Case Of the Month

Transmural Enteritis & Peritonitis

Transmural Enteritis & Peritonitis in a Cat

Images obtained by Andi Parkinson RVT, RDMS (Intrapet Diagnostics, Baltimore, MD, USA). Ultrasound and case interpretation by Eric Lindquist DMV (Italy), DABVP (SonoPath.com).

History: A 14-year-old MN DLH cat presented for anorexia, lethargy, and “not doing right.” The physical exam revealed depression, dehydration, and hypothermia.

Transmural Enteritis & Peritonitis in a Cat

Images obtained by Andi Parkinson RVT, RDMS (Intrapet Diagnostics, Baltimore, MD, USA). Ultrasound and case interpretation by Eric Lindquist DMV (Italy), DABVP (SonoPath.com).

History: A 14-year-old MN DLH cat presented for anorexia, lethargy, and “not doing right.” The physical exam revealed depression, dehydration, and hypothermia.

CBC revealed an elevated white blood cell count of 24,000 with a left shift and lymphocytopenia. Blood chemistry analysis was normal. Urinalysis revealed isothenuria with neutral pH and negative culture.

Outcome

The patient survived partial enterectomy and postoperative period but unfortunately died shortly afterward.

Comments

Special thanks to: Eddie Molesworth DVM and staff at Main Street Veterinary Hospital, Baltimore, MD, USA for presenting this interesting case for interpretation.

Clinical Differential Diagnosis

(Frank DVM, DVSc, DACVIM): DDX

Infection/ pyelpnephritis/ other infection
Infectious disease/ Bartonella etc
Neoplasia, (ie GI neoplasia, LSA, other)
Renal insufficiency

Sampling

Laparotomy revealed diffuse necrotic bowel and multifocal peritonitis. Full-thickness surgical biopsies. Histopathology; chronic severe transmural ulcerative and granulomatous enteritis with predominance of lymphocytic & plasmacytic infiltrates. No evidence of neoplasia.

Sonographic Differential Diagnosis

Evidence of marked proximal enteritis with associated gastrointestinal paralytic ileus and peri-intestinal inflammation. Infiltration with lymphoma or an equivalent neoplastic process cannot be ruled out and hence, tissue sampling from the affected region should be considered.

Image Interpretation

(Yanik DVM, DACVR): (Images 1-3) The initial study shows a positive contrast distended stomach with evidence of segmental small bowel fluid and gas distention and adequate abdominal visceral serosal detail. The follow-up study reveals persistent gas and fluid distention of the stomach with retention of a small amount of contrast material. The degree and extent of small bowel fluid and gas distention has increased. The final study reveals generalized fluid and gas distention of the small intestine supportive of significant paralytic ileus or possibly mechanical ileus associated with a transiently partially or intermittently foreign body within the distal small intestines.

Video

Patient Information

Gender : Male, Neutered

Species : Feline