Temporary End Ileostomy as a Strategy to Prevent Anastomotic Leakage in a Dog

Temporary End Ileostomy as a Strategy to Prevent Anastomotic Leakage in a Dog | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Temporary End Ileostomy as a Strategy to Prevent Anastomotic Leakage in a Dog Ponrakit Puorcharoen, Wongsuda Yala, Tanamon Poppinit, Aris Areekul, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8054626/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Anastomotic leakage is a potentially life-threatening complication following intestinal resection and anastomosis in dogs. This report highlights the potential of temporary ileostomy prior to re-anastomosis as a strategy to reduce complications in dogs at high risk of anastomotic leakage. Case presentation A 1-year-old male Chihuahua weighing 2.5 kg presented with a four-day history of vomiting, anorexia, lethargy, abdominal discomfort, and a left inguinal hernia. Ultrasonography revealed a segment of the small intestine herniated into the left inguinal area with evidence of intestinal obstruction and left testicular cryptorchidism. Emergency exploratory surgery identified a strangulated and ruptured ileal segment. The distal ileum was temporarily closed and the proximal segment was exteriorised as an end ileostomy. Three days later, following correction of hypoalbuminaemia and improvement in intestinal viability, a second surgery was performed to restore intestinal continuity via side-to-end anastomosis. The dog recovered uneventfully and showed no signs of anastomotic leakage, peritonitis, or other complications. Follow-up confirmed normal gastrointestinal function. Conclusions Temporary ileostomy followed by delayed re-anastomosis may be a viable strategy for managing anastomotic complications in dogs with a high risk of anastomotic leakage. Figures Figure 1 Figure 2 Figure 3 Figure 4 Background Anastomotic leakage (AL) is a potentially life-threatening complication following intestinal resection and anastomosis in dogs, with a reported rate ranging from 11–15.7% and an associated mortality rate as high as 73–85% [ 1 – 3 ]. Risk factors associated with AL include preoperative serum albumin ≤ 2.5 g/dL, pre-existing inflammatory bowel disease, preoperative peritonitis, foreign body obstruction, intraoperative hypotension, location of the anastomosis, and the length of bowel resected [ 2 – 4 ]. Several strategies have been advocated to reduce the risk of AL, including gentle tissue handling, ensuring adequate vascular supply, achieving a tension-free anastomosis, omental wrapping, and use of a serosal patch [ 5 – 7 ]. However, in patients deemed high-risk, additional protective techniques may be warranted. In human colorectal surgery, temporary diverting stomas are commonly employed as a preventive measure to reduce leakage rates [ 8 ]. However, in veterinary medicine, the use of colostomy and jejunostomy remains uncommon, largely due to the postoperative management they demand from pet owners [ 9 ]. This report highlights the potential of temporary ileostomy prior to re-anastomosis as a strategy to reduce complications in dogs at high risk of anastomotic leakage. Case presentation A 1-year-old male Chihuahua presented with a four-day history of anorexia and vomiting. Physical examination revealed a left inguinal hernia and abdominal discomfort. A complete blood count showed leukocytosis [WBC 22,800 cells/µl; reference interval (RI): 6,000–17,000 cells/µL]. The serum biochemistry panel showed hypoalbuminaemia (2.2 g/dL; RI: 2.3–3.2 g/dL), normal blood urea nitrogen (20.9 mg/dL; RI: 10–26 mg/dL), creatinine (0.4 mg/dL; RI: 0.5–1.3 mg/dL), and alanine aminotransferase (33 IU/L; RI: 6–70 IU/L). Venous blood gas showed respiratory alkalosis with pH (7.552; RI: 7.35–7.45), pCO 2 (22.0 mmHg; RI: 33.6–41.2 mmHg), and HCO₃⁻ (20.1 mmol/L; RI: 20.8–24.2 mmol/L). Electrolyte abnormalities included hyponatraemia (123.1 mmol/L; RI: 138–152 mmol/L), hypokalaemia (3.32 mmol/L; RI: 3.5–5.1 mmol/L), hypochloraemia (91.5 mmol/L; RI: 109–125 mmol/L), and ionised hypocalcaemia (1.0 mmol/L; RI: 1.09–1.3 mmol/L). Abdominal ultrasonography identified a left inguinal hernia, the ring measuring 1.5 cm in diameter, containing a segment of small intestine and hyperechoic mesenteric fat. The proximal bowel segment was dilated and hypoperistaltic, with changes consistent with pancreatitis also noted. Given the evidence of intestinal obstruction, emergency surgery was prompted. Premedication included intravenous (IV) 0.2 mg/kg midazolam (Midazolam-hameln; Hameln Pharma), 2 µg/kg fentanyl (Fentanyl-hameln; Hameln Pharma), and 1 mg/kg ketamine (Ketamine-hameln; Hameln Pharma). An epidural block was performed with 0.4 mg/kg bupivacaine (Marcaine Spinal Heavy Solution; Cenexi) and 0.1 mg/kg morphine (Morphine sulfate injection; M&H Manufacturing). 20 mg/kg IV Cefazolin (Cefaben; L.B.S. Laboratory Ltd.) was also administered as antibiotic prophylaxis. General anaesthesia was induced with propofol (Troypofol; Troikaa Pharmaceuticals) 6 mg/kg IV and maintained with isoflurane (Attane; Piramal Critical, Inc.)) and fentanyl continuous rate infusion (CRI; 10 µg/kg/h). With the dog positioned in dorsal recumbency, an incision was made over the left inguinal area, and the hernia sac was incised, revealing the strangulated jejunal and ileal segment and the left testis torsion with severe ischemia. Therefore, a left orchiectomy was performed. The hernia opening and muscle layers were extended to access the abdominal cavity, allowing for repositioning the herniated bowel into the peritoneal cavity. Gross examination revealed a ruptured ileum with marked congestion and dark red discolouration (Fig. 1 ). The devitalised intestine was trimmed using Metzenbaum scissors at both ruptured ends. The distal segment was temporarily closed using a simple interrupted pattern with 4 − 0 polydioxanone (PDS; Johnson & Johnson International). The proximal end was exteriorised through the incision of the abdominal