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Wiener Tierärztliche Monatsschrift – Veterinary Medicine Austria 102 (2015)

From the Department of Small Animal Surgery1 and the Department of Veterinary Pathology2, Justus-Liebig-
University, Giessen, Germany

Gastrointestinal intussusception in the Maine Coon:


A review of 19 cases
J. VERSCHOOF1*, C. THIEL1, M. HENRICH2 and M. KRAMER1

received April 14, 2014


accepted August 30, 2014

Keywords: cat, small intestines, Schlüsselwörter: Katze, Dünn-


intestinal disease. darm, Darmerkrankung.

Summary Zusammenfassung
To date there have been no claims Darminvagination bei der Die Diagnose wurde bei 90% (17/19)
of a breed predilection for intus- Maine Coon: Eine Übersicht der Maine Coons sonographisch
susception in Maine Coon cats. über 19 Fälle gestellt. Eine Enterektomie und
The medical records of 19 Maine Omentopexie erfolgten bei 88%
Coons with gastrointestinal tract in- Einleitung (15/17), bei 12% (2/17) war eine
tussusception diagnosed between Darminvaginationen werden manuelle Reduktion der Invagina-
2000 and 2012 were reviewed to häufig bei der Europäischen Kurz- tion erfolgreich. Das Jejunum war
determine history, physical exami- haarkatze beschrieben. Eine Ras- mit 84% (16/19) am häufigsten be-
nation, diagnostic imaging, surgery seprädisposition der Maine Coon troffen. Die Überlebensrate lag bei
and outcome and to compare the für diese Erkrankung wurde bisher 74% (14/19). Drei Katzen wurden in-
histology with the aim of identify- nicht untersucht. traoperativ euthanasiert und zwei
ing possible predisposing factors. Katzen wurden aufgrund postope-
Intussusception was diagnosed in Material und Methoden rativer Komplikationen (septische
25 cats, of which 76% (19/25) re- Im Zeitraum 2000–2012 wurden Peritonitis, Aspirationspneumonie)
presented Maine Coons and were 19 Maine Coons mit Darminvagi- euthanasiert. Eine histologische Un-
further analyzed. The median age nation untersucht. Retrospektiv tersuchung erfolgte bei 68% (13/19)
of the affected Maine Coons was wurden die Angaben aus Anam- der Maine Coons, jedoch ohne Hin-
one year (range three months – nese, bildgebender Diagnostik und weise auf eine mögliche Ursache.
five years) with 74% (14/19) being chirurgischer Therapie sowie vor- Bereits bestehende ursächliche Er-
younger than two years. Clinical liegende histologische Befunde krankungen konnten ebenfalls bei
and physical findings were similar untersucht, um mögliche prädispo- keiner der betroffenen Katzen nach-
to those of previous studies in cats nierende Faktoren zu identifizieren. gewiesen werden. Bei sechs Katzen
with intussusception. The median wurde anamnestisch eine chroni-
duration of clinical signs was two Ergebnisse sche Magen-Darmerkrankung ver-
days (range 1–21 days). Diagnosis Bei insgesamt 25 Katzen wurde mutet und drei Katzen erkrankten
was made ultrasonographically in eine Invagination diagnostiziert. post partum.
90% (17/19) of the cases, including Hiervon waren 76% (19/25) Maine
those following surgery. Enterecto- Coons. Das mediane Alter der Maine Schlussfolgerungen
my and omentopexy were perfor- Coons lag bei einem Jahr (drei Mo- Die vorliegende Untersuchung
med in 88% (15/17); in two cases naten bis fünf Jahren), hiervon beschreibt ein vermehrtes Auftre-
(12%, 2/17) manual reduction was waren 74% (14/19) jünger als zwei ten von Darminvaginationen bei
successful. Entero-enteric intus- Jahre. Die Befunde aus Anamnese der Maine Coon. Eine Ursache
susception was most commonly und klinischer Untersuchung waren konnte nicht festgestellt werden.
localized within the jejunum (84%; vergleichbar mit den Befunden vor- Weitere Untersuchungen sind er-
16/19). The long-term survival rate heriger Untersuchungen. Die medi- forderlich, um eine mögliche Ras-
was 74% (14/19), with no signs of ane Dauer der klinischen Sympto- seprädisposition für diese Erkran-
recurrence on follow-up. Three cats matik betrug zwei Tage (1–21Tage). kung zu verifizieren.

