Case Study

Pancreatic abscessation and pancreatitis in a 10 year old FS Labrador Retriever mixed breed

This 10-year-old FS Labrador cross presented for profound lethargy and anorexia. The physical exam revealed only moderate pyrexia. The CBC and blood chemistry analysis were normal except for slight elevations in glucose and SAP. The patient responded fairly well to 72 hours of IV support and antibiotics and was discharged. The sonogram was performed 1 week after discharge to assess for sequelae to the presumptive diagnosis of pancreatitis.

This 10-year-old FS Labrador cross presented for profound lethargy and anorexia. The physical exam revealed only moderate pyrexia. The CBC and blood chemistry analysis were normal except for slight elevations in glucose and SAP. The patient responded fairly well to 72 hours of IV support and antibiotics and was discharged. The sonogram was performed 1 week after discharge to assess for sequelae to the presumptive diagnosis of pancreatitis.

Sonographic Differential Diagnosis

Pancreatic abscess, necrosis with moderate adjacent peritoneal inflammation; potential underlying neoplasia.

Image Interpretation

A well encapsulated, thick walled cystic structures present within the distal left limb of the pancreas. The cystic structure is filled with echogenic fluid and a moderate amount of hyperechoic sediment is present within the dependent portion. No tissue detail is noted in the video of the lesion and complete loss of curvilinear structure is evident suggesting necrosis, abscessation and potentially neoplasia. The bordering soft tissues are echogenic consistent with referred inflammation.

DX

Pancreatic abscessation and pancreatitis due to penetrating wooden meat skewer

Outcome

The patient responded well to enterotomy and partial pancreatectomy and was discharged after 5 days of hospitalization.

Comments

The wooden skewer was not visible during the sonogram due to extensive mesenteric adhesions and inflammation. The choice of direction for this case was exploratory surgery with expectation of partial left limb pancreatectomy which prompted referral to a specialized surgical facility.

Clinical Differential Diagnosis

Pancreas: pancreatitis. G.I.: gastroenteritis, peritonitis, neoplasia.

Sampling

Surgical exploratory at a specialist facility revealed a penetrating wooden meat skewer into the left limb of the pancreas causing abscessation and pancreatitis.