musculature and a simple interrupted pattern with 4 − 0 polydioxanone was used to suture the full thickness of the skin and the intestine to create a stoma (Fig. 2 ). A sample was taken from the site of the intestinal rupture using a sterile swab for bacterial culture, and the abdominal cavity was lavaged with warm sterile saline. The remaining abdominal wall was closed routinely and a right orchiectomy was also performed. Postoperatively, the dog recovered well from anaesthesia without complications. The dog was given fentanyl (2 mcg/kg/h CRI for 12 hours) for postoperative analgesia. IV fluid maintenance with 2 mL/kg/h acetate Ringer’s solution and 20 mg/kg IV q8h amoxicillin-clavulanic acid (AMK; North China Pharmaceutical) was administered. An Elizabethan collar was used to protect the surgical site from self-mutilation. The surgical site was cleansed daily with sterile saline. The stoma was irrigated and cleaned with normal saline. A topical gauze dressing was applied over the stoma and changed every 2–4 hours depending on soilage. A Fr 6 Foley catheter (Buster Foley Catheter; Kruuse) was used to catheterise the dog to reduce urine scalding at the surgical site. Enteral nutrition was initiated as soon as the dog recovered from anaesthesia. Three days after the initial ileostomy and despite nursing care, the dog developed localized skin irritation from intestinal effluent. The stoma appeared less congested and repeated blood testing revealed a normal complete blood count and resolution of hypoalbuminaemia (2.6 g/dL RI: 2.3–3.2 g/dL). Hyponatraemia (134.8 mmol/L; RI: 138–152 mmol/L), hypochloraemia (101.2 mmol/L; RI: 109–125 mmol/L), and mild hypokalaemia (3.23 mmol/L; RI: 3.5–5.1 mmol/L) were corrected using normal saline solution and 0.1 mEq/kg/h potassium chloride (Potassium Chloride Injection; Atlantic Laboratories). Another surgery was carried out to re-anastomose the ileum. The same anaesthetic protocol as the prior surgery was used. The previous incision was reopened, both the proximal and distal stumps of the intestine appeared markedly less congested and no longer discoloured (Fig. 3 ). Side-to-end anastomosis was performed due to the size discrepancy between the two segments, with the diameter of the stoma being larger than the distal part. The edge of the stoma was trimmed using Metzenbaum scissors and subsequently closed with 4 − 0 polydioxanone using a simple interrupted pattern. An incision matching the diameter of the aboral segment was made on the antimesenteric border of the proximal segment, approximately 2 cm from its closed end. The previously closed distal stump was excised using Metzenbaum scissors and anastomosis was performed using a simple interrupted pattern with 4 − 0 polydioxanone (Fig. 4 ). The site was lavaged thoroughly with warm sterile saline, a Jackson-Pratt drain was placed, and the abdominal wall was closed routinely. Postoperatively, the dog recovered uneventfully. Bacterial culture and sensitivity results identified Escherichia coli sensitive to amoxicillin-clavulanic acid; antimicrobial therapy was continued at 20 mg/kg IV every 8 hours. The dog received fentanyl (2 mcg/kg/h CRI for 12 hours) for analgesia and daily wound care. Enteral nutrition was initiated within 24 hours postoperatively using a highly digestible commercial diet. Clinical signs and vital parameters (heart rate, respiratory rate, mucous membrane colour, capillary refill time, rectal temperature) were monitored daily. By postoperative day 3, the dog passed normal faeces, indicating restored gastrointestinal function. Drain output was < 1 mL/kg/day and so the drain was removed. Clinicopathological tests repeated three days after the operation showed a normal complete blood count, serum biochemistry, and electrolytes. The dog was transferred to the inpatient unit for ongoing wound care. On postoperative day 10, the stitches were removed and the dog returned home uneventfully. A telephone follow-up conducted one month after discharge revealed that the dog was healthy and passing normal faeces. Discussion The surgical management of patients with risk factors for anastomotic leakage (AL) is challenging. In the present case, several recognised risks were present, including hypoalbuminaemia and reduced vascularisation, as evidenced by congestion and discolouration of the affected intestinal segment [ 2 , 8 , 10 ]. The severity of the intestinal damage meant that achieving viable margins for a single-stage anastomosis would have required extensive resection, placing the dog at risk of short bowel syndrome [ 9 ]. The use of ileostomy and colostomy as a strategy to reduce AL is well established in human colorectal surgery by diverting intestinal contents away from the distal anastomotic site [ 11 – 14 ]. In veterinary medicine, temporary stomas have been described in selected cases to protect distal anastomoses and fistulae associated with anal atresia, colorectal cancer, and rectal infection [ 15 – 20 ]. However, to the authors’ knowledge, this is the first reported use of a temporary end ileostomy in a dog specifically to delay intestinal anastomosis and provide time for patient stabilisation prior to re-anastomosis. In both human and veterinary medicine, conventional diverting stomas require a second anastomosis to reverse the stoma, resulting in two anastomoses: one at the time of initial resection and another during stoma closure. A key difference in the present case is that no primary anastomosis was performed during the initial surgery. The proximal ileum was exteriorised as an end stoma, and intestinal continuity was restored only after tissue viability improved and serum albumin normalised. This approach avoided the need for two separate anastomoses and may have reduced operative time and tissue trauma during the first procedure. In humans, stoma reversal is usually performed 3–6 months after stoma creation, largely based on surgeon preference [ 21 ]. In dogs, during the first three days after intestinal surgery, inflammation