A 7-year-old male Labrador with a history of previous foreign body ingestion was presented for evaluation of vomiting, anorexia, and lethargy. After 24 hours of symptomatic therapy the vomiting had stopped but there was ongoing anorexia. Radiographs showed a gas pattern but no obvious foreign body. Serosanginous fluid was aspirated on abdominocentesis.
Distal small intestinal obstruction with unhealthy bowel and regional lymphadenopathy. Suspect underlying foreign body and perforation with regional peritonitis. Immediate exploratory surgery is recommended with expectations towards aggressive intestinal resection. Lymph node and intestinal wall sampling is essential as well as culture. Abdominal lavage will be necessary. Very guarded prognosis dependent upon underlying histopathology and outcome of surgery.
Variable portions of small intestine were thickened with loss of detail measuring 0.92 cm. Dilated intestine was noted followed by empty small intestine. A significant amount of regional mesenteric inflammation was noted. Some shadowing material was noted in either the colon or the distal small intestine; it was difficult to ascertain, as it was all coalesced together; however this creates an obstructive pattern. Mixed hypoechoic irregular lymph node was noted with hyperechoic surrounding fat and focal areas of cysts or necrosis.
Surgery performed 8/21/15: torsion of the distal ileum to the cecum. Intestine black but no perforations noted. Hard mineralized mass removed from the momentum. Performed resection and anastomosis. Ravaged abdomen. Obtained sample of intestine and mineralized mass for biopsy. Released from the hospital on 8/23/15, returned for medical boarding until 8/31/15. Progress note 9/15/15, doing very well. Returned on 1/18/2016 for small laceration repair but otherwise doing very well since discharge.
Foreign body, focal perforation with peritonitis, necrotic enteritis, ulceration, neoplasia, intussusception
Biopsy of the intestine revealed focal, severe transmural intestinal necrosis and peritonitis as well as mild chronic lymphoplasmacytic enteritis. Biopsy of the mass in the omentum revealed focal, nodular omental hematoma with mineralization.
