Gunner was placed under general anesthesia for an exploratory celiotomy, which revealed a transverse and descending colonic entrapment around the intact right-sided incisional gastropexy site with 180-degree counterclockwise colonic volvulus (Figure 3). The entrapment was gently reduced, and the colon was derotated to a normal anatomic position. Colonic tissue appeared erythemic, tissues were grossly normal on palpation, and normal pulsations were palpated in all segments. The colon was deemed viable based on gross examination and clinician experience.
The colon was distended with gas and fluid, and the stomach was distended with gas. Attempts to digitally reduce the gas and fluid in the colon were unsuccessful. An orogastric tube was placed in the stomach, and a lubricated 10 French red rubber catheter was inserted into the rectum and left in place. Audible intestinal borborygmus was appreciated within a few minutes, and the stomach and colon were decompressed of air. Colonic tissues were reassessed and remained grossly normal.
A 4-cm longitudinal, serosal, antimesenteric incision was made using a #11 scalpel blade, starting at the junction of the transverse and descending colon and continuing aborad. A matching 4-cm longitudinal incision was made through the left transversus abdominis muscle.
Left-sided colopexy was completed by apposing the dorsal body wall incision to the lateral colonic incision using 4-0 polydioxanone suture in a simple continuous pattern from caudal to cranial. A matching parallel closure apposed the ventral margin of the body wall incision to the medial margin of the colonic incision. Three additional 3-0 polydioxanone interrupted sutures were placed in the ventral body wall to the medial colonic incision (Figure 4).
The descending colon was unable to contact the previous right-sided incisional gastropexy with cranial traction, and the gastropexy was left intact. The orogastric tube and red rubber catheter were removed; sponge count was confirmed; the abdomen was copiously lavaged with warm sterile isotonic saline; and abdominal closure was performed routinely.
Postoperatively, Gunner continued to receive fluid therapy (lactated Ringer’s solution with 16 mEq/L of potassium chloride, 2.2 mL/kg/hour IV CRI), lidocaine (25-50 µg/kg/minute IV CRI), and fentanyl (2-5 µg/kg/hour IV CRI). He appeared comfortable during hospitalization and began voluntarily eating and drinking within 6 hours postoperatively.
Gunner was discharged within 24 hours postoperatively. Gabapentin (8.3 mg/kg PO every 8 hours for 10 days), codeine (1.2 mg/kg PO every 8 hours for 3 days), trazodone (4.1 mg/kg PO every 8 hours for 10 days), and maropitant (1.7 mg/kg PO every 24 hours for 4 days) were dispensed for the 2-week postoperative recovery period.