substantially weakens the intestinal wall, reducing its bursting strength to approximately 15% of normal, with strength gradually returning to normal by day 14 during the proliferative phase [ 22 ]. In the current case, re-anastomosis was performed three days after the initial surgery because the dog demonstrated macroscopic improvement of intestinal tissue, based on the colour of the stoma and normalisation of serum albumin, suggesting a reduced risk of anastomotic leakage. Furthermore, the decision was also influenced by the presence of peristomal dermatitis. While this early timing proved successful, the optimal reversal interval in veterinary patients remains undefined and warrants further investigation. Stoma-related complications include ileus, electrolyte disturbances, stomal prolapse, parastomal herniation, parastomal infection, dehiscence, dermatitis, and kidney injury [ 9 , 23 , 24 ]. In the present case, only peristomal dermatitis developed, likely due to the corrosive nature of the ileal effluent [ 24 ]. The use of an ostomy bag did not effectively prevent peristomal skin irritation or maintain wound hygiene, primarily because commercially available products are not appropriately sized for small-breed dogs. Additionally, adhesive skin barriers commonly used to secure ostomy bags often fail to adhere reliably to canine skin, particularly in regions with uneven or mobile surfaces [ 15 ]. In the current case, the temporary stoma was positioned adjacent to the prepuce, further complicating secure attachment of an ostomy appliance and limiting effective wound management. In future cases, positioning the stoma on the lateral abdominal wall or flank may provide better access, improved appliance adherence, and facilitate peristomal skin care. Immediately after both surgeries, the dog was offered a highly digestible diet, as early enteral nutrition (EEN) has been shown to reduce anastomotic complications and shorten the time to defecation without increasing the risk of anastomotic leakage, compared with postoperative fasting until return of gastrointestinal function [25, 26, 8]. In dogs, those receiving EEN demonstrated significantly higher intestinal bursting strength compared with those that did not receive enteral nutrition [ 21 ]. In conclusion, a temporary end ileostomy as a staged approach to intestinal anastomosis may be a valuable strategy in dogs at high risk of anastomotic leakage, particularly when poor tissue viability or severe hypoalbuminaemia is present. This technique allowed patient stabilisation and successful restoration of intestinal continuity with only minor complications. While promising, the findings should be interpreted with caution due to the inherent limitations of a single-case report. Further research is required to define this approach for broader clinical applicability and long-term outcomes. Abbreviations AL Anastomotic leakage Declarations Acknowledgements The authors thank all colleagues at the Kasetsart University Veterinary Teaching Hospital Hua Hin, Thailand, for their support. The authors are also grateful to the dog owners and their pets, who made it possible to successfully complete this study. AUTHOR CONTRIBUTIONS Puorcharoen P. DVM: Identified suitable medical records, recorded demographic information, compiled all data, interpreted data, drafted and revised the manuscript, and gave final approval of the version to be published. Yala W. DVM: Contributed to the design of the study, performed radiographic measurements, performed data curation and interpreted data. Poppinit T. DVM and Areekul A. DVM: Contributed to the design of the study and drafted and revised the manuscript. Yippaditr W. DVM: Contributed to the design of the study, was responsible for the surgical management of the case, oversaw data collection, provided intraoperative photographs, interpreted data, provided scientific, in-line editing of the manuscript, and gave final approval of the version to be published. All authors provided a critical review of the manuscript and endorse the final version. All authors are aware of their respective contributions and have confidence in the integrity of all contributions. Funding The authors received no funding for this case report. Data availability All data generated during this study are included in this published article. Ethics declaration not applicable Consent for publication Written informed consent was obtained from the owner of the cat for publication of the case report Conflict of interest There are no conflicts of interest to declare. References Allen D, Smeak D, Schertel E. Prevalence of small intestinal dehiscence and associated clinical factors: a retrospective study of 121 dogs. J Am Anim Hosp Assoc. 1992;28(1):70–6. Ralphs SC, Jessen CR, Lipowitz AJ. Risk factors for leakage following intestinal anastomosis in dogs and cats: 115 cases (1991–2000). J Am Anim Hosp Assoc. 2003;223(1):73–7. Snowdon KA, Smeak DD, Chiang S. Risk Factors for Dehiscence of Stapled Functional End-to‐End Intestinal Anastomoses in Dogs: 53 Cases (2001–2012). Vet Surg. 2016;45(1):91–9. Mouat EE, Davis GJ, Drobatz KJ, Wallace KA. Evaluation of Data From 35 Dogs Pertaining to Dehiscence Following Intestinal Resection and Anastomosis. J Am Anim Hosp Assoc. 2014;50(4):254–63. McLachlin AD, Denton DW. Omental protection of intestinal anastomoses. Am J Surg. 1973;125(1):134–40. Hansen LA, Monnet EL. Evaluation of serosal patch supplementation of surgical anastomoses in intestinal segments from canine cadavers. Am J Vet Res., Man J, Hrabe J. Anastomotic Technique—How to Optimize Success and Minimize Leak Rates. Clin Colon Rectal Surg. 2021;34(06):371–378. Sripathi S, Khan MI, Patel N, Meda RT, Nuguru SP, Rachakonda S. October. Factors Contributing to Anastomotic Leakage Following Colorectal Surgery: Why, When, and Who Leaks? Cureus. 2022. Smeak DD. Colostomy and Jejunostomy. In: Monnet E, Smeak DD, editors. Gastrointestinal Surgical Techniques in Small Animals. John Wiley & Sons, Inc.; 2020. pp. 225–9. Zarnescu EC, Zarnescu NO, Costea R. Updates of Risk Factors for Anastomotic Leakage after Colorectal Surgery. 