Colon torsion

Accession 151617

Clinical picture• Present as acute abdomens - vomiting

– +/- tenismus, lactic acidosis, peritoneal effusion– Can clinically look like a mechanical ileus/foreign body, or less commonly like functional

ileus .– But are a surgical emergency!

• Most have very rapid clinical progression. • Two reports of dogs with clinical history of several days – both dogs had 180° colonic

torsions, both had a poor out come.• Rare! (literature describes 7 dogs and 1 cat)

– Large breed male dogs are over represented

Diagnostic imaging• Radiographs: Gas distension of portions of the intestinal

tract. – Only identified as colon in 50% of cases– Appearance of intraluminal material feces– Don’t see descending colon– Dilated loop often makes a large ‘C’ shape

Bear• 9 yr old MC German Sheppard dog. • Presented to NCSU emergency service for

vomiting. – The day before presentation while on a walk, he

went down in the rear and then proceeded to drag is right hind limb. Had history of previous/chronic IVDD and owner administered Tramadol. He vomited at least twice the next day prior to administration.

• At presentation Bear was assessed to be stable and started on supportive care over night. He vomited once that night in hospital and was straining to defecate.

• Abdominal radiographs were taken at 9:48 AM the next day.Bears spine rads from 2

years prior.

Bear

Treatment• Surgical emergency!– Time to surgery will

determine viability and survival.

– Torsion is around mesenteric root. Includes cranial mesenteric artery!

• Colopexy by attaching the descending colon to body wall and/or gastrocolopexy connecting transverse colon to greater curvature of stomach.

Prognosis

• Prognosis: ~50% survived in the cluster of case reports that I read.

• But of 3 cases reported from Tufts – who had peracute signs and where decompressed in less than 4 hours from time of presentation – all survived and were healthy 10 months post-op.

• This fits with equine literature, where colon torsions are much more common. There is a ~4 hour window from torsion to the colon being inviable.

• In humans and horses large intestinal torsion is less severe than small intestinal.

Duration and degree of rotation will determine survival.

Colonic torsion• Relatively short colon on short

mesentery. • Most freely moveable portions

are cecum, ascending and transverse colon.

• Counterclockwise rotation.• Colon torsion can progress or

predisposes to mesenteric volvulus.

• Interestingly almost all reported cases have some kind of GI history. Several had previous GDV’s and pexy, foreign bodys, inflammatory bowel disease with previous biopsies, EPI.

The colon is dilated and rotated360° counterclockwise around mesenteric root.

Bear• Bear’s radiographs were correctly interpreted to represent

a mechanical obstruction and require surgery. • After radiographs Bear collapsed in his crate and treatment

for shock was initiated. • At surgery there was a mesenteric volvulus and the entire

intestinal tract was devitalized; from distal duodenum to rectum and he was euthanized.

References• Bentlry, O’Toole, Kowaleski, Casale, McCarthy. Volvulus of the colon in four

dogs. 2005. JAVMA 227:2 253-256• Carol Carberry & James Flanders. Cecal-colic volvulus in two dogs. 1993.

veterinary surgery 22:3 225-228.• Darien, Stone, Dubielzig, Clayton. Morphologic changes of the ascending colon

during experimetnal ischemia and reperfusion in ponies. 1995. Veterinary pathology. 32:280-288.

• Johnston, Holcombe, Hauptman. Plasma lactate as a predictor of colonic viability and survival after 360° volvulus of the ascencding colon in horses. 2007. Veterinary surgery. 36:563-567.

• Halfacree, Beck, Lee, Lipscomb. Torsion and volvulus of the transverse and descending colon in a German shepherd dog. 2006. Journal of small animal practice. 47, 468-470.

• Snyder, Pascoe, Olander et al. Ultrastructural alterations observed during experimental ischemia of the equine large colon. 1988. American journal veterinary research 41:801.