This case was recently presented in our NEW Daily Virtual Diagnostic Imaging Resident Rounds Sessions!
If you attended the session, you may remember this case. We thought it was so interesting, we’d share it here for the CaseConnexx Community!
History: Previously healthy cat attacked by 3 dogs approx 4 hours prior to radiographs being taken. Stable on presentation, wound on caudal dorsum, minor scratches elsewhere. Known to be pregnant and stress of attack believed to have brought on late term abortion, has given birth to 4 kittens so far. Last kitten is palpable, feels very cranial and close to the skin (ddx abdominal wall hernia, ruptured uterus).
Images: Three views are provided (opposite lateral and dorsoventral projections)
Based on the position of the cardiac apex, gastric fundus, and splenic head, the dorsoventral view is likely mislabeled for laterality. The pulmonary parenchyma is normal; regions of unstructured interstitial or alveolar pattern suggestive of contusions are not identified. The pleural space is normal, with no evidence of free gas or pleural effusion identified. There is no evidence of free gas within the mediastinal space; the mediastinal structures including the trachea and esophagus are within normal limits. The cardiac silhouette and pulmonary vessels are within normal limits of size and shape.
The serosal detail is adequate. On the right lateral view, there is an irregularly-shaped gas opacity in the craniodorsal abdomen that is not definitively located within the gastrointestinal tract. Linear gas opacities line the margin of the caudoventral abdominal body wall on both lateral views, with the caudal aspect of the body wall at the approximate anatomic location of the prepubic tendons being mildly indistinct, within the limitation of partial superimposition of the pelvic limbs with this region. There is focal disruption of the right lateral abdominal body wall at the level of the L2-L5 vertebral bodies, with a small intestinal segment containing a combination of gas and granular soft tissue opaque material present in the subcutaneous tissues at this location. A few small gas opacities are present in the subcutaneous tissues adjacent to this segment. A well-mineralized, near full-term fetus is present in the left uterine horn, which is moderately distended and fluid-filled; the fetus appears to be surrounded by the uterine horn on all images. On the dorsoventral view, there is the impression of a small step in the left lateral aspect of the caudal fetal skull, within the limitation that the skull is mildly rotated in the mandible is present at this location. The stomach is severely distended with granular soft tissue opaque ingesta and admixed pinpoint mineral opacities. Several small intestinal segments are approaching the upper limits of normal size to mildly enlarged in size, containing a combination of homogenous gas opacity and small amounts of granular soft tissue opacity that is similar in appearance of the gastric contents. A combination of gas and granular fecal material with admixed mineral opacities is present in the colon. The visible margins of the liver are within normal limits. The margins of the spleen and kidneys are not well identified. The urinary bladder is moderately distended.
In addition to the gas lining the caudoventral abdominal body wall, there is moderate subcutaneous emphysema in the the perineal and inguinal soft tissues as well as mild gas along the dorsal soft tissues of the lumbar spine. Multiple open physes are present, consistent with young patient age; the included skeletal structures of the study are otherwise within normal limits for patient positioning.
1. A right lateral body wall hernia is present with herniation of at least one small intestinal segment into the subcutaneous tissues at this location.
–The indistinct margination and subcutaneous gas along the caudoventral abdominal body wall is concerning for prepubic tendon rupture; severe inflammation at this location is also considered.
2. The gas opacity in the craniodorsal abdomen on the right lateral view that is not definitively identified within the gastrointestinal tract is highly suspicious for pneumoperitoneum; superimposition of subcutaneous gas due to known bite wounds is also considered.
3. The appearance of the small intestinal segments is consistent with an early or partial small intestinal mechanical obstruction, which may be secondary to incarceration of the small intestinal segment within the body wall hernia. Functional ileus is also considered.
–Granular soft tissue opaque ingesta in the stomach and several normally sized small intestinal segments likely represent recent ingestion of a meal. The pinpoint mineral opaque foreign material within the gastrointestinal tract may be due to dietary indiscretion or mineral opaque content as part of the patient’s normal diet.
4. One near full-term fetus is present within the uterus; definitive evidence of uterine rupture is not identified. The questionable step along the left caudal lateral aspect of the fetal skull may represent a positional artifact; a skull fracture cannot be entirely excluded.
5. Subcutaneous emphysema in the inguinal/perineal region and along the dorsal soft tissues of the lumbar spine is consistent with known bite wounds.
6. The thorax is within normal limits, with no evidence of pulmonary contusions, pneumothorax, pneumomediastinum, or pleural effusion.
Exploratory laparotomy is warranted for correction of the right lateral body wall hernia and for cesarean section. If further evaluation of fetal viability, the right lateral abdominal body wall hernia, and the suspected caudoventral abdominal body wall/prepubic tendon rupture is desired prior to surgical intervention, an abdominal ultrasound would be warranted.
Case Follow up:
The submitting veterinarian reported via email that the prepubic tendon was intact at the time of surgical correction of the right body wall hernia and that the final kitten was delivered alive without immediate complications.