Case Study

Intussusception in a 6 month old MN American Eskimo Spitz dog

A 6-month-old MN American Eskimo Spitz dog was presented with a history of chronic gastrointestinal illness and protein losing enteropathy. Blood work revealed hypoalbuminemia (albumin 1.8 g/dl) hypoproteinemia (total protein 4.3 g/dl), elevated GGTP, and poorly regenerative anemia (hematocrit 31). Leukocytosis with a left shift (22000/hpf).

A 6-month-old MN American Eskimo Spitz dog was presented with a history of chronic gastrointestinal illness and protein losing enteropathy. Blood work revealed hypoalbuminemia (albumin 1.8 g/dl) hypoproteinemia (total protein 4.3 g/dl), elevated GGTP, and poorly regenerative anemia (hematocrit 31). Leukocytosis with a left shift (22000/hpf).

DX

Ileocecocolic intussusception. Multifocal ulcerations and acute on chronic active enteritis/colitis.

Sonographic Differential Diagnosis

Distal small intestinal intussusception, not currently involving the ileocecal valve. This is a jejunal-ileal intussusception.

Image Interpretation

The gastrointestinal tract presented a significant obstructed pattern with fluid filled stomach and dilated, hyper-peristaltic upper small intestine with ingesta and a 10-12 cm intussusception at the distal jejunum/ileum. The intussusception ended approximately in the area of the ileocecal valve. Mesenteric root lymph nodes were enlarged and reactive. However, they were not enveloped by the intussusception. A mild amount of free fluid was noted. Depending on what the current albumin level is, this may be transudate from poor oncotic pressure or potential inflammatory origin.

Outcome

Patient was referred to a boarded surgeon who performed a resection and anastomosis on an ileocecocolic intussusception. Histology revealed multifocal ulcerations and acute on chronic active enteritis/colitis.
The R&A dehisced spontaneously 2 days post op and the patient was euthanized for financial reasons.
No video is available on this patient.

Comments

Plasma transfusion followed by immediate exploratory was recommended with intussusception reduction and/or resection and left liver biopsy. Bile acid profile would also be warranted given that microhepatica was present with no macroscopic shunting (Not shown).

Clinical Differential Diagnosis

Chronic GI, anemia: PLE, parasitism, IBD, chronic intestinal obstruction, pancreatitis, GI or other neoplasia. Protein loss: Liver pathology ( PLE, PLN, liver failure)