predilection.17–19,21 A sex predis-position has not been identified in dogs diagnosed withintussusception.16–21

The most common presenting clinical signs in dogswith intestinal intussusceptions are vomiting, diarrheawith hematochezia or melena, anorexia, and weightloss.16–21 Other reported clinical signs includedehydration, abdominal pain, tenesmus, and rectalprolapse.16–21 A palpable abdominal mass was present in50% to 70% of dogs with intussusception, mostfrequently in the cranial abdomen.16–21

The clinical signs of intestinal intussusception maybe acute or chronic in nature. The reported durationof signs from onset to presentation ranges from 1 to90 days.18,19,21 The nature, severity, and duration ofclinical signs are related to the location of theintussusception within the intestinal tract.16 The mostsevere cl inical s igns, including vomiting andelectrolyte imbalance, are more likely to occur withintussusceptions that are in the proximal intestinaltract (i.e., enteroenteric).22 Other factors, such as thedegree of intestinal obstruction, the amount ofcompromised intestine involved in the intussus-ceptum, and the presence and severity of peritonitis,may contribute to both the severity and duration ofclinical signs prior to presentation.16

DiagnosisPhysical examination in dogs with intestinal intussus-

ceptions may reveal a palpable cranial abdominal mass.In some cases, the intussusceptum may protrude fromthe anus, in which case the intussusceptum must bedifferentiated from a rectal prolapse.16 This isaccomplished by attempting to pass a blunt, lubricatedprobe between the rectal wall and the prolapsed tissue.In the case of a small-intestinal or colonic intussus-ception, the probe can be passed to a level cranial to thepubis23; however, the probe cannot be advanced when arectal prolapse is present.

Abdominal radiographs in dogs with intussusceptionscommonly reveal fluid- or gas-distended bowels,consistent with mechanical intestinal obstruction.16–18 Asoft-tissue opacity mass may be identified on surveyradiographs, but a definitive diagnosis of intussus-ception is difficult without contrast radiography orultrasonography.16–18 In some cases, there is sufficientgas accumulation within the affected bowel to outlinethe intussusceptum on plain radiographs.16 Contrastradiography using either an upper GI study or a



Figure 6—Lateral (A) and ventrodorsal (B) views of an enterocolic intussusception following an upper GI barium study. A largefilling defect (small intestine intussusceptum) is seen in the ascending colon (intussuscipiens). A “ribbonlike” line of barium is seenwithin the filling defect and represents barium within the lumen of the intussusceptum segment. Lateral (C) and ventrodorsal (D)views of an enterocolic intussusception following a barium enema. A large “coiled-spring”–appearing filling defect is present withinthe transverse and descending colon. Barium is present within the lumen of the colon surrounding the intussusceptum.

Figure 6A

Figure 6B

Figure 6C

Figure 6D


barium enema may increase the likelihood ofdiagnosing intussusceptions (Figure 6).16,24 The mostappropriate contrast radiographic study to performdepends on the type of intussusception suspected.Enterocolic, cecocolic, or colocolic intussusceptions arebest identified with a barium enema, while intussus-ceptions in a more orad location (i.e., enteroenteric) arebest identified by an upper GI study or ultrasound.16,24

Contrast media may outline the intussusceptum withinthe lumen of the intussuscipiens of an enterocolicintussusception following a barium enema, or a ribbonof contrast media may be present within the intussus-ceptum of an enterocolic, a cecocolic, or an ileocolicintussusception following an upper GI contrast study.16

Factors influencing the success of positive contraststudies include location of the intussusception,completeness of the obstruction, and the presence ofsignificant intestinal ileus.16,24

Abdominal ultrasonography has also been shown tobe a reliable diagnostic tool for diagnosis of intestinalintussusceptions in dogs.25,26 The characteristicultrasonographic appearance of an intestinal intussus-ception is a series of concentric rings in the transverseplane, frequently described as a “target sign” or “bulls-eye lesion,” and multiple parallel lines in thelongitudinal plane (Figure 7).26 These findings correlatewith the different layers of intestinal wall of the intussus-ceptum and intussuscipiens present within the intussus-

ception. Ultrasonography may also identify concurrentabdominal abnormalities, such as lymphadenopathy,liver or splenic lesions, or infiltrative GI lesions.26

