Case Study

Acute Transmural Enteritis from Perforation in a 13 year old FS Cockapoo dog

This 13-year-old FS Cockapoo was presented for vomiting and diarrhea with mild anorexia. The clinical exam was normal except for mild mid abdominal discomfort on palpation. Body temperature was normal. The CBC revealed a mild regenerative anemia and moderate leukocytosis with a left shift. Blood chemistry analysis revealed moderately elevated SAP and mildly elevated amylase with mild hypoalbuminemia. This patient had a long history of persistently elevated SAP of similar levels. The urinalysis was normal. ACTH stimulation was normal.

This 13-year-old FS Cockapoo was presented for vomiting and diarrhea with mild anorexia. The clinical exam was normal except for mild mid abdominal discomfort on palpation. Body temperature was normal. The CBC revealed a mild regenerative anemia and moderate leukocytosis with a left shift. Blood chemistry analysis revealed moderately elevated SAP and mildly elevated amylase with mild hypoalbuminemia. This patient had a long history of persistently elevated SAP of similar levels. The urinalysis was normal. ACTH stimulation was normal.

DX

Acute transmural enteritis from perforation

Sonographic Differential Diagnosis

Segmental small bowel ileus with severe, adjacent peritoneal inflammation and suspect adhesions. Differentials include neoplasia, foreign body, and marked focal inflammatory or granulomatous disease likely with perforation.

Image Interpretation

Abrupt termination of a moderately to markedly distended ileum (left side of the image) is noted. The discernible ileal wall is diffusely, uniformly, moderately to markedly thickened with subtle loss of layering noted throughout its length. The regional mesentery is markedly echogenic and faintly shadowing which is hindering clinical assessment of the ileal wall within the far field and differentiation between intra- or extra-luminal obstruction is not possible. There is a focal, marked increase in mesenteric echogenicity, coupled with a peripheral lobulation, which borders the thickened affected segment of ileum and supports marked inflammation with probable adhesions.

Outcome

The patient recovered uneventfully with a nearly complete resolution of the hematological abnormalities. The SAP remained moderately elevated in follow-up analysis.

Clinical Differential Diagnosis

GI pathology -Protein losing enteropathy, IBD, neoplasia, peritonitis; pancreatic pathology – pancreatitis; liver pathology – cholangiohepatitis, chronic hepatitis, neoplasia

Sampling

Based on the sonographic findings and focal pain present when imaging the lesion, exploratory laparotomy was performed. Resection of a 10 cm portion of distal ileum was performed that demonstrated 3 regions of perforation and omental adhesions. No foreign body was present. Histopathology: severe acute to subacute transmural enteritis with peritonitis.