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Temporary end-on colostomy as a treatment for anastomotic dehiscence after a transanal rectal pull-through procedure in a dog. Vet Surg. 2019;48(5):897–901. Silva P, Pereira R, Franca A, et al. Modified temporary colostomy in a dog for treatment of rectal infection after complication of perineal herniorrhaphy. Open Vet J. 2024;14(11):3120. O’Sullivan NJ, Temperley HC, Nugent TS, et al. Early vs. standard reversal ileostomy: a systematic review and meta-analysis. Tech Coloproctol. 2022;26(11):851–62. Mullen KM, Regier PJ, Ellison GW, Londoño L. A Review of Normal Intestinal Healing, Intestinal Anastomosis, and the Pathophysiology and Treatment of Intestinal Dehiscence in Foreign Body Obstructions in Dogs. Top Companion Anim Med. 2020;41:100457. Murken D, Bleier J, Ostomy-Related, Complications. Clin Colon Rectal Surg., Du R, Zhou J, Tong G et al. Postoperative morbidity and mortality after anterior resection with preventive diverting loop ileostomy versus loop colostomy for rectal cancer: A updated systematic review and meta-analysis. Eur J Surg Oncol. 2021;47(7):1514–1525. Kirchhoff P, Clavien PA, Hahnloser D. Complications in colorectal surgery: risk factors and preventive strategies. Patient Saf Surg. 2010;4(1):5. Tian W, Xu X, Yao Z, et al. Early Enteral Nutrition Could Reduce Risk of Recurrent Leakage After Definitive Resection of Anastomotic Leakage After Colorectal Cancer Surgery. World j surg. 2021;45(1):320–30. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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10:04:15","extension":"xml","order_by":15,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":55190,"visible":true,"origin":"","legend":"","description":"","filename":"626e3bc18f2d496fb7e76279ccdd51891structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8054626/v1/58b2a9267ce25a2b247d4ef5.xml"},{"id":98763435,"identity":"90b747c7-19ba-41ee-8b79-04f69744c8ce","added_by":"auto","created_at":"2025-12-22 10:04:15","extension":"html","order_by":16,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":62483,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8054626/v1/3a94aaeec8f0289974a17ab6.html"},{"id":98763438,"identity":"c36cd04b-097e-4580-b167-e52b77a1a052","added_by":"auto","created_at":"2025-12-22 10:04:15","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":18180245,"visible":true,"origin":"","legend":"\u003cp\u003eIntraoperative image of the strangulated jejunal and ileal segment (arrow) and left testis (asterisk). The affected intestinal segment is ruptured. The intestinal segment and testis severely congested, and discolored.\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8054626/v1/8da3df19caa504e1d6264881.jpg"},{"id":98763444,"identity":"b5828c8d-6794-4244-8824-6ef2cecc6f14","added_by":"auto","created_at":"2025-12-22 10:04:15","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":21296523,"visible":true,"origin":"","legend":"\u003cp\u003eCreation of a temporary end ileostomy. The proximal ileum is exteriorized and sutured to the skin at the cranial edge of the incision using a simple interrupted pattern (arrow).\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8054626/v1/5f851e7e99c24dd39c637da6.jpg"},{"id":98763432,"identity":"853bb2d0-b9af-4059-8e07-dff6ed39c619","added_by":"auto","created_at":"2025-12-22 10:04:15","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":9556177,"visible":true,"origin":"","legend":"\u003cp\u003eIntraoperative image during the second surgery showing the previously exteriorized proximal (white arrow). \u0026nbsp;and distal intestinal segments (yellow arrow). Both segments appear uniformly pink, with resolution of prior congestion and discoloration.\u003c/p\u003e","description":"","filename":"Figure3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8054626/v1/55ce0485f3bbc098b52ef641.jpg"},{"id":98763442,"identity":"22d626f3-cb62-408e-b1de-e35b9707d9fb","added_by":"auto","created_at":"2025-12-22 10:04:15","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":21383801,"visible":true,"origin":"","legend":"\u003cp\u003eIntraoperative image during the second surgery showing the completed side-to-end anastomosis of the ileum.\u003c/p\u003e","description":"","filename":"Figure4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8054626/v1/51d9859a44088a2bc6bb9851.jpg"},{"id":104835581,"identity":"803595b3-faae-4038-8d7a-42a1ac78338d","added_by":"auto","created_at":"2026-03-17 17:46:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":70791983,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8054626/v1/9e95c01e-ecce-4589-9cfa-c16c5b6ad99a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Temporary End Ileostomy as a Strategy to Prevent Anastomotic Leakage in a Dog","fulltext":[{"header":"Background","content":"\u003cp\u003eAnastomotic leakage (AL) is a potentially life-threatening complication following intestinal resection and anastomosis in dogs, with a reported rate ranging from 11\u0026ndash;15.7% and an associated mortality rate as high as 73\u0026ndash;85% [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Risk factors associated with AL include preoperative serum albumin\u0026thinsp;\u0026le;\u0026thinsp;2.5 g/dL, pre-existing inflammatory bowel disease, preoperative peritonitis, foreign body obstruction, intraoperative hypotension, location of the anastomosis, and the length of bowel resected [\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Several strategies have been advocated to reduce the risk of AL, including gentle tissue handling, ensuring adequate vascular supply, achieving a tension-free anastomosis, omental wrapping, and use of a serosal patch [\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. However, in patients deemed high-risk, additional protective techniques may be warranted. In human colorectal surgery, temporary diverting stomas are commonly employed as a preventive measure to reduce leakage rates [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. However, in veterinary medicine, the use of colostomy and jejunostomy remains uncommon, largely due to the postoperative management they demand from pet owners [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. This report highlights the potential of temporary ileostomy prior to re-anastomosis as a strategy to reduce complications in dogs at high risk of anastomotic leakage.