Case Of the Month

Gastro-Enteritis

Surprise, surprise, surprise! After 2 months of GI foreign bodies on ultrasound, take a look at this foreign body that was not in the stomach and this is no April fools trick.

Sonogram (Pancreas): Gunner (Name changed to protect the innocent

History: A 3-year-old, NM Pointer cross was presented for vomiting/diarrhea. Endoscopy of the stomach and duodenum was within normal limits. Blood work was unremarkable and palpation of the cranial abdomen revealed some discomfort.

Clinical Differential Diagnosis (Lobetti):

Surprise, surprise, surprise! After 2 months of GI foreign bodies on ultrasound, take a look at this foreign body that was not in the stomach and this is no April fools trick.

Sonogram (Pancreas): Gunner (Name changed to protect the innocent

Clinical Differential Diagnosis (Lobetti):

GIT – non-specific gastro-enteritis (viral, bacterial, helminths, protozoa, dietary indiscretion, toxins), dietary hypersensitivity, IBD, foreign body, emerging lymphoma
Pancreas – pancreatitis, abscess
Addison’s disease

Sonographic Interpretation (Lindquist):

The gastrointestinal tract presented relatively normal mucosa with an empty lumen.

Outcome

A gauze sponge was removed surgically without complication and debridement of necrotic tissue was performed. The patient had undergone gastrointestinal surgery in the past at another facility but the history was unclear. The patient recovered uneventfully.

Sampling

Surgical intervention: ex-lap.

Sonographic Differential Diagnosis

Sonographic Differential Diagnosis (Lindquist): Large pancreatic abscess with peri pancreatic inflammation and gastrointestinal impingement. Spasmic duodenum and duodenitis.

There is the possibility for foreign body embedded within this abscess given the organization. At time foreign bodies can pass through the intestinal wall and embed into the abscess. Surgical intervention would be recommended; however, it will be difficult to resect the lesion completely. Therefore, removal of as much necrotic debris as possible and omentopexy would likely be the intervention of choice. Guarded prognosis.