Surgical Case Notes – Colonic TorsionFebruary 11, 2019

Surgery Case Notes

Colonic Torsion in a Canine

Written by Chloe Wormser, DVM, DACVS

Case Summary

An approximately one-year old intact male Labrador Retriever was presented to his primary care veterinarian for an acute onset of shaking, tenesmus, and vomiting.  Physical exam and bloodwork (complete blood count and serum biochemistry panel) were unremarkable.  Abdominal radiographs showed a markedly gas dilated segment of colon in the cranial abdomen, with the descending colon being relatively narrow in diameter.  Due to concern for colonic torsion, the dog was referred to Capital District Veterinary Referral Hospital (CDVRH) for exploratory laparotomy.

The patient was stabilized with intravenous fluids and analgesics.  Once anesthetized, a barium enema was performed which confirmed the presence of a colonic torsion (Figure 1). For surgery, the patient was positioned in dorsal recumbancy, and a routine laparotomy incision was made.  A 180-degree torsion of the mesocolon was identified, and the colon orad to the torsion was markedly gas dilated.  The mesocolon was untwisted, and vascular pulses to the colon were assessed to be normal.  A left-sided colopexy was performed between the transversus abdominus muscle and the seromuscular layer of the descending colon.  The abdomen was lavaged and closed routinely.  The patient recovered without complication and was discharged from the hospital 24 hours post-operatively.  At two week re-exam, he was doing well.

Colonic Torsion_1

Figure 1. Right lateral abdominal radiograph following barium enema. Coning and complete attenuation of the barium column at the level of the mid-descending colon can be seen.  No barium was noted to reach the transverse or ascending colon which are gas dilated. This was diagnostic for a colonic torsion.

Colonic Torsion_2

Figure 2. Intra-operative photograph of the colonic torsion.  A 180-degree torsion of the mesocolon was identified (white arrow).  The colon orad to the torsion was gas dilated but healthy.

Colonic Torsion

Colonic torsion has been infrequently described in the veterinary literature. The majority of cases are large-breed, young to middle-aged dogs.  The most common clinical signs include vomiting, depression, inappetence, and diarrhea with our without tenesmus.  Less commonly, dogs can present in hypovolemic shock with marked abdominal distension and/or pain. Importantly, colonic torsion has been described in dogs with previous gastric dilatation-volvulus that underwent gastropexy; and in about half of these cases, large intestinal entrapment and strangulation around the previous gastropexy site was found at the time of surgery.

Radiographic findings of colonic torsion include segmental distension of the colon, focal narrowing of the colon, displacement of the cecum, and/or displacement of the descending colon.  Typically, there is mild to no small intestinal distention.  Barium enema can be useful in making a diagnosis of colonic torsion, as it more clearly highlights focal colonic narrowing when compared to survey radiographs.

Successful management of colonic torsion requires prompt diagnosis; aggressive stabilization with intravenous fluids, antibiotics, and analgesics; and exploratory surgery to derotate the colon and re-establish blood flow to the bowel.  Colopexy is also recommended to minimize risk of recurrence.  In a case series of 13 dogs diagnosed with colonic torsion, 10 survived surgery and were discharged from the hospital following surgical intervention.  Thus, the disease appears to carry a better prognosis than mesenteric torsion.

 

About the author

Chloe Wormser, DVM, DACVS

wormser_cDr. Chloe Wormser is a Diplomate of the American College of Veterinary Surgeons. She is originally from Chicago and graduated from the University of Pennsylvania School of Veterinary Medicine in 2011. She continued her training at UPenn, completing a rotating internship followed by a residency in small animal surgery.  She moved with her husband and three dogs to Saratoga Springs, New York in 2017.

Dr. Wormser’s surgical interests include orthopedic surgery, microvascular surgery, urinary tract surgery, oncologic surgery, and minimally invasive surgery.  She has authored several peer-reviewed journal articles, with research focused on feline renal transplantation and ureteral disease. In her free time, she loves traveling and spending time outdoors.

Article notes

References

References

Plavec T, Rupp S, Kessler M. 2017. Colonic or ileocecocolic volvulus in 13 dogs (2005-2016). Vet Surg46(6): 851-859.

Gremillion CL, Savage M, Cohen EB. 2018. Radiographic findings and clinical factors in dogs with surgically confirmed or presumed colonic torsion. Vet Radiol Ultrasound59(3): 272-278.

Gagnon D, Brisson B. 2013. Predisposing factors for colonic torsion/volvulus in dogs: a retrospective study of six cases (1992-2010). J Am Anim Hosp Assoc49(3): 169-174.

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