That's a first...and probably a last.

I got to see a case that I will probably never see again as long as I practice.

An old (13 years old), large breed dog presented for pacing, restlessness, and vomiting this evening. He was previously healthy, just old. He wasn't on any medications, the owners monitored him closely, and he didn't get into anything. He was up to date on his preventative care and not on any medications.

Physical exam showed an elevated hart rate, very injected gums, and bounding pulses. His abdomen was not painful. Rectal exam revealed no feces in colon. Everything else was unremarkable. The dog seemed stable otherwise.

Based on the pacing, restlessness, and vomiting, we recommended that the patient have abdominal xrays. What we saw was exciting and shocking to us...the descending colon, which normally lives on the left side of the abdomen, was displaced to the right side. The cecum, which normally lives more on the midline/right side of the abdomen, was pushed over to the left. The colon was massively dilated, and the small intestine was starting to dilate, as well.

We were staring at a colonic volvulus. This is so rare that when I looked it up in the Slatter surgery textbook, only 5 cases were described (1 cat, 4 dogs). Of those cases, 3 died despite intensive care.

In this case, given the dog's age, the owners elected to euthanize. It was the right decision undoubtedly. It was disappointing in that we didn't get to go into surgery and fix it. I was dying to see what it looked like surgically. As I said, I'll probably never see another in my life. Oh well. At least I got to see the xrays and the clinical signs. In case I ever do see one again.