Jejuno-Jejunal Intussusception Due to Jejunal Mass

Patient Information:

Age: 8 years
Gender: Spayed Female
Breed: Golden Doodle
Species: Canine

History:

Presented with a two week history of vomiting and regurgitation. Laboratory work is within normal limits.

Ultrasonographic Findings:

There is a jejuno-jejunal intussusception noted in the left cranial abdomen in the mid-jejunum. Blood flow to entrapped mesenteric fat is adequate. There is a hypoechoic mucosal vascular mass with punctate hyperechoic shadowing foci noted at the aboral end of the intussusception measuring 1.5x1.9cm. The rest of the small intestinal loops have normal bowel layering, thickness, and motility. (Duodenum-5.8mm; Jejunum-4.5mm; Ileum-3.9mm). Minimal luminal dilatation is present orad to the intussusception.

Origin of jejuno-jejunal intussusception.

Intussusception in transverse showing normal blood flow to entrapped mesentery.

Jejunal Mass present at the termination of the intussusception

Still image of jejunal mass showing position color uptake on Doppler exam.

Abdominal Ultrasound Interpretation:

Jejuno-jejunal intussusception-the findings are moderate to severe.

Jejunal Mass - the findings are moderate: DDx: adenocarcinoma vs. infiltrative neoplasia (lymphosarcoma vs. mast cell tumor) vs. leiomyosarcoma vs. leiomyoma.

Recommendations:

The prognosis was guarded since the type and behavior of mass was yet to be determined. 3 view thoracic radiographs and resection and anastomosis with histopathology of mass was recommended for optimal treatment plan.

Outcome:

Unfortunately due to guarded prognosis and financial constraints, euthanasia was elected.

Discussion:

Intussusceptions are common in younger animals with 75% present in dogs <1 year of age. Any condition that causes increased motility can predispose. They are often the result of parasitism or enteritis (e.g. parvo virus), but can also be caused by foreign bodies and intestinal neoplasia. Idiopathic cases are also possible. Clinical signs can be acute or chronic and often include vomiting, diarrhea, and weight loss. The most common type of intussusception is enterocolic which accounts for ⅔’s of cases. While radiographs can often increase suspicion of intussusception, ultrasound is the diagnostic modality of choice. Surgical reduction is usually necessary with resection and anastomosis if bowel is found to be compromised. This procedure often carries a good prognosis, provided surgical complications do not occur. In this case, hypermotility was caused by the presence of a luminal jejunal mass likely causing a partial obstruction. This accounts for the unusual location of the intussusception (jejuno-jejunal).

Sonographer: Kara Woody, DVM

Thank you to Shirlington Animal Hospital for collaborating with us on this interesting case.