4 month-old, Female, Intact, Pitbull

If you attended IDEXX Daily Virtual Rounds (North America) with Dr. Mason Savage, you saw this case presented and discussed it with the group. The answer is below!

History: Patient has diarrhea and is thin.  Has not thrived.

Findings:

Survey Radiographs :

The stomach is mildly distended with granular material, possibly ingesta

A heterogeneous mass effect is present in the left cranial aspect of the abdomen with linear adjacent gas accumulation

Barium Series:

In the 10-minute images the barium appears normal.  There is a large soft tissue mass surrounded by gas in the left cranial aspect of the abdomen in the territory of the left colonic flexure.

In the 60-minute images barium has advanced into the colon.  There is a large soft tissue filling defect in the colon with a “coiled” appearance.  A thin column of barium is present in the center of this filling defect.

Radiographic Diagnosis : Ileocolic intussusception

Stock Pitbull Photo by Justin Veenema on Unsplash

3 comments

  1. Hi All

    Very cool case. My thoughts

    We are provided with RLR and VD survey abdominal radiographs, followed by positive contrast GI study (barium), with a series of RLR and VD radiographs (not timestamps) with contrast transiting through the small intestine, and on the last series reaching the rectum.

    On the survey studies, there is reduced serosal detail, but within normal limits for the age of the dog. The stomach is moderately distended by gas-speckled soft tissue content but remains within the costal arch and normal in position. On the VD, the duodenum is challenging to identify, but the orad segment of the descending duodenum contains a small amount of fluid and gas. The jejunum is located in the mid-caudal abdomen, and are moderately distended by gas and fluid. In several of the segments are small collections of gas-speckled luminal content. In the craniodorsal abdomen and caudal to the stomach, is a soft tissue mass effect. It appears tubular and is in the region of the transverse colon. Within it is a thin crescent of gas. The descending colon contains a small amount of gas.
    The liver, dorsal extremity of the spleen, and region of the kidneys and urinary bladder, abdominal wall, included thorax and musculoskeletal system are normal in appearance.

    Following the administration of positive contrast, there is good opacification of the stomach and small intestine. On the earlier series, there are small, variable-sized, smooth margined ovoid filling defects within several segments of jejunum. The small intestine is not overdistended and normally distributed. On the earlier contrast series, there is a tubular soft tissue mass extending within the transverse and descending colon, bordered by gas. This is confirmed in the last series, where there is a large tubular filling defect extending through the ascending, transverse, and descending colon, which are all moderately distended. The filling defect terminates in the mid descending colon with a smooth, convex margin (meniscus sign). The filling defect has a thin line of contrast extending longitudinally along its axis. There is barium within the lumen of the colon from the ileocolic junction to the rectum. The stomach has emptied of barium, and there is persistent contrast in the aborad small intestine. There is no evidence of contrast extravasation.

    Interpretation – ileocolic (jejunocolic) intussusception with incomplete intestinal obstruction

  2. Serial abdominal contrast (Barium P.O. administration) study of a young dog with reduced body condtion.

    The diaphragm is delineable.
    The retroperitoneal detail is noral. The peritoneal detail in the mid abdomen, caudal to the stomach is focally mildly reduced.
    The liver has an unremarkable size and shape, the margins are pointed.
    The spleen head is in normal position and is unremarkable.
    The cranial contour of the left kidney is delineable and unremarkable. The right kidney cannot be identified. The urinary bladder is not delineable.

    The stomach and small intestines shows an unremarkable filling and complete passage (no time mark) of positive contrast media. The caecum lies in normal position and is unremarkable. Part of the colon, probably the colon ascendens, transversum and the most oral part of the colon descendens, is moderately distended and gas filled. The serosal surface of this colonic portion is mildly irregular. The continuity of this distended colon segment is oral and aboral not completely delineable. The last segment of the colon descendens has a narrower and unremarkable diameter. There is no appreciaple “torsion sign”.

    Moderate segmental distension of the colon with irregular serosal surface and unclear connection with the adjacent colonic segment.
    Reduced peritoneal detail – young age, minimal peritoneal effusion.

    Differentials: congenital colon malformation. Less likely: 360° colonic torsion, colitis (infectious, inflammatory), pneumotosis coli?

    A negative contrast colonogramm (after barium excretion) could better characterize the course of the colon.

    Difficult case… I’m probably missing something…

  3. Abdominal radiographs in right lateral and ventrodorsal views are provided as a survey study, normograde positive gastroenterography and probably retrograde positive colonography.
    Survey abdominal radiographs show a lack of detail in meso- and hypogastrium. The stomach is filled with a granular soft-tissue opacity admixed with gas and mildly dilated. There is a heterogenous dilation of small intestines and filled with gas and granular soft-tissue opacity (similar as in the stomach). In the right midportion of the abdominal cavity (region of caecum/colon ascendens) an enlarged gas-filled intestinal loop is visible with a sharp gas and soft-tissue border present. The normal caecum is not visible. Another sharply marginated interface of soft-tissue and gas opacities is present on the left side in the region of colon descendens.
    The liver and spleen are unremarkable. Kidneys and urinary bladder are not visible, probably due to superimposition. Proximal physes of femurs and vertebral physes are opened.
    The positive normograde gastroenterography shows a normal filling of the stomach and most of the small intestines with contrast medium. An abrupt and sharp ending of contrast material is visible in a loop of the small intestine (susp. ileum) in the region of the caecum. There is a small amount of contrast medium in the left cranial quadrant, the region of the colon descendens, that is not filling completely the colonic lumen. A well-marginated band of gas opacity is present in this region between the contrast material and colonic wall. The same region shows on the next postcontrast study a peripheral distribution of contrast medium and the same appearance is present in colon transversum. This is compatible with some radiolucent/soft-tissue material obstructing most of the lumen of these parts of the colon. A filling defect in the region of caecum and colon ascendens.
    All these findings are giving a strong suggestion for caeco-colic instususception. Obstruction of colon transversum and part of colon descendens is evident. A linear foreign body cannot be excluded. Another reason for intussusception could be severe enteritis. The loss of serosal detail could be the variability of normal finding giving the young age of the patient, but a free peritoneal fluid cannot be excluded.

    Ultrasound examination of the abdominal cavity should be done as a next diagnostic step. If the intususception is confirmed a laparotomy is indicated.

    Very nice case. For me was not easy because of the two postcontrast series.

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