Gastric dilation and intestinal obstruction

Frances Harcourt-Brown

doi:10.22233/9781910443163.14

British Small Animal Veterinary Association , 172 (2013); https://doi.org/10.22233/9781910443163.14

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Gastric dilation and intestinal obstruction

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Author: Frances Harcourt-Brown
From: BSAVA Manual of Rabbit Surgery, Dentistry and Imaging
Item: Chapter 14, pp 172 - 189
DOI: 10.22233/9781910443163.14
Copyright: © 2013 British Small Animal Veterinary Association
Publication Date: January 2013

Abstract

Gastric dilation is a common clinical syndrome in rabbits and is often confused with ileus, gastrointestinal hypomotility or gut stasis. Some of the confusion originates in the terminology used, so the terms used in this chapter are defined in Figure 14.1 . This chapter covers anatomy and physiology of the gastrointestinal tract; intestinal obstruction; diagnosis of intestinal obstruction; site of obstruction; causes of intestinal obstruction; gastrointestinal hypomotility, together with a protocol for rabbits with gastric dilation. Quick Reference Guides/Techniques: Passing a stomach tube to decompress the stomach; Milking a foreign body through the small intestine.

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14.2

The ileocaecolic complex is a coiled spiral that contains the caecum, the proximal colon and the terminal ileum, which are attached to each other. It occupies most of the caudoventral abdomen. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2013 British Small Animal Veterinary Association

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14.2 The ileocaecolic complex is a coiled spiral that contains the caecum, the proximal colon and the terminal ileum, which are attached to each other. It occupies most of the caudoventral abdomen. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.

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14.3

Appearance of abdominal contents during the hard faeces phase of digestion. The lateral view of the abdomen was taken at about 9 am, after the rabbit had been eating hay. The stomach and ileocaecocolic complex are full of full of ingesta, which is mottled due to its fibre content. © 2013 British Small Animal Veterinary Association

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14.3 Appearance of abdominal contents during the hard faeces phase of digestion. The lateral view of the abdomen was taken at about 9 am, after the rabbit had been eating hay. The stomach and ileocaecocolic complex are full of full of ingesta, which is mottled due to its fibre content.

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14.4

Appearance of abdominal contents during the soft faeces phase of digestion. This lateral view of the abdomen of a healthy rabbit with a normal appetite was taken in the late morning when the rabbit had been resting for a few hours. It shows a small stomach and ileocaecocolic complex containing ingesta with a homogenous appearance because it is composed of small particles. Some pockets of gas are visible. Soft faeces can be seen in the rectum. Other abdominal organs, such as the kidneys, can easily be identified because the abdomen is empty. © 2013 British Small Animal Veterinary Association

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14.4 Appearance of abdominal contents during the soft faeces phase of digestion. This lateral view of the abdomen of a healthy rabbit with a normal appetite was taken in the late morning when the rabbit had been resting for a few hours. It shows a small stomach and ileocaecocolic complex containing ingesta with a homogenous appearance because it is composed of small particles. Some pockets of gas are visible. Soft faeces can be seen in the rectum. Other abdominal organs, such as the kidneys, can easily be identified because the abdomen is empty.

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14.5

Gastric dilation. This lateral radiographic view of the abdomen shows a dilated stomach that was palpable behind the ribs on the left side of the abdomen. The stomach extends well beyond the costal arch and is just in contact with the ventral abdominal floor. The radiograph was taken with the rabbit lying on its right side and the pocket of gas that has collected in the pyloric area of the stomach can be seen as a dark circle in the stomach. This ‘fried egg’ appearance is typical of gastric dilation. There is some radiodense sediment in the urine, which is an incidental finding. On exploratory laparotomy, a foreign body was found in the small intestine and milked through to the ileocolic junction. The rabbit made a full recovery. © 2013 British Small Animal Veterinary Association

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14.5 Gastric dilation. This lateral radiographic view of the abdomen shows a dilated stomach that was palpable behind the ribs on the left side of the abdomen. The stomach extends well beyond the costal arch and is just in contact with the ventral abdominal floor. The radiograph was taken with the rabbit lying on its right side and the pocket of gas that has collected in the pyloric area of the stomach can be seen as a dark circle in the stomach. This ‘fried egg’ appearance is typical of gastric dilation. There is some radiodense sediment in the urine, which is an incidental finding. On exploratory laparotomy, a foreign body was found in the small intestine and milked through to the ileocolic junction. The rabbit made a full recovery.