*E-Mail: joyce@verschoof.de

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Wiener Tierärztliche Monatsschrift – Veterinary Medicine Austria 102 (2015)

were euthanized during surgery and two cats were eu- chronic gastro-intestinal tract disease and three cats
thanized because of post-surgery complications (septic were post-parturient queens. The results indicate that
peritonitis due to foreign-body perforation; aspiration Maine Coons have a high susceptibility for gastrointes-
pneumonia). Histology was evident for 68% (13/19) of tinal intussusception. No predisposing factors could
the Maine Coons. Histological examination revealed be identified. Further research is necessary to verify a
no underlying cause. No previously managed diseases possible breed predilection for the disease.
were obvious but six cases were suspected to have

Introduction
Gastrointestinal tract intussusception in dogs has Siamese and Burmese (KAVANAGH, 1981; LEVITT and
been well characterized in the literature (LEVITT and BAUER, 1992; BELLENGER and BECK, 1994; CULVENOR,
BAUER, 1992; OAKES et al., 1994; RALLIS et al., 2000; 1997). Only one case series noticed a majority of affected
APPLEWITHE et al., 2001) but there is less informa- cats to be Maine Coons (THIEL et al., 2008).
tion concerning cats (LEVITT and BAUER, 1992; This retrospective study aimed to analyse possible
BELLENGER and BECK, 1994). Three larger case predisposing factors leading to gastro-intestinal intus-
series have been published, relating to twelve cats susception in the Maine Coon and to identify breed-
(BELLENGER and BECK, 1994), 13 cats (THIEL et al., related histological findings.
2008) and 20 cats (BURKITT et al., 2009), but most
publications about intussusception in cats have been Materials and Methods
individual case reports (DEMETRIOU et al., 1999;
MARTINEZ et al., 2001; OWEN et al., 2005; SCHWANDT, A review was conducted of the medical records and histologi-
cal results of Maine Coons examined at the Veterinary Clinic of the
2008). Risk factors that predispose to intussusception Justus-Liebig University Giessen (Germany), Small Animal Surge-
have been described for dogs and may be applicable ry, identified with gastrointestinal intussusception between Janu-
to cats. The disease has been associated with intestinal ary 2000 and December 2012. Maine Coons were included in the
study when historical information was available and a diagnosis of
parasitic infestation, alimentary foreign bodies, viral-
gastrointestinal tract intussusception was confirmed at surgery.
induced enteritis, intestinal masses and prior surgery Medical records of the affected Maine Coons were reviewed
(OAKES et al., 1994; DEMETRIOU et al., 1999; RALLIS with regard to history, physical examination, diagnostic imaging,
et al., 2000; APPLEWITHE et al., 2001). However, as in surgery, histological findings and outcome. Historical information
included duration and type of clinical signs and previously treated
dogs, most cases of gastrointestinal intussusception diseases. Findings on physical examination included body condi-
in cats appear to be idiopathic (WILSON and BURT, tion, hydration status and vital signs as well as special findings on
1974; LEVITT and BAUER, 1992; THIEL et al., 2008). A abdominal palpation. Abdominal radiographs were taken in lateral
coincidence with puerperium as described in women and dorsal recumbency. If performed, abdominal ultrasonography
included examination of all intra-abdominal organs. All diagnostic
has been reported. Hormonal changes in the postpartum images were examined by a board-certified radiologist. Intussus-
period may predispose to intussusception (DOHERTY ception was diagnosed on a transverse ultrasonographic section
et al., 2000). when a target-like mass was observed that consisted of outer hy-
Histological examination of tissue samples of ani- perechoic and inner hypoechoic concentric rings around a circular
hyperechoic centre (Fig. 2).
mals with intussusception is prudent and may help In all cats that underwent surgery, a ventral midline laparotomy
in identifying the underlying cause of the disease, al- was performed with routine examination of the gastrointestinal tract
though the procedure is not commonly reported in and abdominal viscera. The anatomic localization and the length
the veterinary literature. Only few reviews have inves- of the intussusception were recorded. The method of correction
included manual reduction and/or enterectomy with omentopexy or
tigated the value of histopathologic examination in enteroplication. Monofilamentous resorbable sutures, employed in
identifying possible underlying causes of the disease a simple interrupted pattern, were used for the enterectomy. When
(SCHWANDT, 2008; BURKITT et al., 2009; LEVIEN and the intestinal suture was additionally secured via omentopexy, the
omentum majus was pulled around the intestine and fixated with a
BAINES, 2011). BURKITT et al. (2009) noticed a bimodal
simple suture. For both omentopexy and enteroplication, monofi-
age distribution: gastrointestinal tract intussusception lamentous suture material was also used. If present, other atypical
appeared to be associated with gastrointestinal lym- abdominal findings were recorded and examined. Abdominal closure
phoma and inflammatory bowel disease in older cats was performed routinely. Pathological examinations of the intus-
suscepted regions or biopsies of surgically obtained lymph nodes
(≥6 years), whereas in younger cats (<1 year) idiopathic were evaluated for possible underlying diseases. After discharge
intussusception was obvious. In addition, underlying of the cats, the owners were contacted by telephone to follow up
neoplasia was more often histologically evident in cats on recurrence of intussusception.
than in dogs (LEVIEN and BAINES, 2011). This study also
suggested an improvement in identifying the underlying Results
cause by submission of additional biopsies. Multiple
biopsies have been shown to maximize the sensitivity Between 2000 and 2012, 25 cats were presented at
of histopathology (WILLARD et al., 2008; WASHABAU our clinic with gastrointestinal intussusception, with
et al., 2010). Most cats in previous reports were domestic 76% (19/25) representing Maine Coons. In total, 2.2%
shorthairs: a breed predilection has been described for (276/12,545) of the cats presented during this time

