2.5 year old male neutered Golden Retriever

History: Poor appetite for 4 days. Vomited twice 3 days ago. Lethargic. Had Cerenia 2 days ago and the next days there was no more vomiting.

Ate 1 cup chicken and rice at 6:00 pm last night-no food since. Blood work pending.

Images:

 
  
  

Questions to ask upon reviewing Radiographs:

  1. Is the history accurate and how does that affect what I think the contents of the stomach are?
  2. What do I think of the small intestinal pattern, especially in the right abdomen on the ventrodorsal projection?
  3. Is there evidence of perforation?

Still images from Ultrasound, performed 6 hours post radiographs:

Questions to ask upon reviewing Ultrasound images:

  1. How complete do I think the sonographer was and what do I know to be true based on the radiographs?
  2. Do I believe the radiographs or the ultrasound more, and would it make a difference in my recommendations?

Findings (Abdominal Radiographs):

There is a moderate amount of heterogeneous soft tissue material within the stomach as well as short wispy mineral to faint metallic strands and a short thin curvilinear metallic wire.  The small intestines are diffusely plicated with multiple irregular small gas opacities.  The largest loop of intestine containing gas likely represents the colon +/- cecum.  The colon also contains normal fecal material.  No abnormalities of the liver, spleen, kidneys, retroperitoneal space, urinary bladder, or region of the prostate or urethra are seen.  Serosal detail is adequate.  The caudal thorax is unremarkable.  The osseous structures and external soft tissues are unremarkable.

Conclusions: There is a small intestinal linear foreign body with a moderate amount of gastric foreign material +/- food.  There is no evidence of perforation.

Recommendations: Exploratory laparotomy is recommended.

Results:   The patient went to exploratory laparotomy. A linear foreign body was not present, however he passed pantyhose in his stool during recovery. A gastrotomy was performed yielding socks, underwear, and human hair out of his stomach.

References:

Textbooks:

Textbook of Veterinary Diagnostic Radiology: The Small Bowel [Chapter 45 in the 7th ed]

Atlas of Small Animal Ultrasonography: Gastrointestinal Tract [Chapter 8 in either edition]

Small Animal Diagnostic Ultrasound: Gastrointestinal Tract [Chapter 12 in the 3rd edition]

Journals:

Root, Charles R., and Peter F. Lord. “Linear Radiolucent Gastrointestinal Foreign Bodies in Cats and Dogs: Their Radiographic Appearance 1.” Veterinary Radiology 12.1 (1971): 45-52.

Hoffmann, Karon L. “Sonographic signs of gastroduodenal linear foreign body in 3 dogs.” Veterinary Radiology & Ultrasound 44.4 (2003): 466-469.

Tyrrell, Dayle, and Cathy Beck. “Survey of the use of radiography vs. ultrasonography in the investigation of gastrointestinal foreign bodies in small animals.” Veterinary Radiology & Ultrasound 47.4 (2006): 404-408.

Hayes, G. “Gastrointestinal foreign bodies in dogs and cats: a retrospective study of 208 cases.” Journal of small animal practice 50.11 (2009): 576-583.

 

5 comments

  1. Looks like a linear foreign body to me – cloth or something like tinsel maybe, in the stomach and small intestine. There is also a thin metal-opaque, wire-like FB in the stomach. The stomach is moderately distended with this material, multiple segments of the small intestine are crowded, plicated and gas distribution is abnormal (small tear-shaped or geometrical gas pockets). Preserved peritoneal serosal details and no free gas, likely no GI tract perforation.
    History may not be very accurate. US does not really support the radiographic appearance – the US study may be limited, I would not change the radiographic diagnosis.

  2. I would have diagnosed a SI linear FB with resultant mechanical obstruction and sent the dog to surgery without further diagnostics. The gastric material does not look like normal ingesta (or the reported chicken and rice) and has some features of cloth, with areas of striation. Given the delay between the rads and ultrasound, it is possible that the linear component of the foreign body is not anchored in the stomach, but to a separate piece that made it partially through the small intestines and then started the plication. Alternatively, the segment labeled duodenum was actually jejunum and the affected segment was never imaged.

  3. Thank you to share this beautiful case!!

    The small intestine (likely including also the proximal duodenum) has a markedly diffuse plicated appearance with hair pin turns. In the small intestine there are multiple tear-drop, crescent to triangular and several other geometrical irregular sharply shaped intraluminal gas opacities. Additionally the small intestine is markedly bounded in a mass like fashion (ventral to the descending colon, level of L6 in a caudal lateral view it has a circular-concentric appearance with multiple eccentric tear-drop shaped intralunimal gas). In the stomach there is a moderate to marked amount of heterogeneous soft tissue and gas opacity content with a striated appearance and a curvilinear thin metallic object (lenght of a vertebral body approx). In the colon a small amount of formed fecal material is present.
    The serosal detail is adequate.
    Liver, spleen, kidneys/retroperitoneal space, urinary bladder and skeletal structure within normal limits.
    Caudal thorax: equivocal caudal vena cava decreased thickness. No signs of aspiration pneumonia.
    Summary:
    -marked small intestinal plication
    -striated gastric content
    -non obstrcutive gastric metallic foreign body
    -CVC equivocally decreased in size
    Conclusion:
    Gastrointestinal (or at least small intestinal) mechanical obstruction due to a linear (likely textile, fabric) foreign body.
    Surgery is indicated.
    Suspect hypovolemia.

    Comments:
    I would believe more the rx than the US (eg. no plication pattern with linear foreign body visible and not really convinced about the image labelled as duodenum), but it likely confirms no abdominal effusion, irreguarly shaped acoustic shadowing gastric content.
    The intestinal loops ventral to L5 have a spectacular apperance (peony flower? on VD it doesn t appear, but can it be like a partial “whirl sign” or it is just superposition of the plicated loops?).

    Thank you again for the case and your time!

      1. Hi Daniel! Thank you for taking time and read my long description and comments!:))
        Actually, it was my question too..In humans it is described in both CT and ultrasound (US mainly for pediatric patients: https://doi.org/10.1148/radiol.2403040370). Maybe performing a study applying compression that loop would be just plicated, but to me it has a very unusual appearance..that increased my curiosity..Lets see if anybody else has other input!

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