Specialist: Dr Adam Mugford BVetMed MVetMed DACVECC MRCVS, Board-Certified Emergency and Critical Care Specialist
A 2 year old male boxer, Sid presented with an 11 hour history of acute weakness and failing to respond to initial fluid therapy. An abdominal radiograph and ultrasound confirmed the presence of a mesenteric torsion, and rapid emergency surgical intervention with advanced anaesthetic monitoring allowed removal of nearly 90% of the jejunum.
Postoperatively, as might be expected with such a severe injury, Sid developed SIRS. His albumin decreased rapidly to 3 g/l and led to peripheral oedema and severe hypotension, which was unresponsive to colloid therapy. This was corrected with rapid administration of 20% human serum albumin.
Further therapy included a packed red blood cell and plasma transfusion, early enteral nutrition via naso-oesophageal tube feeding and a continuous rate infusion of metoclopramide for ileus. Continuous electrocardiography allowed management of cardiac dysrhythmias and ischaemic reperfusion injury post operatively. Analgesia was provided by individually-titrated fentanyl, ketamine and lidocaine infusions and renal assessment was aided by urine output monitoring via an indwelling urinary catheter placement.
After 8 days Sid was successfully discharged. He is maintaining stable body weight with ongoing advice provided to his partner clinic for short bowel syndrome (hyper-acidity, hypocobalaminaemia and malabsorptive disease). With rapid diagnosis and specialist care survival rates can approach 50%, but rarely with such extensive resection and post-operative critical illness.