Case Presentation

A 2-year-old male castrated Labrador retriever was presented in status epilepticus, with a rectal temperature over 43°C, severe hypersalivation and hemorrhagic diarrhea.

Main Diagnostic Investigations

A measurement of cholinesterase in blood confirmed the suspicion of cholinesterase inhibitor intoxication. Because of ongoing gastrointestinal signs at the 8th day of hospitalization an ultrasound of the abdomen showed evidence of small intestinal intussusception.

Therapy

At presentation the neurological signs were controlled with anticonvulsant therapy followed by gastrointestinal decontamination and symptomatic therapy with metoclopramide as continuous rate infusion. During the following days the dog suffered from aspiration pneumonia and hypocoagulable disseminated intravascular coagulation (DIC). Multiple plasma transfusions were given to control the DIC. When the intussusception was diagnosed, a preanesthetic stabilization with whole blood was necessary before the laparotomy to control the anemia due to gastrointestinal blood loss. An irreducible intussusception of the ileum and distal part of the jejunum in the colon was observed during surgery and an end-to-end anastomosis was performed. Three days later the patient developed a septic abdomen, and a new laparotomy revealed dehiscence at the sutures of the anastomosis. A new enterectomy and anastomosis was performed. Overall, the dog had a long recovery, needed multiple blood products, human albumin, as well as cobalamin substitution.

Outcome

The patient was discharged after 22 days of hospitalization in good clinical condition and remained on cobalamin substitution.

New/Unique Information

The intussusception formation in this case probably followed an abnormal gastrointestinal motility due to the increased acetylcholine in the nerve synapses and neuromuscular junctions of the gastrointestinal tract. Possible risk factors for the intussusception were the process of gastrointestinal decontamination, as well as the use of metoclopramide. The main difference of our case from previous cases is the age of the patient. The dog reported here was an adult whereas the dogs at the already published cases where <8 months of age. Moreover, our patient had a more severe disease progression with DIC and development of an aspiration pneumonia.

Disclosures

No disclosures to report.