Derotation of Intestines in Dogs

Intestinal rotation is a rare but extremely dangerous condition for dogs. When the membranes that attach the intestines to the abdomen separate, portions of the large or small intestines can flip and become completely obstructed. This blockage is life threatening, as neither digestive contents nor blood flow can pass the obstruction. This occurrence will become obvious as the dog will likely begin to vomit fluids, have yellow diarrhea and be very listless. 

Derotating the intestines is a fairly invasive surgical procedure only done in the event of an emergency as a last resort option. It should only be attempted by an ACVS board-certified veterinary surgeon. The intestines involved can twist either clockwise or counterclockwise and can rotate over 360°. The procedure must be performed as soon as possible because the intestinal tissues will begin to die almost immediately after torsion.

Derotating the intestines is something that is only done in an emergency setting. Pre-anesthetic blood work may be done along with an ultrasound to confirm the location of the torsion if the dog’s condition allows it. If surgery is attempted, a large incision is made into the abdomen. The surgeon may need to explore the cavity to assess the full extent of the damage. All affected portions of intestine will likely be very dark in color. 

A slow derotation paired with a resection and anastomosis of the damaged intestine portions will be needed. All darkened tissue will have to be removed as it has begun to die. After the intestines have been derotated and are reattached, they will need to be thoroughly flushed with water to lower the chance of infection. The abdomen will then be sealed shut with sutures or staples.

Partial torsions are generally more successfully corrected than full torsions. Early treatment is associated with much higher rates of survival. Even after a successful procedure, relapse is possible and even likely. If a resection can be performed without derotating the intestines, the overall outlook may improve, as dead tissue will not be released into the healthy sections of intestine. This can only be performed if a very small section has rotated. There is not yet enough research on the outcomes of these procedures for further recommendations. 

After the operation has been completed, the dog will need to be kept in hospital to receive aggressive supportive care including intravenous fluids. The dog will be closely monitored for any signs of shock or change in blood pressure. Broad spectrum antibiotics paired with saline or colloids will be administered via the IV to help stave off abdominal infection and sepsis. Even if the dog survives the initial recovery period, survival is not guaranteed. A follow-up appointment will be needed to assess how the dog is healing.

An uncomplicated abdominal surgery involving the derotation of the intestines can vary in cost from $2,500 to $6,000. One thing that influences the overall cost is whether the surgery has to be performed in an animal hospital, as emergency surgery tends to carry higher costs than veterinary clinic surgery. Any diagnostic imaging performed before or after the procedure will also affect the total price. Preventative surgeries, such as a gastropexy, can be performed in high-risk breeds and can cost as little as $500 to $1500.

Stomach and intestinal torsion results in death if not immediately treated. Surgeries to correct these issues carry many risks, but offer the chance of survival. Some risks associated with derotating the intestines include peritonitis, ischemic necrosis, short bowel syndrome and death. Short bowel syndrome results in the the intestinal contents spilling out into the abdominal cavity and causing sepsis. A resection of the intestines without derotation should be attempted if at all possible. In many situations, the dog is brought in for treatment too late and euthanization is the only option.

The dogs at most risk of developing intestinal torsion are generally young males who are larger in size. Brachycephalic dog breeds with shortened snouts are at a higher risk of needing this surgery, along with large, deep chested dog breeds. Dogs should not be allowed to chew on sticks, stones or other inedible material. Slow eating should be encouraged and running before or after meals should be prevented. Opting for a preventative surgery in high risk breeds may be the best way to avoid an emergency torsion scenario. Dogs who have reported instances of torsion within their family should be watched with extra caution.