12 year-old, Female, Spayed, Boston Terrier

History: Presented after being at referring DVM, who was concerned about a possible GDV.  The mucous membranes are pale, and the pulse is weak.  Patient is a known diabetic.

Images:

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Findings:

The abdomen is distended. The stomach is markedly distended with gas. There is diffuse, severe small intestinal dilation with stippled gas and fluid opacity luminal contents. Serosal contrast is diminished.  The kidneys and urinary bladder are not clearly defined. Spondylosis deformans is present. Anomalous vertebrae compatible with patient breed are also present. No other significant findings are noted.

Conclusions:

1.There is diffuse, marked, small intestinal dilation. Given the extent of involvement and size of the affected intestinal loops, mesenteric root torsion is the most likely diagnosis. Distal small intestinal obstruction is less likely due to the degree of intestinal distension and the distension of the stomach.  Infarction of the cranial mesenteric artery with secondary paralytic ileus cannot be ruled out.

2.Dysautonomia is unlikely given the lack of other common signs, such as dysuria, mydriasis, absent pupillary light response, decreased tear production, dry mucous membranes and decreased anal tone.

3.The reduction in serosal contrast is most likely due to crowding.  A small amount of abdominal fluid is not ruled out; this would not be unexpected.

4.The volvulus likely had no association with the diabetes mellitus.

Recommendations:

An exploratory laparotomy is indicated as soon as possible.

Discussion:

Mesenteric volvulus usually results in occlusion of the cranial mesenteric artery and vein, leading to vascular obstruction and venous congestion of the bowel. Complete mesenteric volvulus is an emergency and a laparotomy is indicated. Death is usually due to shock and endotoxemia.  Patients can survive if surgery is initiated early in the disease; 5 of 12 patients in one report survived (1).  A chronic partial mesenteric volvulus associated with a 4-month history of gastrointestinal signs has been reported in a dog.  In radiographs of this dog, there was initially marked gas distension of the small intestine compatible with an obstruction.  24 hours later the obstructive gas pattern had resolved (2).

References:

1.Junius G, Appeldoorn AM, Schrauwen E. Mesenteric volvulus in the dog: A retrospective study of 12 cases. J Small Anim Pract. 2004;45:104–107.

2.Spevakow AB, Niblett BMD, Carr AP, Linn KA.  Chronic mesenteric volvulus in a dog.  Can Vet J 2010;51:85-88.

3 comments

  1. Findings: The entire small intestinal tract is gas filled and distended.

    Conclusion: Jejunal volvulus. DD Functional ileus of other reason less likely.

    Recommendations: Explorative surgery.

  2. Findings:
    Laterolateral and ventrodorsal views of the abdomen. There is a loss of serosal detail. All the intestines are severely dilated with gas, and some of the intestinal loops contain material of a mixed opacity, soft-tissue with small gas bubbles. The small and large intestine can’t be differentiated from each other. The fundus of the stomach is best seen on VD view, mildly gas-dilated. Spleen is small, from the VD view in a normal position and normal shape. No other organs could be evaluated.
    Conclusion:
    Severe homogenous intestinal dilation indicates paralytic ileus. Very suggestive of mesenteric volvulus.
    Suspicion of a free fluid in the peritoneal cavity.
    Recommendation:
    Exploratory laparotomy

  3. Orhthogonal projection of the Abdomen of a skeletally mature dog in normal body condition.
    In the dorsoventral projection the cranial abdomen is not visible.

    The abdomen is mildly to moderate distended.
    The peritoneal detail is mildly reduced.
    The majority of the small bowel loops are filled with gas and severly distended. Multiple stacked and hair pins formed small bowel loops can be identified.
    The distended small bowels loops fill the whole abdomen and create a masse effect with visceral crowding.
    The stomach is mederately filled with gas and mildly displaced to the left.
    The colon descendens can be identified in the left caudal abdomen (normal position). The remaining colon is not completely delineable.

    The liver extends caudally to the rib cage and is not completely delineable.
    The head of the spleen lies in normal position.

    The retroperitoneal space cannot be assessed.

    Mild smooth and solid new bone formation ventrally to multiple vertebral bodies (Th10-L1, L3-S1) with mild narrowing of theintervertebral disc space between L2-3).

    Severe, generalised small bowel loops distension with mild loss of the peritoneal detail.
    Suspicion of hepatomegaly.
    Mild spondylosis deformans of Th10-L1, L3-S1.

    Together with the clinical condition of the dog are the radiographic findings highly suspicious for a mesenteric volvolus. A partially intestinal volvolus is also possible, however less likely. A paralytic ileus is much less likely.
    After stabilisation an emergency explorative celiotomy is advised.

    Ad loss of peritoneal detail: visceral crowding, peritoneal effusion.
    Ad Hepatomegaly: most likely glycogen storage disease cause by the diabetes mellitus. Differentials: other storage disease, chronic hepatitis, neoplesia.

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