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Wiener Tierärztliche Monatsschrift – Veterinary Medicine Austria 102 (2015)

were Maine Coons. Medical records for the 19 Maine the abdominal changes were not distinguishable from
Coons with gastrointestinal intussusception met the those caused by gastroenteritis or ileus due to other
criteria for inclusion in the study. Five Maine Coons causes. In none of the cases was contrast radiography
were sexually intact males, seven were neutered males, performed. Additional sonographic examination was
six were sexually intact females and one was a spayed performed on 90% (17/19) of the cats. A definitive diag-
female. The median age was one year (range: three nosis of intestinal intussusception was obtained ultraso-
months – five years). Fourteen (74%) of the 19 Maine nographically in all 17 cats. Further sonographic findings
Coons were younger than two years. included mesenteric lymph node hypertrophy (n=6), a
Historical information was available for all Maine gastric foreign body with signs of gastric perforation
Coons. The median duration of clinical signs was two and peritonitis (n=1) and mild ascites with generalized
days (range: 1–21 days). Acute onset of clinical signs lymph node hypertrophy and peritonitis (n=1), which was
was observed in 13 cats (1–2 days) and six cats had diagnosed as FIP (feline infectious peritonitis).
clinical signs in more than seven days (7–21 days). The A complete blood analysis was available in 47%
most common clinical symptoms were vomiting (n=11), (9/19) of the cases. Findings included general
depression (n=9), anorexia (n=7), weight loss (n=4) non-specific signs of mild inflammation with leu-
and diarrhoea (n=3). Dehydration (n=7), poor body kocytosis (n=5) and neutrophilia (n=5), decreased
condition (n=7) and fever (n=1) were found on physical electrolytes (potassium, chloride) (n=9), mild decrease
examination. All cats that showed clinical signs for of triglycerides and cholesterol (n=4) and mildly to
more than seven days had had chronic medical con- moderately increased urea (n=8).
ditions pretreated by the local veterinarian. Four cats Intussusception occurred in 84% (16/19) of the
were treated with antibiotics (amoxicillin-clavulanic cases within the jejunum (Fig. 3). Duodeno-colonic
acid (n=3), enrofloxacin (n=1)) and antiemetics (meto- intussusception was found in one cat and jejuno-colic
clopramide) because of vomiting. One cat was treated intussusception in two animals (Fig. 4). The length of
for food intolerance (with Royal
Canin® Sensitivity Control diet) and
one showed signs of dysphagia.
This latter cat was subsequently
diagnosed with FORL (feline
odontoclastic resorptive lesions).
Three cats had been lactating on
clinical presentation for a median
of five weeks (range 4–5 weeks).
Information on vaccination and
deworming status was available
for 14 cats, nine of which were
regularly dewormed and eleven of
which were vaccinated, with 82%
(9/11) vaccinated and dewormed.
No faecal examination was per-
formed at our clinic.
Information on clinical findings of
abdominal palpation was available
for 15 cats. In 87% (13/15) of them,
an intra-abdominal mass was pal-
pable, located in the medial-cranial
(n=9) and medial-caudal (n=4) part
of the abdomen.
Abdominal radiographs in dorsal
and lateral recumbency were taken
in 79% (15/19) of the cases. Radio-
logical signs of intestinal luminal
obstruction were identified, such
as multiple loops of various diame-
ters of gas-dilated and fluid-filled
small intestine. Depending on Fig. 1a,b: Lateral and ventrodorsal projection of the abdomen of an one year old Maine
the severity of obstruction, the Coon; gas and fluid filled intestinal loops of various diameters showing a mild gravel sign./
Laterolaterale und ventrodorsale Röntgenaufnahme des Abdomens einer einjährigen Maine
bowel appeared turgid with sharp Coon; die Dünndarmschlingen stellen sich teilweise gas- und flüssigkeitsgefüllt dar in un-
loops (Fig. 1). The radiographs of terschiedlicher Ausprägung mit teilweise fein granuliertem Inhalt.

