This week we have a young adult terrier cross that presents for evaluation of emaciation, inability to gain weight, and panhypoproteinemia. This is not your run of the mill case! Post your comments below.
Teaching and learning about veterinary diagnostic imaging.
This week we have a young adult terrier cross that presents for evaluation of emaciation, inability to gain weight, and panhypoproteinemia. This is not your run of the mill case! Post your comments below.
There is severe loss of serosal detail due to the thin body condition of the patient. Multiple loops of small bowel are severely gas distended and appear to have a plicated pattern. The stomach is full of granular appearing ingesta, which is also seen extending down the duodenum on the v/d projection. An angular mineral opacity is present in the caudal small bowel. There is a convex soft tissue density seen intruding into an enlarged loop of small bowel in the dorsal abdomen on the left lateral projection.
Distended bowel loops with a convex soft tissue appearance could indicate intussusception. The foreign material in the stomach and duodenum, gravel sign, and plication suggest a linear foreign body and chronic partial obstruction. Decreased dorsal detail is likely in part due to poor body condition although the presence of peritoneal effusion is likely.
Chronic linear foreign body with multiple intussusceptions
Multiple intussusceptions containing hard-shadowing foreign material were seen on ultrasound exam. On radiographs, the intussuscepting bowel is often outlined by gas in the distal portion of the bowel loop, appearing as a blunt-ended, soft tissue opacity.
Because of poor prognosis, euthanasia was elected. The gastrointestinal tract is plicated and enlarged (white arrows) with several intussusceptions (black arrows). The plication pattern is difficult to discern because of the marked distension of the bowel loops.
The patient has a poor body condition, mild abdominal distension, and very poor abdominal serosal detail. A large amount of mottled opacity ingesta is present within the stomach as well as in a loop of intestine along the right body wall that most likely represents the duodenum. There is marked, segmental gas dilation of multiple loops of small intestine; the dilated loops in the cranioventral abdomen shouldn’t be colon and multiple small, rounded gas opacities are present in the caudoventral abdomen representing normal diameter intestinal loops. More specifically, on the VD projection, there are a couple of gas opacities that bother me: in the left cranial abdomen, there is a crescent-shaped gas-filled viscus superimposed on the left 13th rib that looks like cecum; in the right cranial abdomen, there is a large, round, gas-filled viscus.An irregular, angular, mineral opacity is present in the caudal abdomen on the left lateral projection. Radiographic diagnoses: (1) Peritoneal effusion, most likely transudate given the history of hypoproteinemia; (2) Mechanical intestinal obstruction; it would have to be a chronic partial obstruction to explain the history and the lack of vomiting, although I don’t see a gravel sign. I would still include foreign body ingestion, intestinal parasitism, intestinal stricture / adhesion. The unusual gas-filled viscuses in the cranial abdomen (and the date) make me wonder about something unusual like a colonic torsion (not classic, since I see the descending colon pretty clearly) or congenital anomaly like an intestinal diverticulum. The mineral opacity in the caudal abdomen on the left lateral projection may represent a foreign body or an unusual accumulation of indigestible material (i.e. gravel sign).
Wow – awesome case!
I’d thought intussusception based on the strange tear shaped gas bubbles and the geometric rectangular gas pattern in a loop of bowel by the left body wall (which I wrongly thought was an ileocaecocolic intussusception), but didn’t pick the linear foreign body! In retrospect I can appreciate the plication!