Treatment and PreventionBefore surgical intervention, the patient’s

hemodynamic and electrolyte status must be stabilized.Definitive treatment of intestinal intussusception mustinclude reduction of the intussusceptum from theintussuscipiens and reestablishment of a patent GItract. In dogs, this requires exploratory celiotomy andeither manual reduction of the intussusception orresection of the intussusception with anastomosis of theremaining intestine.16–21 Manual reduction of theintussusception should be attempted by gentle“milking” of the intussusceptum from within theintussuscipiens. This technique should employ morepressure on the intussuscipiens in an effort to reducethe intussusceptum by pushing it out rather than usingtraction on the intussusceptum. Care must be taken toavoid tearing the serosa.2 Serosal adhesions, vascularcompromise, or the presence of intestinal perforationprohibited manual reduction and necessitated resectionand anastomosis in approximately 81% of 123 reportedcases of intussusception in dogs.16–21 Serosal adhesionsthat preclude manual reduction of an intussusceptionhave been proposed to be related to the duration ofclinical signs.17 One retrospective study, however, foundno statistically significant correlation between durationof clinical signs and the presence of adhesions.18

The recurrence rate of intestinal intussusception aftersurgical intervention in dogs reportedly ranges from 3%to 25%.17–21 Historically, recurrence was reported in 22%of 18 dogs having undergone manual reduction aloneand in 17% of 88 dogs having undergone resection andanastomosis.17–21 Recurrence of the disease process inboth dogs and humans usually occurs in an anatomiclocation other than the original site.27–30 The recurrence isfrequently in a location orad to the original intussus-ception and is reported more commonly in idiopathicintussusceptions.16–21 Butorphanol tartrate has beenreported to decrease the occurrence of intussusceptionformation in a canine model of renal transplantion.31 Inthis model, the incidence of intussusception followingrenal transplantation was decreased from 17% to 3%when butorphanol tartrate was administered during theperioperative period. It is hypothesized that opioidadministration increases the tone of the small intestineand reduces or prevents local bowel wall inhomogeneityand segmental ileus and, therefore, decreases thelikelihood of intussusception.31 Recently, an increase inthe use of perioperative opioids in clinical veterinarymedicine has been suggested to be associated with a

Figure 7—Transverse sonographic image of an enterocolicintussusception. Alternating hyperechoic and hypoechoicconcentric rings are present within the lumen of a distendedbowel segment, giving it the typical “target” appearance.


lower rate of recurrence of intestinal intussusceptionsfollowing initial correction of this condition.19

Enteroplication, defined as the formation of perma-nent serosal adhesions between adjacent loops of smallintestine, has been advocated as a means to preventrecurrence of intussusception in dogs.16,17,30 Enteropli-cation was originally introduced in human abdominalsurgery to prevent obstructive adhesions followingmultiple abdominal surgeries, but it has not beenadvocated for the prevention of recurrent intussus-ceptions. Although two previous retrospective studiesreport no significant difference in recurrence rates withor without enteroplication,18,19 results of the five largestretrospective studies involving 30 dogs indicated no dogthat has undergone enteroplication of the entire smallintestine has developed a recurrent intussusception. Incontrast, 17% of 63 dogs that did not receive enteropli-cation developed recurrent intussusception.17–21

Until recently, there have been only isolated reportsof significant complications associated with enteropli-cation in dogs.32 In a recent retrospective study, compli-cations of enteroplication performed for the preventionof recurrent intestinal intussusception in dogs includedintestinal obstruction with vegetative material andstrangulation of enteroplicated loops of jejunum

between enteroplication sutures.19 This study suggestedthat the likelihood of a dog requiring a second surgicalprocedure following surgical correction of intussus-ception is no different between dogs that undergoenteroplication at the time of the initial surgery anddogs that do not. In order to fully evaluate the role ofenteroplication in the treatment of recurrent intestinalintussusception, a randomized, multi-institutional,prospective clinical study using a standardized enter-oplication technique is needed. Until such a study iscompleted, the decision to perform enteroplication is atthe discretion of the individual surgeon who mustbalance the potential benefit with the risk of compli-cation. If enteroplication is performed, the techniqueused must create gentle loops in the intestines tominimize the possibility of foreign material becominglodged at the bends during transit. Plication sutures,using nonabsorbable or absorbable suture material,should be placed at intervals that will prevententrapment and strangulation of other portions ofbowel (Figure 8). Sutures should incorporate thesubmucosal layer of both loops of bowel withoutpenetrating the lumen. The entire small intestine fromthe duodenocolic ligament to the ileocolic junctionmust be plicated.33


PrognosisThe prognosis for dogs with intestinal intussus-

ceptions depends on many factors. Rapid identifi-cation of the intussusception with correction of fluidand electrolyte disorders, followed by immediatesurgical intervention, is critical to the long-termoutcome. Although early reports suggested recoveryrates ranging from 35% to 65%,20–21 recent studies inwhich dogs received aggressive fluid therapy and rapidsurgical intervention suggest a survival rate greaterthan 80%.17–19 The location of the intussusception

within the GI tract affects the disease process. Patientswith intussusceptions of the proximal GI tract aremore severely affected by electrolyte imbalancessecondary to vomiting and loss of gastric secretions.22

The presence of generalized peritonitis, secondary toperforation of the bowel, also worsens the prognosisfor this disease.