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Wiener Tierärztliche Monatsschrift – Veterinary Medicine Austria 102 (2015)

Enteroplication was performed in


one of these cats.
Five of the 19 cats in the study
(26%) did not survive. Three cats
were euthanized during surgery
because of non-reducible duo-
deno-colonic intussusceptions,
cardiac arrest during anaesthesia
and FIP. Two cats were euthanized
because of complications post-
surgery; the complications inclu-
ded aspiration pneumonia and
septic peritonitis after additional
gastric foreign body perforation.
One cat treated with enterectomy
developed ascites four days after
surgery, which was cytologically
confirmed as septic. Follow-up
Fig. 2: Transverse sonographic section of the jejunum of an one year old Maine Coon; laparotomy revealed intestinal
representing the typical target like mass consisting of hyper- and hypoechoic concentric necrosis contiguous with anas-
rings around a hyperechoic center and a part of small intestine./Sonographie des Abdo-
mens; Transversalschnitt des Jejunums einer einjährigen Maine Coon mit einem zwiebel- tomosis (Fig. 6). After a second
schalenartigen Aufbau, hyper- und hypoechogenen konzentrische Ringe (mehr als fünf enterectomy, no further compli-
Darmschichten) und einem hyperechogenen Zentrum. cations occurred.
No recurrence of intussuscepti-
the intussuscepiens ranged from 2 to 20 cm (median on was apparent in any of the cases during a follow-up
10 cm). A total of 79% (15/19) of intussusceptions were period of at least one year.
managed surgically with enterectomy including omen- Histological examination of the resected intestinal
topexy. Surgical resection was deemed necessary due segment was performed in 68% (13/19) of the cats
to questionable viability after manual reduction (n=3), treated. In 77%, (10/13) histology revealed signs of
failure of manual reduction or severe serosal adhesions inflammatory intestinal wall changes secondary to
and/or intestinal wall defects (n=12) (Fig. 5). In 11% (2/19) intestinal intussusception within the invaginated parts
of the cats, intestinal intussusception was successfully (Fig. 7). No underlying diseases responsible for intesti-
reduced manually and intestinal biopsies of the intussu- nal intussusception could be identified in the samples
scepted region were taken for histological examination. (Tab. 1) and no signs of neoplasia were detected. Of
the other three cats, one showed
muscular thickening with hyper-
trophy of the lamina muscularis,
one had a septic peritonitis and
one had FIP.

Discussion
According to previous reports,
Burmese and Siamese are the cat
breeds most susceptible to gas-
trointestinal tract intussusception
(KAVANAGH, 1981; LEVITT and
BAUER, 1992; BELLENGER and
BECK, 1994; CULVENOR, 1997),
although some reports did not
identify any breed predisposition
(BURKITT et al., 2009). In the present
study, 75% of the cats diagnosed with
gastrointestinal tract intussusception
in 2000–2012 were Maine Coons. In
Fig. 3: Jejuno-jejunal intussusception; the oral part of the jejunum is dilated with mild se- the overall population of cats treated
rosal bleedings and discolouration of the intussusceptum./Invagination des Jejunums; oral
der Invagination stellt sich das Jejunum dilatiert dar, die Serosa weist Blutungen auf und in our hospital during that time, Maine
das Intussuszeptum ist dunkel verfärbt. Coons represented only 2.2%.