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14.6

Gastric tympany. This lateral radiographic view of the abdomen was taken with the rabbit lying on its left side. The rabbit had been totally inappetent for 24 hours despite treatment by the owner with simethicone and pineapple juice. The stomach is grossly distended. It occupies half the abdomen and is in contact with the ventral abdominal floor. Loops of distended small intestine can be seen proximal to the site of the obstruction, which was due to marked thickening of the intestinal wall and narrowing of the lumen, causing a chronic partial obstruction. A large amount of hair was located at this site during post-mortem examination. © 2013 British Small Animal Veterinary Association

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14.6 Gastric tympany. This lateral radiographic view of the abdomen was taken with the rabbit lying on its left side. The rabbit had been totally inappetent for 24 hours despite treatment by the owner with simethicone and pineapple juice. The stomach is grossly distended. It occupies half the abdomen and is in contact with the ventral abdominal floor. Loops of distended small intestine can be seen proximal to the site of the obstruction, which was due to marked thickening of the intestinal wall and narrowing of the lumen, causing a chronic partial obstruction. A large amount of hair was located at this site during post-mortem examination.

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14.7

Ventrodorsal view of rabbit with gastric tympany. The radiograph shows the ventrodorsal view of the abdomen in the same rabbit as in Figure 14.6 . A dilated section of small intestine can be seen leaving the pylorus and extending to the left side of the abdomen. Despite intravenous fluid therapy and passing a stomach tube, which released a large volume of gas and partially decompressed the stomach, the rabbit died shortly after induction of anaesthesia for exploratory laparotomy. © 2013 British Small Animal Veterinary Association

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14.7 Ventrodorsal view of rabbit with gastric tympany. The radiograph shows the ventrodorsal view of the abdomen in the same rabbit as in Figure 14.6 . A dilated section of small intestine can be seen leaving the pylorus and extending to the left side of the abdomen. Despite intravenous fluid therapy and passing a stomach tube, which released a large volume of gas and partially decompressed the stomach, the rabbit died shortly after induction of anaesthesia for exploratory laparotomy.

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14.8

Free gas in the abdomen. This lateral radiograph of a moribund rabbit was taken prior to exploratory surgery. A duodenal foreign body was found and there was a small perforation in the stomach. Free gas in the abdomen can be seen outlining the ventral border of the stomach (arrow). The rabbit was euthanased. © 2013 British Small Animal Veterinary Association

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14.8 Free gas in the abdomen. This lateral radiograph of a moribund rabbit was taken prior to exploratory surgery. A duodenal foreign body was found and there was a small perforation in the stomach. Free gas in the abdomen can be seen outlining the ventral border of the stomach (arrow). The rabbit was euthanased.

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14.9

Ruptured intestine. This ventrodorsal view of the abdomen of a moribund rabbit was taken shortly after admission. It shows free gas in the abdominal cavity (arrow). The rabbit died after the radiograph was taken and post-mortem examination confirmed intestinal rupture. A pellet of hair was found in the ingesta that was released into the abdomen. © 2013 British Small Animal Veterinary Association

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14.9 Ruptured intestine. This ventrodorsal view of the abdomen of a moribund rabbit was taken shortly after admission. It shows free gas in the abdominal cavity (arrow). The rabbit died after the radiograph was taken and post-mortem examination confirmed intestinal rupture. A pellet of hair was found in the ingesta that was released into the abdomen.

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14.10

Presumed moving foreign body. This radiograph shows the lateral abdomen of a rabbit that had been totally anorexic for a number of hours. The stomach was palpably distended. The radiograph shows a dilated stomach and gas in the hindgut. The diameter of the section of intestine suggests that the gas was in the ileocaecocolic complex and colon (arrow). The gas shadow extends to the rectum. This radiograph suggests that an intestinal obstruction has moved through the ileocolic junction and allowed gas from the stomach and small intestine to escape into the hindgut. The rabbit was treated with analgesics and prokinetic therapy. He started to eat voluntarily within 2 hours of radiography. © 2013 British Small Animal Veterinary Association

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14.10 Presumed moving foreign body. This radiograph shows the lateral abdomen of a rabbit that had been totally anorexic for a number of hours. The stomach was palpably distended. The radiograph shows a dilated stomach and gas in the hindgut. The diameter of the section of intestine suggests that the gas was in the ileocaecocolic complex and colon (arrow). The gas shadow extends to the rectum. This radiograph suggests that an intestinal obstruction has moved through the ileocolic junction and allowed gas from the stomach and small intestine to escape into the hindgut. The rabbit was treated with analgesics and prokinetic therapy. He started to eat voluntarily within 2 hours of radiography.

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14.11

Paralytic ileus. This radiograph shows the lateral view of the abdomen of a rabbit that had been anorexic for 36 hours before undergoing surgery. It was shocked, hypothermic and collapsed. A pellet of hair was found obstructing the small intestine and was milked through to the colon. The rabbit died despite treatment with fluids, prokinetic therapy and analgesics. There is gas in the stomach, small intestine and ileocaecocolic complex. © 2013 British Small Animal Veterinary Association

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14.11 Paralytic ileus. This radiograph shows the lateral view of the abdomen of a rabbit that had been anorexic for 36 hours before undergoing surgery. It was shocked, hypothermic and collapsed. A pellet of hair was found obstructing the small intestine and was milked through to the colon. The rabbit died despite treatment with fluids, prokinetic therapy and analgesics. There is gas in the stomach, small intestine and ileocaecocolic complex.

