Case Study

Pyloric duodenal foreign body obstruction with severe gastric stasis in a 8 year old MN DSH cat, pre and post surgery

An 8-year-old NM DSH was presented for vomiting and anorexia that had been present for few days. Survey radiographs showed minimal movement of barium from stomach, the latter done the day before.

Sonographic Differential Diagnosis

Pyloric duodenal foreign body obstruction with regional inflammation and severe gastric stasis. The foreign body appeared to enter into the distal duodenum and part of the jejunum. I recommend gastric decompression and immediate exploratory surgery with intestinal biopsies to rule out underlying disease given the age of the patient. J tube placement may be most appropriate in this patient for post-operative recovery.

Image Interpretation

The stomach was severely dilated in this patient. Progressively shadowing pyloric fabric type foreign body was noted and continued into the upper duodenum. The shadowing material measured approximately 4.0 cm caudal from the pyloric outflow. There was regional inflammation. The ileocecal region was free of evident pathology. The colon was full of stool material. The right lobe of the pancreas revealed extended inflammation that was deriving from the duodenal foreign body.

DX

Pyloroduodenal foreign body obstruction with regional inflammation and severe gastric stasis

Outcome

The foreign body appeared to enter into the distal duodenum and part of
the jejunum. Gastric decompression and immediate exploratory surgery
with intestinal biopsies to rule out underlying disease given the age of the patient is recommended. J
tube placement may be most appropriate in this patient for post operative recovery.

Comments

Recheck ultrasound 4 days later – surgical duodenal resection 3 days prior, about 3-4 cm near pancreas. Unable to resect the recommended 2 cm of bowel ether side of necrosis due to proximity to pancreas. cat still anorexic, febrile.

The stomach was filled with fluid, chyme and partially shadowing material. This caused an obstructive pattern in the pyloric outflow. The caudal abdomen revealed shadowing material that measured approximately 4.0 cm. The origin of this material is not discernable owing to reactive surrounding fat. Minor, regional, mixed echogenic changes were noted throughout the pancreas.

Exploratory surgery is recommended