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- Should we ultrasound GI surgery post op routinely?
Paul Rafael, Carole Soulé, Paul Sériot, et al.
Objective:
To evaluate the feasibility and reliability of early ultrasound for diagnosing postoperative intestinal dehiscence in dogs and cats, identify the most reliable ultrasound criteria, and assess its impact on survival and hospitalization.
Key Points:
Animals Studied:
114 cases: 31 cats and 83 dogs undergoing enterotomy or enterectomy.
Methods:
Retrospective study.
-Postoperative ultrasound screenings performed between 48 and 96 hours after surgery.
-Ultrasound findings (e.g., wall discontinuity, gas bubbles, local effusion) were analyzed.
Results:
-Dehiscence cases: Suspected in 7 of 83 dogs and confirmed in 6 via revision surgery.
-No dehiscence was suspected in cats.
-The most significant ultrasound findings associated with dehiscence:
-Direct wall discontinuity (100% sensitivity and specificity).
-Gas bubbles and local effusion at the surgical site.
-Survival rate after revision surgery: 83% (5 of 6 dogs survived).
-Overall survival rate: 99.1% for all cases.
-Risk Factor Identified: Preoperative hypoalbuminemia significantly increased dehiscence risk.
Clinical Relevance:
-Early ultrasound screening between 48–96 hours allows for sensitive and early detection of dehiscence.
-Early detection and intervention improve survival rates compared to septic peritonitis.
-Routine ultrasound screening may be particularly beneficial for high-risk patients, such as those with hypoalbuminemia or undergoing enterectomy.
Conclusion:
Systematic postoperative ultrasound is a reliable and feasible method for early detection of intestinal dehiscence, leading to improved survival rates and shorter hospitalization durations when revision surgery is promptly performed.
Figure 2—Imaging features seen in patients classified as dehiscent. A—Ultrasonographic image of the area adjacent to an enterotomy site with suspected dehiscence 72 hours postoperatively in a 1-year-old female crossbreed dog. Marked steatitis (arrowheads) is noted in the surrounding
fat with loculated hypoechoic fluid containing gas bubbles (black arrow) at the level of the enterotomy site (white ar- row). The latter is more conspicuous in panel B. EPIQ, highfrequency linear transducer. B—Ultrasonographic image of the same dog as panel A at the level of an enterotomy site with suspected dehiscence 72 hours postoperatively. The tract of the incision site is enlarged, and gas bubbles are visible inside (white arrows). Marked steatitis (arrowheads) in the surrounding fat with loculated hypoechoic fluid (black arrow) is still visible. Further controls had shown an amelioration of these findings, and a conservative treatment was decided with good outcomes. EPIQ, high frequency linear
transducer. C—Transverse ultrasonographic image of an enterotomy site with evidence of dehiscence 72 hours postoperatively in a 2-year-old female Akita Inu. The tract of the incision site is discretely enlarged, and material with features similar to digestive content is visible inside, extend- ing into the adjacent tissue (arrowhead), indicating a direct observation of wall discontinuity. At this level, this material is surrounded by a hypo- to anechoic area probably representing inflammatory tissue and fluid. Moderate steatitis is visible in the surrounding fat. A surgical revision had confirmed the presence of dehiscence. EPIQ, high-frequency linear transducer