Case Study

Multiple Gastric Foreign Bodies in a 9 year old MN Pug dog

This 9-year-old MN Pug was presented for persistent vomiting and anorexia over one week that was non responsive to medical therapy over the prior 36 hours. The physical exam of the dog revealed moderate dehydration despite aggressive fluid therapy, multifocal pain on abdominal palpation, mild fever, and weight loss. CBC revealed moderate leukocytosis with toxic neutrophils, Dohle bodies and mild regenerative anemia. The blood chemistry analysis demonstrated mild to moderate hypoalbuminemia, mild hypoproteinemia, and slightly elevated amylase. Urinalysis was normal.

This 9-year-old MN Pug was presented for persistent vomiting and anorexia over one week that was non responsive to medical therapy over the prior 36 hours. The physical exam of the dog revealed moderate dehydration despite aggressive fluid therapy, multifocal pain on abdominal palpation, mild fever, and weight loss. CBC revealed moderate leukocytosis with toxic neutrophils, Dohle bodies and mild regenerative anemia. The blood chemistry analysis demonstrated mild to moderate hypoalbuminemia, mild hypoproteinemia, and slightly elevated amylase. Urinalysis was normal.

DX

Multiple gastric foreign bodies

Sonographic Differential Diagnosis

Gastrointestinal obstructive pattern with complicated inflammatory disease and risk of perforation. Intestinal and gastric foreign body.

Image Interpretation

Image 1: Softly shadowing gastric FB. Image 2: Linear duodenal FB. Image 3: Jejunal obstruction. Image 4: Omental adhesion associated with small intestine with deviation of intestinal contour suggestive of perforation.

Outcome

The patient responded well initially over the following 72 hours but then declined with signs of vomiting, fever, and abdominal pain. Repeat blood analysis revealed increases in the leukocytosis and rapidly declining albumin. Repeat sonogram revealed multiple adhesions and echogenic free fluid consistent with peritonitis. A positive fluid culture revealed resistant Enterococcus, Proteus mirabilis, and Staphylococcus intermedius. The patient was explored again confirming peritonitis, and adhesions. Dehiscence of the duodenal anastomosis site had occurred. This portion was resected and anastomosed with abdominal lavage and j-tube placement. The patient died 8 hours postoperatively.

Clinical Differential Diagnosis

GI pathology – Pancreatitis, GI ulceration, GI obstruction, PLE, IBD, neoplasia.

Sampling

Exploratory laparotomy was performed after plasma expander therapy was initiated. Gastrotomy revealed luminal foreign body of half of a man’s sock with a gastroduodenal linear foreign bodies (elastic hair band with a metal crimp). These were removed via gastrotomy. The linear duodenal foreign body as well as the bottom half of the man’s sock were obstructing the lumen (image 2/3) and were associated with several small intestinal perforations. Adhesions associated with the duodenum overlying the serosa were evident (image 4). Biopsies of the small intestine revealed ulcerative enteritis with transmural necrosis and subacute fibrinosuppurative inflammation.