\u003c/p\u003e"},{"header":"Case presentation","content":"\u003cp\u003eA 1-year-old male Chihuahua presented with a four-day history of anorexia and vomiting. Physical examination revealed a left inguinal hernia and abdominal discomfort. A complete blood count showed leukocytosis [WBC 22,800 cells/\u0026micro;l; reference interval (RI): 6,000\u0026ndash;17,000 cells/\u0026micro;L]. The serum biochemistry panel showed hypoalbuminaemia (2.2 g/dL; RI: 2.3\u0026ndash;3.2 g/dL), normal blood urea nitrogen (20.9 mg/dL; RI: 10\u0026ndash;26 mg/dL), creatinine (0.4 mg/dL; RI: 0.5\u0026ndash;1.3 mg/dL), and alanine aminotransferase (33 IU/L; RI: 6\u0026ndash;70 IU/L). Venous blood gas showed respiratory alkalosis with pH (7.552; RI: 7.35\u0026ndash;7.45), pCO\u003csub\u003e2\u003c/sub\u003e (22.0 mmHg; RI: 33.6\u0026ndash;41.2 mmHg), and HCO₃⁻ (20.1 mmol/L; RI: 20.8\u0026ndash;24.2 mmol/L). Electrolyte abnormalities included hyponatraemia (123.1 mmol/L; RI: 138\u0026ndash;152 mmol/L), hypokalaemia (3.32 mmol/L; RI: 3.5\u0026ndash;5.1 mmol/L), hypochloraemia (91.5 mmol/L; RI: 109\u0026ndash;125 mmol/L), and ionised hypocalcaemia (1.0 mmol/L; RI: 1.09\u0026ndash;1.3 mmol/L). Abdominal ultrasonography identified a left inguinal hernia, the ring measuring 1.5 cm in diameter, containing a segment of small intestine and hyperechoic mesenteric fat. The proximal bowel segment was dilated and hypoperistaltic, with changes consistent with pancreatitis also noted. Given the evidence of intestinal obstruction, emergency surgery was prompted. Premedication included intravenous (IV) 0.2 mg/kg midazolam (Midazolam-hameln; Hameln Pharma), 2 \u0026micro;g/kg fentanyl (Fentanyl-hameln; Hameln Pharma), and 1 mg/kg ketamine (Ketamine-hameln; Hameln Pharma). An epidural block was performed with 0.4 mg/kg bupivacaine (Marcaine Spinal Heavy Solution; Cenexi) and 0.1 mg/kg morphine (Morphine sulfate injection; M\u0026amp;H Manufacturing). 20 mg/kg IV Cefazolin (Cefaben; L.B.S. Laboratory Ltd.) was also administered as antibiotic prophylaxis. General anaesthesia was induced with propofol (Troypofol; Troikaa Pharmaceuticals) 6 mg/kg IV and maintained with isoflurane (Attane; Piramal Critical, Inc.)) and fentanyl continuous rate infusion (CRI; 10 \u0026micro;g/kg/h). With the dog positioned in dorsal recumbency, an incision was made over the left inguinal area, and the hernia sac was incised, revealing the strangulated jejunal and ileal segment and the left testis torsion with severe ischemia. Therefore, a left orchiectomy was performed. The hernia opening and muscle layers were extended to access the abdominal cavity, allowing for repositioning the herniated bowel into the peritoneal cavity. Gross examination revealed a ruptured ileum with marked congestion and dark red discolouration (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The devitalised intestine was trimmed using Metzenbaum scissors at both ruptured ends. The distal segment was temporarily closed using a simple interrupted pattern with 4\u0026thinsp;\u0026minus;\u0026thinsp;0 polydioxanone (PDS; Johnson \u0026amp; Johnson International). The proximal end was exteriorised through the incision of the abdominal musculature and a simple interrupted pattern with 4\u0026thinsp;\u0026minus;\u0026thinsp;0 polydioxanone was used to suture the full thickness of the skin and the intestine to create a stoma (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). A sample was taken from the site of the intestinal rupture using a sterile swab for bacterial culture, and the abdominal cavity was lavaged with warm sterile saline. The remaining abdominal wall was closed routinely and a right orchiectomy was also performed. Postoperatively, the dog recovered well from anaesthesia without complications. The dog was given fentanyl (2 mcg/kg/h CRI for 12 hours) for postoperative analgesia. IV fluid maintenance with 2 mL/kg/h acetate Ringer\u0026rsquo;s solution and 20 mg/kg IV q8h amoxicillin-clavulanic acid (AMK; North China Pharmaceutical) was administered. An Elizabethan collar was used to protect the surgical site from self-mutilation. The surgical site was cleansed daily with sterile saline. The stoma was irrigated and cleaned with normal saline. A topical gauze dressing was applied over the stoma and changed every 2\u0026ndash;4 hours depending on soilage. A Fr 6 Foley catheter (Buster Foley Catheter; Kruuse) was used to catheterise the dog to reduce urine scalding at the surgical site. Enteral nutrition was initiated as soon as the dog recovered from anaesthesia. Three days after the initial ileostomy and despite nursing care, the dog developed localized skin irritation from intestinal effluent. The stoma appeared less congested and repeated blood testing revealed a normal complete blood count and resolution of hypoalbuminaemia (2.6 g/dL RI: 2.3\u0026ndash;3.2 g/dL). Hyponatraemia (134.8 mmol/L; RI: 138\u0026ndash;152 mmol/L), hypochloraemia (101.2 mmol/L; RI: 109\u0026ndash;125 mmol/L), and mild hypokalaemia (3.23 mmol/L; RI: 3.5\u0026ndash;5.1 mmol/L) were corrected using normal saline solution and 0.1 mEq/kg/h potassium chloride (Potassium Chloride Injection; Atlantic Laboratories). Another surgery was carried out to re-anastomose the ileum. The same anaesthetic protocol as the prior surgery was used. The previous incision was reopened, both the proximal and distal stumps of the intestine appeared markedly less congested and no longer discoloured (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Side-to-end