Vomited twice since yesterday, ate table scraps yesterday. rDVM worried about radiographs, sent for referral. Comfortable on palpation. Normal lactate. Images taken at 11AM, 3PM, and 7PM. Presenting Complaint: Vomiting
11 am composite of images:
3 pm composite of images:
7 pm composite of images:
QUESTIONS TO ASK ONESELF:
- Where is the cecum on all images?
- Where is the colon dilated and normal, and can the path be traced?
- Does the history match the findings and does that alter the diagnosis?
11AM FINDINGS: The ascending though mid descending colon are dilated with gas and somewhat formed fecal material, with variable dilation of the distal descending colon. The majority of the cranially positioned colon is within the right abdomen. The cecum is within the left abdomen. The stomach is empty. The small intestines are within normal limits for size and contents. No abnormalities of the liver, spleen, kidneys, retroperitoneal space, urinary, or region of the prostate or urethra are seen. Serosal detail is adequate. The caudal thorax, osseous structures, and external soft tissues are unremarkable.
3PM FINDINGS: The findings are similar, though the cecum is now in the right abdomen. The stomach also now contains a mild amount of gas and soft tissue material.
7PM FINDINGS: The transverse colon is now severely distended with gas, though the ascending and mid to proximal descending colon are only mildly dilated with semi-formed fecal material. There is focal tapering of the dilation at the level of the mid descending colon, with the distal descending colon being empty. The cecum is to the left of midline. The stomach contains a similar small amount of gas and soft tissue. The small intestines are relatively empty.
CONCLUSION: These findings are consistent with a progressive colonic torsion, likely a 360 degree torsion at the level of the mid descending colon.
RECOMMENDATIONS: Exploratory laparotomy is recommended.
Textbook of Veterinary Diagnostic Radiology: The Large Bowel [Chapter 48 in the 7th ed]
Gagnon, Dominique, and Brigitte Brisson. “Predisposing factors for colonic torsion/volvulus in dogs: a retrospective study of six cases (1992–2010).” Journal of the American Animal Hospital Association 49.3 (2013): 169-174.
Gremillion, Christine L., Mason Savage, and Eli B. Cohen. “Radiographic findings and clinical factors in dogs with surgically confirmed or presumed colonic torsion.” Veterinary radiology & ultrasound 59.3 (2018): 272-278.
Plavec, Tanja, Stefan Rupp, and Martin Kessler. “Colonic or ileocecocolic volvulus in 13 dogs (2005‐2016).” Veterinary Surgery 46.6 (2017): 851-859