Case Of the Month

Spontaneous Bowel Torsion

Spontaneous Bowel Torsion On Sonogram. Sonogram performed by Robyn Roberts RDMS of Mettasound Imaging, Austin, Texas, USA. (http://www.mettasound.com/)
Case managed at Bryckerwood Veterinary Hospital, Austin, Texas, USA.

Sonogram: (Abdomen): Kira

History: A 3-year-old FS Yellow Labrador had been hit by a car one week prior. The patient sustained pulmonary contusions and was stabilized and discharged. Four days after discharge the patient started intermittent vomiting, diarrhea and inappetance. The patient possibly ate chicken bones around this time frame. The patient was given cerenia for the vomiting. The patient became listless, demonstrated further anorexia and tarry diarrhea. Physical exam revealed a very painful abdomen, capillary refill time of 2 seconds. Bloodwork revealed moderate elevation in ALT, mild decrease in albumin, and no other abnormalities.

Outcome

The patient recovered uneventfully without further problems.

Comments

More information regarding bowel obstructions and sonographic criteria may be found here in our abstract on this subject from ECVIM 2009, Porto, Portugal on our resources page. Special thanks and congratulations to Dr. Donna Henry and Dr. Gregory Biehle at Bryckerwood Veterinary Hospital, Austin, Tx, USA for the medical and surgical management of this case

Clinical Differential Diagnosis

(Remo Lobetti PhD, DECVIM):

Upper GIT obstruction – foreign body
Focal gastric/duodenal necrosis secondary to trauma
Gastric ulceration
Pancreatitis
Focal peritonitis

Sampling

Exploratory surgery was performed. Bowel torsion was found in the region of the bowel in question noted on the sonogram. Then surgeon was able to untwist the bowel without resection and restore normal position.

Sonographic Differential Diagnosis

(Lindquist DMV, DABVP): Focal bowel dysfunction and obstructive pattern owing to spontaneous necrosis, torsion, inflammatory or neoplastic disease. Associated mesenteric lymphadenopathy likely reactive. Potential for non-visible foreign body.

Image Interpretation

Images 1, 2:
Abdomen:

Thorax: no evidence of the historical pulmonary contusion or other evidence of traumatic thoracic lesions.
Stomach: mild gas and fluid-filled. No foreign body noted.
Small intestines: Mostly clumped caudally in the mid-caudal abdomen. Luminal dimensions of this subset are within normal limits. A second population is suspected in the mid-cranial abdomen on the lateral and ventral-dorsal projections. This subset of intestines have ill-defined serosal margins and measurements are not possible. On the lateral projection one of the loops has a crescent-shaped luminal gas bubble.
The large intestines are uniformly empty, except the terminal descending colon which has faintly mineral-opaque contents. The exact location of the cecum and the relationship o with the aforementioned small intestinal loops can not be determined.
No evidence of free peritoneal air or significant free fluid noted.
Diagnostic Interpretation:

Possible segmental small intestinal dilation; mechanical obstruction (causes include lucent foreign body, intussusception, necrosis, neoplasia)
No distinct gastrointestinal foreign object noted.
No evidence of traumatic thoracic changes or aspiration pneumonia

Testing Considerations:

Abdominal ultrasound and complete thoracic radiographs
Alternatively, pneumocolonography or upper GI series.

Video

Patient Information

Gender : Female, Spayed

Species : Canine