5 yr old DSH MN ADR with two day history anorexia
– not passing urine or stool; goes outside
– no v/d
-pyrexic at 39.3C and no evidence of cat bites wounds or scars
-abdomen tense and painful
– urinary bladder palpable but not blocked
– bloodwork unremarkable other than low K+
– fPLI normal
– will eat things he shouldn’t according to the owner
– survey rads do not show evidence of an obstructuve patten but there is a thickened loop of bowel in the mid-abdomen
5 yr old DSH MN ADR with two day history anorexia
– not passing urine or stool; goes outside
– no v/d
-pyrexic at 39.3C and no evidence of cat bites wounds or scars
-abdomen tense and painful
– urinary bladder palpable but not blocked
– bloodwork unremarkable other than low K+
– fPLI normal
– will eat things he shouldn’t according to the owner
– survey rads do not show evidence of an obstructuve patten but there is a thickened loop of bowel in the mid-abdomen
– abdominal u/s mostly unremarkable other than an abnormal loop of bowel shown with surrounding hyperechoic mesentery and enlarged LN’s
– submucosal layer is thickened and there is fluid in the lumen with hyperechoic regions with a dirty shadow
Could this be a FB? Focal enteritis?
Comments
With there pyrexia, abdominal
With there pyrexia, abdominal pain and ultrasonographic changes I would be suspicious for intestinal perforation either from foreign body, enteritis (bacterial/granulomatous), or lymphoma.
Laparotomy would give both a diagnosis and therapy, and often the sooner the better to reduce potential complications. Another approach would be systemic antibiotics, fluids with potassium, and to monitor the abdomen by ultrasound and see what develops.
With there pyrexia, abdominal
With there pyrexia, abdominal pain and ultrasonographic changes I would be suspicious for intestinal perforation either from foreign body, enteritis (bacterial/granulomatous), or lymphoma.
Laparotomy would give both a diagnosis and therapy, and often the sooner the better to reduce potential complications. Another approach would be systemic antibiotics, fluids with potassium, and to monitor the abdomen by ultrasound and see what develops.
Jacquie, image 2 right in the
Jacquie, image 2 right in the middle see that hyperechoic ill-defined fat and how its attached to the serosa? This is the body’s own band-aid and tells you that this part of the bowel it the issue and there are some reactive nodes around as well. Transmural lesion like this ddx spontaneous necrosis, emerging lsa, mct and dry form fip, +./- bowel infarction
Cutting these out with intraoperative US is best in my opinion that way you don’t have to wait and see if it will settle down medically, which happens but you have to baby sit it with the probe daily and monitor the focal pain (+murphy sign) because you don’t know if there is a perf or bowel infarction starting. Plus if you are cutting it yourself is one thing but unfortunately the surgeons don’t see what we see and often sample the wrong region or don’t resect enough. Intraop US resolves this.
see cases of the month
april 2011
June 2011
Jan 2011
Dec 2010
Jacquie, image 2 right in the
Jacquie, image 2 right in the middle see that hyperechoic ill-defined fat and how its attached to the serosa? This is the body’s own band-aid and tells you that this part of the bowel it the issue and there are some reactive nodes around as well. Transmural lesion like this ddx spontaneous necrosis, emerging lsa, mct and dry form fip, +./- bowel infarction
Cutting these out with intraoperative US is best in my opinion that way you don’t have to wait and see if it will settle down medically, which happens but you have to baby sit it with the probe daily and monitor the focal pain (+murphy sign) because you don’t know if there is a perf or bowel infarction starting. Plus if you are cutting it yourself is one thing but unfortunately the surgeons don’t see what we see and often sample the wrong region or don’t resect enough. Intraop US resolves this.
see cases of the month
april 2011
June 2011
Jan 2011
Dec 2010
No FB just focally
No FB just focally dysfucntional bowel with a little stasis before the lesion. Technically the echogenic material in the lumen could be hair or similar but likely just ingesta hung up a bit but not the issue here, the bowel wall is the problem whatever histopath is looming. My guess is complicated ibd with a bad bacteria having a party with friends but run the histopath so you aren’t surprised and if its neoplasia or fip you got it early. FIP in these scenarios can do very well in my experience…its a localized form of dry fip. Remo do you have any of these focal dry FIP cases archived? I have a few in the archive including the case of the month mentioned.
No FB just focally
No FB just focally dysfucntional bowel with a little stasis before the lesion. Technically the echogenic material in the lumen could be hair or similar but likely just ingesta hung up a bit but not the issue here, the bowel wall is the problem whatever histopath is looming. My guess is complicated ibd with a bad bacteria having a party with friends but run the histopath so you aren’t surprised and if its neoplasia or fip you got it early. FIP in these scenarios can do very well in my experience…its a localized form of dry fip. Remo do you have any of these focal dry FIP cases archived? I have a few in the archive including the case of the month mentioned.