Case Of the Month

GI Tract and Abdominal Mass

The patient is a canine Boxer, NM, 5 years of age presented to the clinic by a rescue organization. The patient was emaciated, vomiting and anorexic. Bloodwork was unremarkable. Physical exam revealed a mid abdominal thickening potentially of intestinal origin. Lateral radiograph revealed a mid cranial abdominal mass with mass effect upon the intestinal tract displacing the mesentery caudally. A volume-contracted heart was also visible. Image 1.

Outcome

The patient recovered well and is gaining weight readily. (Image 8).

Comments

Special thanks to Dr. Harvey Hummel and Head Technician Diane McFadden & staff at Andover Animal Hospital, Andover, NJ, USA (http://www.andoveranimalhospital.com/) for their wonderful management and care for Jonah, the curious Boxer that just wanted to play with a monkey.

For an update on dear Jonah please click on the forum link below that highlights his case.

Forum Update on Jonah the Boxer

Clinical Differential Diagnosis

GI tract – neoplasia, foreign body, IBD
Pancreas – chronic pancreatitis, neoplasia
Abdominal mass – neoplasia/cyst/granuloma of intestine, spleen, liver.

(http://www.sonopath.com/about/specialists/remo-lobetti)

Sampling

Patient had exploratory surgery with solid foreign body removal (Image 6) that revealed an underlying monkey toy (Image 7) (plastic monkey from barrel of monkeys). Intestinal biopsy revealed fibrosing enteritis/peritonitis adjacent to the intestinal wall without evidence of neoplasia.

Sonographic Differential Diagnosis

Obstructive foreign body with likely underlying mural disease and minor regional omental inflammation.

Exploratory surgery with enterotomy, gastric and intestinal biopsies were recommended. Guarded prognosis depending on underlying histopathology whether concurrent intestinal neoplasia is present versus inflammatory related mural hypertrophy.

Image Interpretation

Image 2: Split screen of stomach (right) and duodenum (left) that revealed upper GI stasis. Image 3: A distinctly shadowing intestinal foreign body is seen (arrow) with mural thickening and loss of layering of the affected intestinal wall (measurement). Images 4 & 5: The 6 cm shadowing foreign body is visible with adjacent stasis followed by empty small intestine finalizing the obstructive pattern defined in our prior study (Sonographic Criteria for the Diagnosis of Gastrointestinal Obstruction in 39 Dogs and Cats, ECVIM 2009, http://www.sonopath.com/resources/articles). A minor amount of ill-defined surrounding fat is noted adjacent to the intestinal wall in the near field indicative of transmural disease process in act indicating a surgical emergency before further breakdown of the intestinal wall occurs.

Video

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Patient Information

Gender : Male, Neutered

Species : Canine

Status : Complete

Clinical Signs

Vomiting

Images

Clinical Signs

Vomiting