anastomosis was performed due to the size discrepancy between the two segments, with the diameter of the stoma being larger than the distal part. The edge of the stoma was trimmed using Metzenbaum scissors and subsequently closed with 4\u0026thinsp;\u0026minus;\u0026thinsp;0 polydioxanone using a simple interrupted pattern. An incision matching the diameter of the aboral segment was made on the antimesenteric border of the proximal segment, approximately 2 cm from its closed end. The previously closed distal stump was excised using Metzenbaum scissors and anastomosis was performed using a simple interrupted pattern with 4\u0026thinsp;\u0026minus;\u0026thinsp;0 polydioxanone (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). The site was lavaged thoroughly with warm sterile saline, a Jackson-Pratt drain was placed, and the abdominal wall was closed routinely. Postoperatively, the dog recovered uneventfully. Bacterial culture and sensitivity results identified Escherichia coli sensitive to amoxicillin-clavulanic acid; antimicrobial therapy was continued at 20 mg/kg IV every 8 hours. The dog received fentanyl (2 mcg/kg/h CRI for 12 hours) for analgesia and daily wound care. Enteral nutrition was initiated within 24 hours postoperatively using a highly digestible commercial diet. Clinical signs and vital parameters (heart rate, respiratory rate, mucous membrane colour, capillary refill time, rectal temperature) were monitored daily. By postoperative day 3, the dog passed normal faeces, indicating restored gastrointestinal function. Drain output was \u0026lt;\u0026thinsp;1 mL/kg/day and so the drain was removed. Clinicopathological tests repeated three days after the operation showed a normal complete blood count, serum biochemistry, and electrolytes. The dog was transferred to the inpatient unit for ongoing wound care. On postoperative day 10, the stitches were removed and the dog returned home uneventfully. A telephone follow-up conducted one month after discharge revealed that the dog was healthy and passing normal faeces.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe surgical management of patients with risk factors for anastomotic leakage (AL) is challenging. In the present case, several recognised risks were present, including hypoalbuminaemia and reduced vascularisation, as evidenced by congestion and discolouration of the affected intestinal segment [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The severity of the intestinal damage meant that achieving viable margins for a single-stage anastomosis would have required extensive resection, placing the dog at risk of short bowel syndrome [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The use of ileostomy and colostomy as a strategy to reduce AL is well established in human colorectal surgery by diverting intestinal contents away from the distal anastomotic site [\u003cspan additionalcitationids=\"CR12 CR13\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. In veterinary medicine, temporary stomas have been described in selected cases to protect distal anastomoses and fistulae associated with anal atresia, colorectal cancer, and rectal infection [\u003cspan additionalcitationids=\"CR16 CR17 CR18 CR19\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. However, to the authors\u0026rsquo; knowledge, this is the first reported use of a temporary end ileostomy in a dog specifically to delay intestinal anastomosis and provide time for patient stabilisation prior to re-anastomosis. In both human and veterinary medicine, conventional diverting stomas require a second anastomosis to reverse the stoma, resulting in two anastomoses: one at the time of initial resection and another during stoma closure. A key difference in the present case is that no primary anastomosis was performed during the initial surgery. The proximal ileum was exteriorised as an end stoma, and intestinal continuity was restored only after tissue viability improved and serum albumin normalised. This approach avoided the need for two separate anastomoses and may have reduced operative time and tissue trauma during the first procedure. In humans, stoma reversal is usually performed 3\u0026ndash;6 months after stoma creation, largely based on surgeon preference [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. In dogs, during the first three days after intestinal surgery, inflammation substantially weakens the intestinal wall, reducing its bursting strength to approximately 15% of normal, with strength gradually returning to normal by day 14 during the proliferative phase [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. In the current case, re-anastomosis was performed three days after the initial surgery because the dog demonstrated macroscopic improvement of intestinal tissue, based on the colour of the stoma and normalisation of serum albumin, suggesting a reduced risk of anastomotic leakage. Furthermore, the decision was also influenced by the presence of peristomal dermatitis. While this early timing proved successful, the optimal reversal interval in veterinary patients remains undefined and warrants further investigation. Stoma-related complications include ileus, electrolyte disturbances, stomal prolapse, parastomal herniation, parastomal infection, dehiscence, dermatitis, and kidney injury [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. In the present case, only peristomal dermatitis developed, likely due to the corrosive nature of the ileal effluent [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The use of an ostomy bag did not effectively prevent peristomal skin irritation or maintain wound hygiene, primarily because commercially available products are not appropriately sized for small-breed dogs. Additionally, adhesive skin barriers commonly used to secure ostomy bags often fail to adhere reliably to canine skin, particularly in regions with uneven or mobile surfaces [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. In