Surgical Resection in Refractory Canine IBD: What a Maltese Case Reveals About Managing Severe PLE

Inflammatory bowel disease (IBD) in dogs is typically regarded as a medically managed condition, with dietary therapy and immunosuppressive agents forming the foundation of treatment^1,2. Yet, occasional cases challenge conventional expectations, particularly when protein-losing enteropathy (PLE), persistent hypoalbuminemia, and focal intestinal lesions complicate disease progression. 

A recent case involving a geriatric Maltese dog illustrates how surgical intervention, although not routinely recommended in canine IBD, may provide unexpected clinical benefit in carefully selected patients. 

A Stable IBD Patient Suddenly Deteriorates¹ 

The patient was a 14-year-old spayed female Maltese weighing 2.2 kg with a 2-year history of stable IBD management using prednisolone at 0.25 mg/kg q12h. The dog had tolerated long-term corticosteroid therapy well and had not demonstrated significant adverse effects. However, the clinical picture changed abruptly with the onset of diarrhea and progressive hypoalbuminemia. 

Serum albumin concentrations declined from values above 2.0 mg/dL to as low as 1.5 mg/dL despite escalation of prednisolone therapy to 1 mg/kg q12h. Importantly, the patient had previously failed to respond to mycophenolate mofetil, limiting additional immunosuppressive options. 

For clinicians, this scenario reflects a common frustration in refractory canine IBD cases: worsening gastrointestinal signs and declining albumin levels despite escalation of conventional therapy. 

Imaging Changed the Clinical Direction¹ 

Because of the dog’s deteriorating status and poor therapeutic response, abdominal ultrasonography was performed to rule out alternative gastrointestinal pathology. Imaging revealed a focal small intestinal mass lesion. Computed tomography further characterized the lesion as localized within the small intestine, measuring 25 mm in length, 4.6 mm in height, and 4.3 mm in width. 

At this stage, differentiating severe inflammatory disease from intestinal neoplasia became clinically essential. While diffuse intestinal thickening may commonly accompany IBD, focal lesions should prompt veterinarians to reconsider differential diagnoses, particularly in geriatric patients. 

The decision to proceed surgically was therefore driven primarily by diagnostic necessity rather than curative intent. 

Postoperative Improvement and Albumin Stabilization¹ 

Following surgical resection of the affected intestinal segment, histopathology confirmed the lesion was inflammatory rather than neoplastic in origin. Postoperative management included a single albumin transfusion, increasing serum albumin levels from 1.6 mg/dL preoperatively to 2.8 mg/dL afterward. 

Interestingly, the dog demonstrated sustained clinical improvement during the subsequent 2-month follow-up period. Prednisolone dosage was successfully reduced to 0.25 mg/kg PO q24h, while serum albumin concentrations remained comparatively stable relative to presurgical values. 

Although intermittent diarrhea occurred shortly after surgery, gastrointestinal signs stabilized within 2 weeks, with resolution of diarrhea and soft stools. 

This outcome highlights an important clinical consideration: while surgery is not standard treatment for canine IBD, removal of severely affected intestinal segments may occasionally reduce inflammatory burden sufficiently to improve clinical control in selected refractory cases. 

Important Surgical Limitations and Clinical Cautions 

Despite the favorable outcome in this case, surgical resection should not be interpreted as routine therapy for canine IBD. Unlike localized surgical diseases, IBD is typically diffuse throughout the intestinal tract, limiting the curative potential of segmental resection. 

Veterinarians must also consider significant postoperative risks. Extensive bowel resection can result in maldigestion, malabsorption, bile acid dysregulation, and chronic colonic diarrhea due to disruption of normal intestinal microbiota. Additionally, factors such as preoperative steroid exposure, poor nutritional status, and recurrent disease flares increase the risk of septic complications and impaired healing^1,3. 

Consequently, surgery should remain reserved for carefully selected cases where diagnostic uncertainty persists, focal lesions are identified, or medical therapy has clearly failed despite comprehensive management. 

Clinical Takeaway for Practitioners 

This case reinforces an important principle in veterinary gastroenterology: refractory IBD cases require clinicians to continually reassess both diagnosis and treatment strategy. Before considering surgery, medical management should remain the priority, including optimization of diet, antibiotics, immunosuppressants, probiotics, prebiotics, and even fecal microbial transplantation. 

However, when focal intestinal pathology develops in a medically unresponsive patient, surgical exploration and resection may occasionally provide both diagnostic clarity and meaningful clinical improvement. 

Reference 

1. Ha JH, Jeong Y, Kwak HH, Choi S, Ahn JO, Chung JY. Prognosis for surgical intestinal resection in inflammatory bowel disease refractory to medical treatment in a dog. The Canadian Veterinary Journal. 2025 Dec 1;66(12):1303-7. https://pmc.ncbi.nlm.nih.gov/articles/PMC12825713/ 

2. Craven MD, Washabau RJ. Comparative pathophysiology and management of protein-losing enteropathy. Journal of veterinary internal medicine. 2019 Mar;33(2):383-402. https://academic.oup.com/jvim/article/33/2/383/8448101 

Zhang R, Ray JW, Jain MK, Han S. Ileectomy-induced bile overaccumulation in mouse intestine. Journal of Visualized Experiments: JoVE. 2017 Aug 21(126):55728. https://pmc.ncbi.nlm.nih.gov/articles/PMC5614358/pdf/jove-126-55728.pdf