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Wiener Tierärztliche Monatsschrift – Veterinary Medicine Austria 102 (2015)

Results concerning age, sex


and clinical findings were compa-
rable to those of others (LEVITT
and BAUER, 1992; BELLENGER
and BECK, 1994; PATSIKAS et al.,
2003; BURKITT et al., 2009). As with
dogs, young cats were most com-
monly affected (73%). Because no
underlying disease was identified
in most cases, either historically
or histologically, intussusception
in young animals appears to be
primarily idiopathic (TANGNER,
1982). A possible genetic predis-
position to intussusception in the
Maine Coon is unknown.
In human medicine, intussuscep-
tion is also primarily a disease of
infants, commonly in those aged
3–9 months. Also largely idiopa-
thic in nature, intussusceptions
Fig. 4: Inoperable intussusception of the distal duodenal part into the colon, which was
in 2%–12% of children older than impossible to reduce manually because of severe serosal tears and intestinal haemorrhagic
two years are known to have a pre- infarction./Große inoperable Invagination des distalen Anteils des Duodenums in das Kolon;
disposing pathological formation. ein manuelles Ausmassieren war auf Grund von Einrissen der Serosa und hämorrhagischer
Infarzierung nicht möglich.
After infancy, there is an increased
likelihood that a pathological lead
point (Meckel’s diverticulum, polyp and lymphoma) is (BURKITT et al., 2009). No association with previous
the cause of intussusceptions (PFÜNDER et al., 1999; systemic disease or recent extra- or intra-abdominal
GFÖRER et al., 2009). These findings are comparable to surgery appeared in the present study. One cat had an
those of BURKITT et al. (2009), who found a bimodal age additional gastric foreign body and three cats were
distribution with more specific diagnoses in older cats. post-parturient queens. The latter status has previously
The presenting signs of cats and dogs with intus- been suggested as a possible predisposing factor
susception are commonly non-specific and may be (DOHERTY et al., 2000; BURKITT et al., 2009).
consistent with acute abdominal conditions (LEVITT In infants, intussusception is frequently preceded by
and BAUER, 1992; APPLEWITHE et al., 2001). The viral gastroenteritis (GFÖRER et al., 2009). A strong
majority of cases in the present study had a history association between an oral rotavirus vaccine and
of vomiting (n=11) followed by de-
pression (n=9); however, both sym-
ptoms could be the cause or the
result of the disease. Most (n=13)
of the affected cats showed acute
onset of clinical symptoms. All cats
(n=6) with chronic signs of intestinal
disease were already being trea-
ted symptomatically, although no
primary underlying gastrointestinal
tract disease had been diagnosed.
Development of intussusception
in cats due to severe gastrointes-
tinal tract disease or diseases of
non-gastrointestinal origin is con-
sistent with information on dogs
with intussusception (LEVITT and
BAUER, 1992; APPLEWITHE et
al., 2001). Older cats may suffer
more often from chronic diseases
Fig. 5: Jejuno-jejunal intussusception with prominent serosal tears, discolouration and
such as inflammatory bowel dis- exposure of the muscular layer./Jejunale Invagination mit Einrissen der Serosa und Aus-
ease or gastrointestinal neoplasia stülpung der Muskularis sowie deutlicher Verfärbung des Darms.

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Wiener Tierärztliche Monatsschrift – Veterinary Medicine Austria 102 (2015)

Tab. 1: Histologic diagnoses of 13 cats diagnosed with intestinal intussusception and surgical findings/Histologische Diagnose sowie
intraoperative Befunde von 13 Katzen mit Darminvagination

Number of
Histologic diagnoses Surgical findings
affected cats

• fibrino-purulent transmural • jejunal intussusception 10


inflammation and peritonitis • no underlying cause
• mucosal ulceration with infiltration
of mononuclear cells
• granulation tissue
• microclots, fibrin clots
• venous infarction

• chronic active purulent inflammation • jejunal intussusception 1


with peritonitis • gastric perforating foreign body
• mucosal infiltration with lymphocytes, • septic peritonitis
plasma cells and neutrophiles
• plant material

• muscular hypertrophy of the intestinal • jejunal intussusception manual reduced 1


lamina muscularis • no underlying cause
• follicular hyperplasia of mesenteric
lymphnode