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14.12

This rabbit had an inoperable obstruction in the duodenum. His stomach was tympanitic and the intestine was about to rupture at the site of the obstruction. The owner found him hiding in a corner when she returned from work. He had been eating well and behaving normally when she left for work 6 hours previously. © 2013 British Small Animal Veterinary Association

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14.12 This rabbit had an inoperable obstruction in the duodenum. His stomach was tympanitic and the intestine was about to rupture at the site of the obstruction. The owner found him hiding in a corner when she returned from work. He had been eating well and behaving normally when she left for work 6 hours previously.

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14.15

Mucoid enteropathy is a non-inflammatory condition that mainly affects the hindgut. The aetiology is not clear and dysautonomia has been confirmed in some outbreaks. The motility of the hindgut is affected so the caecum becomes impacted with hard dry ingesta (arrow) and the colon fills with mucus. Gastric dilation occurs in the late stages, as in this case. The ventrodorsal abdominal radiograph is of a 14-week-old rabbit that was one of number that had died at the same breeding establishment. © 2013 British Small Animal Veterinary Association

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14.15 Mucoid enteropathy is a non-inflammatory condition that mainly affects the hindgut. The aetiology is not clear and dysautonomia has been confirmed in some outbreaks. The motility of the hindgut is affected so the caecum becomes impacted with hard dry ingesta (arrow) and the colon fills with mucus. Gastric dilation occurs in the late stages, as in this case. The ventrodorsal abdominal radiograph is of a 14-week-old rabbit that was one of number that had died at the same breeding establishment.

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14.16

Engorgement. This lateral view of the abdomen was taken because an enlarged stomach was palpated during clinical examination of a rabbit presented for vaccination. The rabbit had just eaten a large bowl of dried food, which it did not normally have access to. She showed no other clinical abnormalities and was not ill. © 2013 British Small Animal Veterinary Association

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14.16 Engorgement. This lateral view of the abdomen was taken because an enlarged stomach was palpated during clinical examination of a rabbit presented for vaccination. The rabbit had just eaten a large bowl of dried food, which it did not normally have access to. She showed no other clinical abnormalities and was not ill.

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14.17

Aerophagia. This lateral view of the chest and abdomen shows hyperinflated lungs and a stomach full of gas. There is gas in the small intestine and rectum. The rabbit was presented for veterinary treatment because of a nasal foreign body, which was subsequently sneezed out. © 2013 British Small Animal Veterinary Association

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14.17 Aerophagia. This lateral view of the chest and abdomen shows hyperinflated lungs and a stomach full of gas. There is gas in the small intestine and rectum. The rabbit was presented for veterinary treatment because of a nasal foreign body, which was subsequently sneezed out.

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14.18

Duodenal obstruction. This image taken during post-mortem examination shows an inflamed, necrotic section of proximal duodenum containing a pellet of compacted hair (see Figure 14.19 ). The patient was a 6-year-old male neutered Rex house rabbit that was reluctant to eat at 11 pm the previous evening. By 6 am he was moribund and tympanitic. He died shortly after admission. © 2013 British Small Animal Veterinary Association

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14.18 Duodenal obstruction. This image taken during post-mortem examination shows an inflamed, necrotic section of proximal duodenum containing a pellet of compacted hair (see Figure 14.19 ). The patient was a 6-year-old male neutered Rex house rabbit that was reluctant to eat at 11 pm the previous evening. By 6 am he was moribund and tympanitic. He died shortly after admission.

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14.19

Typical pellet of hair that obstructs the small intestine. (a) The hard pellet that was obstructing the duodenum of the rabbit shown in Figure 14.18 . (b) The same pellet after it was washed, dried and teased out. © 2013 British Small Animal Veterinary Association

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14.19 Typical pellet of hair that obstructs the small intestine. (a) The hard pellet that was obstructing the duodenum of the rabbit shown in Figure 14.18 . (b) The same pellet after it was washed, dried and teased out.

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14.20

Strangulated herniated section of intestine. A lateral view of the abdomen of a rabbit that was presented ill 36 hours after castration. A section of small intestine had herniated through the inguinal canal and strangulated (arrow). The stomach was dilated and filled with gas and fluid. © 2013 British Small Animal Veterinary Association

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14.20 Strangulated herniated section of intestine. A lateral view of the abdomen of a rabbit that was presented ill 36 hours after castration. A section of small intestine had herniated through the inguinal canal and strangulated (arrow). The stomach was dilated and filled with gas and fluid.

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Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.

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Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.

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