FUTURE PROSPECTSCurrent research into the pathophysiology of

intussusception formation may lead to a betterunderstanding of both primary and recurrent intussus-ceptions. A model of intussusception formation hasbeen developed in mice by the intraperitoneal injectionof lipopolysaccharide.34 This model has been used toevaluate the role of inflammatory mediators such asprostaglandins, nitric oxide, and tumor necrosis factorin the formation of intussusceptions.35 Elucidation ofthe roles of these mediators and other agents (e.g.,opioids) in the formation of intussusceptions may leadto the ability to prevent the recurrence of intussus-ceptions in dogs by pharmacologic intervention.

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2. Hedlund CS: Surgery of the small intestine, in Fossum TW (ed):Small Animal Surgery. St. Louis, Mosby, 1997, pp 311–314.

3. Reymond RD: A mechanism of the kink formation whichprecedes intussusception. Invest Radiol 6:61–64, 1971.

4. Reymond RD: The mechanism of intussusception: A theoreticalanalysis of the phenomenon. Br J Radiol 45:1–7, 1972.

5. Leib MS, Blass CE: Gastroesophageal intussusception in thedog: A review of the literature and a case report. JAAHA20:783–790, 1984.

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Figure 8—The appropriate technique for enteroplication.Plication begins at the duodenocolic ligament and extends tothe ileocecocolic junction, incorporating gentle bends in theintestine. Plication sutures (A) must be close enough togetherto prevent entrapment of other organs and incorporate thesubmucosal layer of both loops of bowel (B).


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1. GEIsa. occur most frequently in older, female dogs.b. may be present in dogs with either acute or chronic

histories of regurgitation/vomiting.c. do not occur in association with esophageal

motility abnormalities.d. are not surgical emergencies when associated with

respiratory difficulty.

2. Treatment of GEIs requiresa. aggressive patient stabilization, including oxygen

supplementation.b. identification of concurrent disease processes,

especially aspiration pneumonia.c. immediate surgical reduction of the intussusception.d. permanent attachment of the stomach to the

abdominal wall to prevent recurrence.e. all of the above

3. PGIsa. are more common in dogs younger than 1 year of age.b. may be present in dogs with a chronic history of

anorexia and weight loss.c. are more common in German shepherds than in

other dogs.d. may be associated with dietary indiscretion and

acute, severe vomiting.

4. Diagnosis of PGIa. is made exclusively by abdominal ultrasonography.b. may be made preoperatively with a variety of tests,

including plain abdominal radiography, contrastradiography, ultrasonography, and gastroduo-denoscopy.

c. has only been successfully made during exploratoryceliotomy.

d. is necessary before surgical treatment of the process.

5. The majority of canine intestinal intussusceptionsa. occur in dogs older than 5 years of age.b. have an identifiable cause for intussusception

formation.c. are identified in German shepherds.d. demonstrate no identifiable breed or sex predilection.

CEARTICLE #2 CE TEST

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6. The duration of clinical signs in dogs afflicted withintestinal intussusceptionsa. is consistent for all dogs, regardless of the location

of the intussusception within the intestinal tract.b. is always predictive of the ability to manually

reduce the intussusception at surgery.c. directly corresponds to the prognosis for recovery.d. is extremely variable, ranging from 1 to 90 days in

the veterinary literature.

7. Diagnosis of intestinal intussusceptionsa. requires advanced imaging tests such as computed

tomography or magnetic resonance imaging.b. may not be successful unless contrast radiography is

incorporated.c. may be suspected based on signalment, history, physical

examination, and plain abdominal radiography.d. may be made with a barium enema, which may also

be incorporated in the successful treatment of amajority of the intussusceptions in dogs.

8. Manual reduction of an intussusceptiona. is never successful in dogs.b. should be attempted with forceful extraction of the

intussusceptum from the intussuscipiens.


c. is frequently unsuccessful in dogs because of severevascular compromise and serosal adhesions of theaffected intestines.

d. should not be attempted in dogs older than 6months of age.

9. Recurrence of intussusceptiona. most frequently occurs at the same location of the

intestinal tract.b. is more common after manual reduction versus

intestinal resection and anastomosis.c. is seen most commonly in dogs older than 5 years

of age.d. is apparently prevented by performing the appro-

priate method of enteroplication of the small intestine.

10. Enteroplication of the small intestine for theprevention of recurrent intussusceptiona. has been associated with severe complications in dogs.b. should incorporate only the affected segment of the

small intestine in the area of the original intussus-ception.

c. is a technique developed in veterinary surgery inthe 1950s.

d. should be performed in every dog with intestinalintussusception.

comments? questions? email: …...intussusception is a normograde intussusception in which the small...

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