• granulomatous and necrotizing • No surgical intervention due to FIP 1


lymphadenitis of mesenteric lymphnode
• multifocal granulomatous peritonitis

intussusceptions in otherwise healthy infants has intussusception, consistent with the report of BURKITT
been suspected to be the cause of a significant in- et al. (2009). The decision to perform an enterectomy was
crease in the disease 3–14 days after vaccination based on the surgeon’s overall evaluation of intestinal
(MURPHY et al., 2001). Viral-induced enteritis has also viability. Failure to achieve complete manual reduction
been reported as a possible cause in dogs (RALLIS or the presence of severe serosal adhesions and/or
et al., 2000; EVERMANN et al., 2005). The retrospec- intestinal wall defects led to intestinal resection. As de-
tive character of this study meant that information on scribed by LEVITT and BAUER (1992), serosal adhesions
recent vaccinations or possible related gastrointestinal reflected the consequences of vascular compromise
symptoms was not consistently present. of the intussusceptum and were independent of the
On clinical evaluation, signs of dehydration were re- duration of clinical signs. In two cats, manual reduction
lated to vomiting. Fever on presentation in one cat was only was successful, although there was no information
consistent with septic peritonitis, which was not related on long-term follow-up for more than two years.
to intussusception but to a gastric perforation with a In human medicine, sonography is used to estima-
foreign body. Findings on abdominal palpation were te the severity of intussusceptions in children when
similar to those of others (THIEL et al., 2008; BURKITT deciding between primary conservative treatment
et al., 2009) and may represent a useful diagnostic aid (ultrasound-guided gas or liquid-contrast enema) or a
(BELLENGER and BECK, 1994). surgical approach (DANEMAN and NAVARRO, 2004).
With regard to diagnostic imaging, radiography was In veterinary medicine, a surgical approach through a
useful for identifying signs of intestinal obstruction. midline laparotomy remains the only possible treatment
However, consistent with other reports, we found in deciding between manual reduction and surgical re-
that abdominal sonography provides a more specific section. As PATSIKAS et al. (2003) only examined non-
diagnosis of intussusception (LEVITT and BAUER, reducible intussusceptions, there are little clinical data
1992; PATSIKAS et al., 2003; BURKITT et al., 2009). to compare sonographic information and the reducibility
The ultrasonic pathognomonic appearance of intus- of intussusception in cats. In the aforementioned study,
susception in dogs and cats has been well described non-reducible intussusceptions in cats were found to
(PATSIKAS et al., 2003) and is readily transferable to have multiple hyperechoic and hypoechoic concentric
the present study. rings. However, in 15 young dogs with intussusception,
Surgical management involved enterectomy in color doppler ultrasonography was found to repre-
84% of the cats, with most having an entero-enteric sent a useful method for predicting the reducibility of

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Wiener Tierärztliche Monatsschrift – Veterinary Medicine Austria 102 (2015)

