Laparoscopic-assisted gastrointestinal biopsies

Tilly, an 8-year 9-month-old female neutered Jack Russell Terrier cross, was referred to East Kent Veterinary Referrals from a local first opinion practice for further investigation of intermittent gastrointestinal signs.

Overview

Tilly had been experiencing recurrent episodes of abdominal discomfort, tenesmus, mucoid diarrhoea and, more recently, vomiting. Her signs were intermittent but progressive, with episodes lasting around 24 to 36 hours and occurring every two to three weeks over the previous two to three months.

Antacid treatment had provided only temporary improvement, and the frequency of episodes had increased in the preceding six weeks.

This case highlights the value of a structured referral approach, combining advanced imaging, careful case discussion and minimally invasive surgical biopsy to reach a practical diagnosis and guide ongoing management.

Initial presentation

At Tilly’s referral consultation, she was quiet but alert and responsive. General clinical examination was unremarkable, and abdominal palpation did not reveal a palpable mass or organ enlargement.

Given the pattern of progressive intermittent signs, further investigation was recommended rather than continuing empirical treatment alone.

The options discussed with Tilly’s owners included repeat blood testing, intestinal function testing and abdominal imaging using radiography, ultrasound or CT. Endoscopy was also discussed as a possible next step, but cross-sectional imaging was recommended first to better understand the distribution of any intestinal or abdominal changes.

Diagnostic assessment and planning

Tilly’s owners elected to proceed with CT. This identified multiple areas of diffuse wall thickening affecting both the small and large intestine, while the remainder of the abdominal organs were largely unremarkable apart from a slightly enlarged right adrenal gland.

Concurrent haematology, biochemistry and electrolytes were within normal limits. Intestinal function testing, including pancreatic markers and vitamin B12/folate assessment, was also reassuring.

The CT findings helped refine the next decision: whether to pursue endoscopic biopsies or laparoscopic exploratory abdominal surgery with biopsies.

The relative advantages and limitations of each approach were discussed with the owners, including the amount and depth of tissue obtained, the ability to visually assess the abdominal organs, and the level of intervention involved. Estimates were provided for both options, allowing the owners to make an informed decision.

Tilly’s owners chose laparoscopic exploratory surgery and biopsy. Pre-operative coagulation testing was performed because multiple biopsies were planned, supporting safe surgical planning.

Surgery and procedure

Tilly underwent a laparoscopic-assisted exploratory laparotomy under general anaesthesia. This keyhole approach allowed visual assessment of the abdomen while keeping the procedure as minimally invasive as possible.

The liver, stomach, spleen, kidneys and gallbladder appeared within normal limits. Thickening was identified in the proximal duodenum, and the pancreas appeared mildly discoloured on visual assessment. The remainder of the small intestine appeared grossly normal.

Biopsies were taken from the liver, pancreas, jejunum and ileum, with the gastrointestinal samples obtained using a laparoscopic-assisted technique.

For owners, this means small abdominal incisions were used to examine the abdomen and obtain tissue samples. For referring vets, the key benefit was the ability to obtain more representative full-thickness intestinal samples alongside liver and pancreatic biopsies, while also assessing the abdomen directly.

Recovery and post-operative support

Tilly recovered well from her anaesthetic and was discharged the same day with clear written instructions, analgesia and a recovery suit to protect her wounds.

Her post-operative plan included strict rest, lead exercise only, daily wound monitoring, a nurse recovery check at three days and an Advanced Practitioner review at ten days.

The team maintained close contact after discharge. A post-operative check-in message was sent the following morning, and Tilly’s owners were encouraged to update the practice on comfort, appetite, drinking and toileting.

At her three-day nurse check, Tilly was bright, eating well, comfortable on abdominal palpation and had passed normal faeces. Her wounds were closed and dry, with bruising reducing.

The owners were asked to send a wound photograph for further nurse review, providing reassurance without unnecessary travel.

At her ten-day review, Tilly was doing well clinically. Her abdominal palpation was normal, and her wounds had healed immaculately.

The biopsy results were discussed, with findings most consistent with lymphoplasmacytic enteritis. Mild reactive liver changes were noted, and the pancreas was normal.

A novel protein or hydrolysed diet trial was recommended for at least eight weeks, followed by careful reassessment and staged dietary challenge if appropriate.

Discussion

Tilly’s case is a good example of how advanced imaging and biopsy can help move an intermittent gastrointestinal case from repeated symptomatic management towards a more specific long-term plan.

For referring vets, several points are worth highlighting.

The intermittent nature of Tilly’s signs, together with normal routine blood results and an unremarkable abdominal palpation, could easily have made the case appear low-yield diagnostically. However, the progressive frequency of episodes and CT evidence of intestinal thickening supported further investigation.

CT was useful in this case because it helped identify the distribution of intestinal change and supported a more targeted discussion about biopsy options.

Endoscopy can be highly valuable in gastrointestinal cases, but in Tilly’s case, laparoscopic-assisted biopsy allowed assessment of the abdominal cavity and collection of samples from multiple relevant sites, including full-thickness intestinal biopsies.

The decision-making process was deliberately collaborative. The referring practice was kept updated and the owners were given clear options with pros and cons.

Outcome

Tilly recovered well from surgery and responded positively to the management plan. Following a change in diet, her owner reported that she was “in fine fettle” and had experienced no further gastric episodes.

The outcome provided the owners with clarity and a practical long-term plan, while giving the referring veterinary surgeon a diagnosis-led framework for ongoing gastrointestinal management.

About East Kent Veterinary Referrals

East Kent Veterinary Referrals provides advanced local referral support for cases requiring further diagnostic clarity, surgical planning or minimally invasive procedures.

Cases such as Tilly’s demonstrate how CT, laparoscopy and collaborative decision-making can help provide answers while supporting continuity between the referral team, the referring vet and the owner.

We are always happy to discuss potential referrals, whether you would like advice on next diagnostic steps, case suitability, imaging options or biopsy planning.

Please contact the team for an informal case discussion or to arrange referral.