Case Study

Focal Intestinal Perforation in a 10 year old MN Golden Retriever dog

This 10-year-old MN Golden Retriever was presented for vomiting and anorexia over a 4 day period. The clinical exam revealed marked weight loss, a tense caudal abdomen, mild fever, tacky mucosal membranes, and mild dehydration. The CBC revealed moderate leukocytosis with a left shift. The blood chemistry analysis was normal except for moderate hypoalbuminemia. Urinalysis was normal. Both of these abnormalities were progressively altered over a 24 hour period.

This 10-year-old MN Golden Retriever was presented for vomiting and anorexia over a 4 day period. The clinical exam revealed marked weight loss, a tense caudal abdomen, mild fever, tacky mucosal membranes, and mild dehydration. The CBC revealed moderate leukocytosis with a left shift. The blood chemistry analysis was normal except for moderate hypoalbuminemia. Urinalysis was normal. Both of these abnormalities were progressively altered over a 24 hour period. The patient was treated for 24 hours prior to the sonogram and passed a 5 inch grouping of foreign material of ribbon, rubber child’s toy, and parts of a tennis ball. The radiographs were performed 24 hours prior with a moderate accumulation of small bowel gas. Barium study was not performed.

DX

Focal intestinal perforation

Sonographic Differential Diagnosis

Partially or intermittently obstructing luminal foreign body and severe focal peritonitis with suspect mesenteric adhesions. The intestinal wall thickening could be the result of chronic obstruction with perforation. Alternatively, mural infiltration with neoplasia resulting in a motility disorder could have secondarily resulted in luminal obstruction and perforation.

Image Interpretation

The images demonstrate a segment of small bowel which is markedly and uniformly thick walled. The affected intestinal wall is hypoechoic with disruption of wall layering and the lumen is moderately distended with echogenic, strongly shadowing material. In the first image, slice volume artifact is creating an artifactual appearance of continuous intra and extra luminal echogenic material. In reality, this is markedly echogenic, pairing intestinal mesentery which is likely adhered to the thickened wall.

Outcome

The patient responded well over the following 72 hours post-op with good appetite and mildly loose stool production. A sudden decline occurred with recurrence of signs and fever. There was evidence of peritonitis on abdominal fluid analysis. The owner declined further intervention due to cost concerns. Breakdown of the intestinal anastomosis site with subsequent peritonitis was confirmed on necropsy.

Clinical Differential Diagnosis

GI pathology – Intestinal obstruction, gastroenteritis, pancreatitis, protein losing enteropathy, IBD, neoplasia.

Sampling

Immediate exploratory surgery was performed with intestinal biopsies to ascertain underlying neoplasia or primary inflammatory disease as the cause of weight and protein loss. Transfusion with fresh frozen plasma and Hetastarch as well as antibiotics were initiated prior to surgery. Direct examination of the compromised distal duodenum (2 inches caudal to the pancreas) revealed 4 different areas of perforated intestine with omental adhesions. No free fluid was found. Full intestinal resection and anastomosis was performed with strong signs of intestinal viability visualized by the surgeon. Histopath: Focal intestinal perforation with transmural necrosis and subacute fibrinosuppurative enteritis. No evidence of neoplasia was found.