the current case, the temporary stoma was positioned adjacent to the prepuce, further complicating secure attachment of an ostomy appliance and limiting effective wound management. In future cases, positioning the stoma on the lateral abdominal wall or flank may provide better access, improved appliance adherence, and facilitate peristomal skin care. Immediately after both surgeries, the dog was offered a highly digestible diet, as early enteral nutrition (EEN) has been shown to reduce anastomotic complications and shorten the time to defecation without increasing the risk of anastomotic leakage, compared with postoperative fasting until return of gastrointestinal function [25, 26, 8]. In dogs, those receiving EEN demonstrated significantly higher intestinal bursting strength compared with those that did not receive enteral nutrition [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn conclusion, a temporary end ileostomy as a staged approach to intestinal anastomosis may be a valuable strategy in dogs at high risk of anastomotic leakage, particularly when poor tissue viability or severe hypoalbuminaemia is present. This technique allowed patient stabilisation and successful restoration of intestinal continuity with only minor complications. While promising, the findings should be interpreted with caution due to the inherent limitations of a single-case report. Further research is required to define this approach for broader clinical applicability and long-term outcomes.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cb\u003eAL\u003c/b\u003e Anastomotic leakage\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank all colleagues at the Kasetsart University Veterinary Teaching Hospital Hua Hin, Thailand, for their support. The authors are also grateful to the dog owners and their pets, who made it possible to successfully complete this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAUTHOR CONTRIBUTIONS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePuorcharoen P. DVM:\u0026nbsp;Identified suitable medical records, recorded demographic information, compiled all data, interpreted data, drafted and revised the manuscript, and gave final approval of the version to be published.\u003c/p\u003e\n\u003cp\u003eYala W. DVM: Contributed to the design of the study, performed radiographic measurements, performed data curation and interpreted data.\u003c/p\u003e\n\u003cp\u003ePoppinit T. DVM and Areekul A. DVM: Contributed to the design of the study and drafted and revised the manuscript.\u003c/p\u003e\n\u003cp\u003eYippaditr W. DVM: Contributed to the design of the study, was responsible for the surgical management of the case, oversaw data collection, provided intraoperative photographs, interpreted data, provided scientific, in-line editing of the manuscript, and \u0026nbsp;gave final approval of the version to be published.\u003c/p\u003e\n\u003cp\u003eAll authors provided a critical review of the manuscript and endorse the final version.\u0026nbsp;All authors are aware of their respective contributions and have confidence in the integrity of all contributions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors received no funding for this case report.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll data generated during this study are included in this published article.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003enot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the owner of the cat for publication of the case report\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere are no conflicts of interest to declare.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAllen D, Smeak D, Schertel E. Prevalence of small intestinal dehiscence and associated clinical factors: a retrospective study of 121 dogs. J Am Anim Hosp Assoc. 1992;28(1):70\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRalphs SC, Jessen CR, Lipowitz AJ. Risk factors for leakage following intestinal anastomosis in dogs and cats: 115 cases (1991\u0026ndash;2000). J Am Anim Hosp Assoc. 2003;223(1):73\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSnowdon KA, Smeak DD, Chiang S. Risk Factors for Dehiscence of Stapled Functional End-to‐End Intestinal Anastomoses in Dogs: 53 Cases (2001\u0026ndash;2012). Vet Surg. 2016;45(1):91\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMouat EE, Davis GJ, Drobatz KJ, Wallace KA. Evaluation of Data From 35 Dogs Pertaining to Dehiscence Following Intestinal Resection and Anastomosis. J Am Anim Hosp Assoc. 2014;50(4):254\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcLachlin AD, Denton DW. Omental protection of intestinal anastomoses. Am J Surg. 1973;125(1):134\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHansen LA, Monnet EL. Evaluation of serosal patch supplementation of surgical anastomoses in intestinal segments from canine cadavers. Am J Vet Res., Man J, Hrabe J. Anastomotic Technique\u0026mdash;How to Optimize Success and Minimize Leak Rates. Clin Colon Rectal Surg. 2021;34(06):371\u0026ndash;378.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSripathi S, Khan MI, Patel N, Meda RT, Nuguru SP, Rachakonda S. October. Factors Contributing to Anastomotic Leakage Following Colorectal Surgery: Why, When, and Who Leaks? Cureus. 2022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSmeak DD. Colostomy and Jejunostomy. In: Monnet E, Smeak DD, editors. Gastrointestinal Surgical Techniques in Small Animals. John Wiley \u0026amp; Sons, Inc.; 2020. pp. 225\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZarnescu EC, Zarnescu NO, Costea R. Updates of Risk Factors for Anastomotic Leakage after Colorectal Surgery. Diagnostics (Basel). 2021;11(12):2382.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMontedori A, Cirocchi R, Farinella E, Sciannameo F, Abraha I. Covering ileo- or colostomy in anterior resection for rectal carcinoma. Cochrane Database of Systematic Reviews [Preprint]. Edited by Cochrane Colorectal Cancer Group. 2010.