This week’s KCC was hosted by one of our emeritus faculty with some excellent abdominal cases. The ultrasound machine was “broken” all night, so we got to look at some special studies. It brought up some debate on the choice between ultrasound and an upper GI as well. The bowel is difficult to evaluate on ultrasound. If you have the skill level, you’ll get the images to make the diagnosis. But an upper GI is an excellent tool because the information is all there. You can always send it for help with interpretation. What do you choose to do more often?
Case 1
9 year old female spayed Labrador with vomiting. There were multiple loops of enlarged small intestine with a corrugated or plicated appearance. Several of these contained many small gas bubbles. There was foreign material in the pylorus on the v/d projection, but no left lateral projection available for better evaluation. (Left lateral fills the pylorus with gas, a great trick for outlining foreign bodies lodged there – see this case for an example.) There was also a linear mixed opacity in the otherwise empty colon. Diagnosis: Linear foreign body – carpet! The carpet strands were also present in the colon.
Case 2
6 year old female Golden Retriever. Vomiting for one week, worsening over the last few days. On the lateral radiograph, there was a focal area of poor detail in the mid-ventral abdomen. This area had a mottled appearance. There were no enlarged bowel loops or other abnormalities. Differentials for the poor detail included focal peritonitis or other small effusion. Given the history of vomiting, an upper GI was requested. On the 15 minute v/d projection, there was leakage of barium from the cranial aspect of the proximal duodenal flexure, with tracking along the right body wall. Diagnosis: Duodenal perforation. The animal had a history of NSAID administration. A duodenal ulcer was resected.
Case 3
2 year old male neutered Labrador Retriever. Acute onset of vomiting. On the radiographs, there was some regular shaped granular material that may have been in small intestine or colon. Some of the small intestinal loops were upper limits of normal size. Since obstruction was suspected, an upper gi was performed. On the 1 hour radiographs, there were several ill-defined filling defects in the pylorus. There were also several radiolucent foreign bodies outlined by barium in the jejunum. In retrospect there was one visible on the pre-contrast radiographs. Diagnosis : Peach pit foreign bodies! They passed during the upper GI. These have a very characteristic look with air inside the seed.
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