intussusception in dogs (PATSIKAS


et al., 2005). Nevertheless, there
are no evidenced-based measure-
ments of the hyperechoic and hy-
poechoic concentric sonographic
rings to determine the reducibility
and prognosis of intussusception
in cats.
Comparable to the figures in
other reports, 74% of the affec-
ted Maine Coons survived treat-
ment (LEVITT and BAUER, 1992;
BELLENGER and BECK, 1994;
THIEL et al., 2008; BURKITT et
al., 2009). Information on recur-
rence of intussusception in cats
varies (LEVITT and BAUER, 1992;
BELLENGER and BECK, 1994;
THIEL et al. 2008). As our case
series was retrospective, the recur-
rence rate was difficult to assess;
Fig. 6: Intestinal necrosis directly next to the original enterectomy suture as a complication
however, over a follow-up period four days after surgery of jejuno-jejunal intussusception./Post-operative Komplikation im
of at least one year, no recurrence Sinne einer Leckage vier Tage nach Enterektomie auf Grund jejunaler Invagination; direkt
was reported and no further gas- neben der Darmnaht hat sich eine Darmwandnekrose entwickelt.
trointestinal clinical signs emerged.
Although surgical resection is assumed to lessen the was based on histology. Although there were some
incidence of recurrence more consistently than manual cats with previously obvious clinical signs of chronic
reduction, others report no significant difference in intestinal disease, no association could be identified.
recurrence rate when different surgical techniques Furthermore, intestinal clinical signs did not reoccur
are compared, including manual reduction (LEVITT on follow-up.
and BAUER, 1992). Recurrent intussusception in in- In contrast to the case in the study of LEVIEN and
fants occurs in 10% of conservatively treated patients BAINES (2011), histological evaluation in our study
(GFÖRER et al., 2009). The efficacy of enteroplication was available only for the resected intussusceptum.
in cats in preventing recurrence remains unclear. No further biopsies from the gastrointestinal tract had
The procedure is reported to be unnecessary due to been taken. Multiple biopsies have proven superior to
intussusceptions`s low recurrence
rate after surgical treatment (THIEL
et al., 2008). Nevertheless, some
studies describe an association
between enteroplication and the
development of ileus after sur-
gery (APPLEWITHE et al., 2001;
BURKITT et al., 2009). In our clinic,
it is not mandatory to perform intes-
tinal enteroplication due to the risk
of post-surgical complications (e.g.
the recurrence of intussusception).
Others describe low recurrence
rates after performing enteropli-
cations on a regular basis (OAKES
et al., 1994; NASH et al., 1998;
WINKELS and WIESNER, 2010).
Histological results revealed
no underlying disease and no
underlying diseases found on Fig. 7: Histology of a jejuno-jejunal intussusception showing from right to left the intus-
historical examination could exp- suscipiens with outward directed serosal surface and mucosa facing the mucosal surface
of the outer part of the intussuceptum./Der histologischer Schnitt einer Invagination zeigt
lain intussusception. A finding of im Bild von rechts nach links das Intussuszipiens mit nach außen gestülpter Serosa und
intussusception of idiopathic origin Mukosa mit direktem Kontakt zur Mukosa des Intussuszeptums.

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Wiener Tierärztliche Monatsschrift – Veterinary Medicine Austria 102 (2015)

single biopsy specimens in maximizing the sensitivity performed, which represents a limitation of the present
of histopathology (EVANS et al., 2006; WASHABAU study. As reported by BURKITT et al. (2009), no gross
et al., 2010). LEVIEN and BAINES (2011) recognized or histological evidence of infection was discovered in
an improvement in diagnosing intestinal diseases any of the 13 Maine Coons.
by submitting additional biopsy samples, although
the population of cats in their study differed from Conclusion
the Maine Coons in the present study with respect
to age and underlying disease. Whether additional Of the affected cats, 76% with intestinal intussuscep-
intestinal biopsies would have changed the histolo- tion were Maine Coons and 74% were young. The re-
gical outcome (i.e. the diagnosis of intussusception sults suggest that young Maine Coons are predisposed
of idiopathic origin) remains unclear. Further studies to gastrointestinal tract intussusception. Histologically,
of the efficacy of multiple biopsy samples in young no signs of an underlying disease could be identified.
cats with intussusception are required to achieve an Intussusception remained idiopathic in young Maine
improvement in histopathological diagnosis. In parti- Coons. Whether additional biopsies of affected Main
cular, when treating cases of inflammatory intestinal Coons would improve the sensitivity of histopathology
diseases, additional biopsies are warranted (LEVIEN is yet to be investigated. Further statistical evidence
and BAINES, 2011). is needed to prove a breed predilection for intestinal
Histopathological diagnosis revealed FIP in one intussusception in the Maine Coon.
case. A second cat had septic peritonitis because of a
perforating gastric foreign body. Whether intussuscep-
tion in this case was secondary to the foreign body is Fazit für die Praxis:
unclear but it has been described to have a role in the Die vorliegende Untersuchung beschreibt ein ver-
aetiology of intestinal intussusceptions (PAPAZOGLOU mehrtes Auftreten von Darminvaginationen bei jungen
et al., 2003). Based on histology, another cat showed Katzen der Rasse Maine Coon. Eine gemeinsame
muscular thickening but no underlying cause could be Ursache konnte nicht festgestellt und eine Rasse-
identified. Enteritis secondary to a parasitic infection disposition statistisch nicht verifiziert werden; trotz-
may have been an underlying cause, as described dem scheint es ratsam, besonders bei jungen Main
in young dogs (LEVITT and BAUER, 1992; BURKITT Coons mit gastrointestinalen Symptomen frühzeitig
et al., 2009). However, faecal examination was not eine mögliche Darminvagination abzuklären.

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