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePhan K, Oh L, Ctercteko G, et al. Does a stoma reduce the risk of anastomotic leak and need for re-operation following low anterior resection for rectal cancer: systematic review and meta-analysis of randomized controlled trials. J Gastrointest Oncol. 2019;10(2):179\u0026ndash;87.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEmile SH, Khan SM, Garoufalia Z, et al. When Is a Diverting Stoma Indicated after Low Anterior Resection? A Meta-analysis of Randomized Trials and Meta-Regression of the Risk Factors of Leakage and Complications in Non-Diverted Patients. J Gastrointest Surg. 2022;26(11):2368\u0026ndash;79.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMyrseth E, Nymo L, Gjessing P, Norderval S. Diverting stomas reduce reoperation rates for anastomotic leak but not overall reoperation rates within 30 days after anterior rectal resection: a national cohort study. Int J Colorectal Dis. 2022;37(7):1681\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHardie EM, Gilson SD. Use of Colostomy to Manage Rectal Disease in Dogs. Vet Surg. 1997;26(4):270\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKumagai D, Shimada T, Yamate J, Ohashi F. Use of an incontinent end-on colostomy in a dog with annular rectal adenocarcinoma. J Small Anim Pract. 2003;44(8):363\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChandler JC, Kudnig ST, Monnet E. Use of laparoscopic-assisted jejunostomy for fecal diversion in the management of a rectocutaneous fistula in a dog. J Am Anim Hosp Assoc. 2005;226(5):746\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTsioli V, Papazoglou L, Anagnostou T, et al. Use of a temporary incontinent end-on colostomy in a cat for the management of rectocutaneous fistulas associated with atresia ani. J Feline Med Surg. 2009;11(12):1011\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCinti F, Pisani G. Temporary end-on colostomy as a treatment for anastomotic dehiscence after a transanal rectal pull-through procedure in a dog. Vet Surg. 2019;48(5):897\u0026ndash;901.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSilva P, Pereira R, Franca A, et al. Modified temporary colostomy in a dog for treatment of rectal infection after complication of perineal herniorrhaphy. Open Vet J. 2024;14(11):3120.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eO\u0026rsquo;Sullivan NJ, Temperley HC, Nugent TS, et al. Early vs. standard reversal ileostomy: a systematic review and meta-analysis. Tech Coloproctol. 2022;26(11):851\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMullen KM, Regier PJ, Ellison GW, Londo\u0026ntilde;o L. A Review of Normal Intestinal Healing, Intestinal Anastomosis, and the Pathophysiology and Treatment of Intestinal Dehiscence in Foreign Body Obstructions in Dogs. Top Companion Anim Med. 2020;41:100457.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMurken D, Bleier J, Ostomy-Related, Complications. Clin Colon Rectal Surg., Du R, Zhou J, Tong G et al. Postoperative morbidity and mortality after anterior resection with preventive diverting loop ileostomy versus loop colostomy for rectal cancer: A updated systematic review and meta-analysis. Eur J Surg Oncol. 2021;47(7):1514\u0026ndash;1525.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKirchhoff P, Clavien PA, Hahnloser D. Complications in colorectal surgery: risk factors and preventive strategies. Patient Saf Surg. 2010;4(1):5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTian W, Xu X, Yao Z, et al. Early Enteral Nutrition Could Reduce Risk of Recurrent Leakage After Definitive Resection of Anastomotic Leakage After Colorectal Cancer Surgery. World j surg. 2021;45(1):320\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-8054626/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8054626/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eAnastomotic leakage is a potentially life-threatening complication following intestinal resection and anastomosis in dogs. This report highlights the potential of temporary ileostomy prior to re-anastomosis as a strategy to reduce complications in dogs at high risk of anastomotic leakage.\u003c/p\u003e\u003ch2\u003eCase presentation\u003c/h2\u003e \u003cp\u003eA 1-year-old male Chihuahua weighing 2.5 kg presented with a four-day history of vomiting, anorexia, lethargy, abdominal discomfort, and a left inguinal hernia. Ultrasonography revealed a segment of the small intestine herniated into the left inguinal area with evidence of intestinal obstruction and left testicular cryptorchidism. Emergency exploratory surgery identified a strangulated and ruptured ileal segment. The distal ileum was temporarily closed and the proximal segment was exteriorised as an end ileostomy. Three days later, following correction of hypoalbuminaemia and improvement in intestinal viability, a second surgery was performed to restore intestinal continuity via side-to-end anastomosis. The dog recovered uneventfully and showed no signs of anastomotic leakage, peritonitis, or other complications. Follow-up confirmed normal gastrointestinal function.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eTemporary ileostomy followed by delayed re-anastomosis may be a viable strategy for managing anastomotic complications in dogs with a high risk of anastomotic leakage.\u003c/p\u003e","manuscriptTitle":"Temporary End Ileostomy as a Strategy to Prevent Anastomotic Leakage in a Dog","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-22 10:04:09","doi":"10.21203/rs.3.rs-8054626/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e926d108-f026-4084-905d-b2d66194fa97","owner":[],"postedDate":"December 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-12T11:11:44+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-22 10:04:09","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8054626","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8054626","identity":"rs-8054626","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}