Case Of the Month

Double Foreign Body In 1-Year-Old Intact Female Labrador/Great Dane Mixed Breed: Our Case Of the Month 2021

A 1-year-old, intact female Labrador Retriever/Great Dane mixed breed was presented for intermittent vomiting. Physical exam found the patient to be thin with pale mucous membranes, and missing left foreleg. The patient was treated with Cerenia after owner deferred diagnostics; while on Cerenia no vomiting was reported. Abdominal ultrasound was performed 12 days after initial visit.

DX

Moderate to marked chronic gastritis with strongly shadowing gastric luminal echo-strongly suspicious for gastric foreign body. Perigastric reactive to inflamed mesentery and mild free fluid- potential for perigastric peritonitis. Suspect reactive to mild vacuolar hepatopathy. Minor gallbladder debris

Outcome

From SonoPath ultrasound report: “Minor potential for gastric mural neoplastic process cannot be excluded yet thought less likely given the subjective intact wall layering and age of the patient. Exploratory laparotomy with expectation towards gastrotomy. Gastric mural biopsies for histopathology +/- culture and sensitivity as well as possible abdominal flush given the potential for perigastric peritonitis recommended.” The patient underwent exploratory surgery on 9/9/21. An entire whole softball core was found in stomach fundus, in addition to an ulcer, a walled off “corndog stick” in the abdomen, and some peritonitis. The patient did well post-operatively and was discharged to the owners. The owners believe the obstruction was there for as long as six weeks!

Image Interpretation

Gastrointestinal: The stomach presented moderate to marked gastric mural thickening with subjective intact wall layering primarily noted in the area of the gastric fundus and body. The ventral gastric body wall measured 1.7 cm in diameter. A mild amount of retained fluid and echogenic ingesta along with strongly shadowing mild asymmetrical to potentially ovoid luminal echo measuring 4.0-5.0 cm in diameter was present. Echogenic chyme was present in the area of the pylorus. No overt evidence of mechanical pyloric outflow obstruction. The small intestine presented intact wall layering with 1:3 muscularis/mucosa ratio. Segmental echogenic digesta/chyme was present without overt evidence of small bowel mechanical obstruction or foreign material. The duodenum wall measured 0.51 cm. The jejunum wall measured 0.40 cm. Free Abdomen: Regional perigastric reactive to potentially inflamed mesentery along with a small amount of scant perigastric to perihepatic fluid was present. Intermittent probable mildly prominent mildly hypoechoic perigastric lymph nodes were present, an example measured 1.0 cm in diameter.