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A 10-year-old NM Keeshond with a history of diabetes mellitus being managed with insulin was presented for evaluation of progressive deterioration following an ultrasound and cytological diagnosis of suppurative pancreatitis that had been treated with famotidine, heparin, Torbugesic, metoclopramide, and Baytril. Abnormalities on serum biochemistry were elevated ALP and ALT activity, and total bilirubin.
Stomach- two intramural abscesses confirmed with ultrasound guided abdominocentesis-the findings are severe and most likely represent continued pathology associated with the closely associated inflamed pancreas. These abscesses were drained yielding ~2 cc’s of orange brown purulent material. Samples were submitted for culture and sensitivity.
Pancreas – the overall findings are less severe than previous exam performed on 1/21/2015, however an abscess has developed in the left limb which was confirmed with ultrasound guided abdominocentesis. The abscess was drained yielding ~2 cc’s of orange-brown purulent material. Samples were submitted for culture and sensitivity.
Gastric walls are moderately to severely thickened with two intramural wall abscesses (confirmed with ultrasound guided abdominocentesis) present at the greater curvature containing echogenic fluid. The largest measured 16.2mm x 7.6mm. There is a moderate amount of anechoic fluid within the lumen of the stomach. The pancreas has moderate enlargement of all limbs having coarse heterogenous hypoechoic echogenicity and having hyperechoic peripancreatic fat with moderate amount of echogenic free fluid within the left limb of the pancreas. This echogenic fluid was confirmed with ultrasound guided abdominocentesis) as an abscess and measured 12.2mm x 16.0mm. Severely hyperechoic mesentery and surrounding peripancreatic fat.
Follow-up recheck exam revealed resolution of both the gastric wall abscesses and the pancreatic abscess in the left limb. There is however what appears to be another possible pancreatic abscess forming in the more proximal aspect of the left limb relative to the last pancreatic abscess. At the time of the exam the patient was significantly improved clinically. Dr. Mike Willard consulted on the case and confirmed the management to-date was best case scenario and to continue with therapy. Ultrasound-guided drainage without infusion of anything is best treatment.
Case courtesy of Marty Henderson, DVM, SonoVet, Inc.
Pancreas – pancreatitis, abscessation, cyst, neoplasia
Peritonitis
Gall bladder – cholecystitis, mucocele
Ultrasound guided abdominocentesis of two stomach abscesses and one abscess in the left limb of the pancreas.
