Case Study

Spontaneous bowel torsion in a 3 year old FS Labrador Retriever dog

A 3-year-old FS Labrador Retriever dog had been hit by a car one week prior to the ultrasound. The patient sustained pulmonary contusions and was stabilized and discharged. Four days after discharge the patient started having intermittent vomiting, diarrhea and inappetance. The patient possibly ate chicken bones around this time. The patient was given Cerenia for the vomiting. The patient became listless, demonstrated further anorexia and tarry diarrhea. Physical exam revealed a very painful abdomen, capillary refill time of 2 seconds.

A 3-year-old FS Labrador Retriever dog had been hit by a car one week prior to the ultrasound. The patient sustained pulmonary contusions and was stabilized and discharged. Four days after discharge the patient started having intermittent vomiting, diarrhea and inappetance. The patient possibly ate chicken bones around this time. The patient was given Cerenia for the vomiting. The patient became listless, demonstrated further anorexia and tarry diarrhea. Physical exam revealed a very painful abdomen, capillary refill time of 2 seconds. Blood work revealed moderate elevation in ALT, mild decrease in albumin, and no other abnormalities.

DX

Bowel torsion.

Sonographic Differential Diagnosis

Focal bowel dysfunction and obstructive pattern owing to spontaneous necrosis, torsion, inflammatory or neoplastic disease. Associated mesenteric lymphadenopathy likely reactive. Potential for non-visible foreign body.

Image Interpretation

The upper gastrointestinal tract was normal as was most of the small bowel. However, a dilated portion of small bowel was noted caudal to the right kidney (Video 1 and 2.) Mesenteric root lymphadenopathy was noted yet the lymph nodes were uniform and maintained contour and structure most consistent with lymphadenitis (Image 3.) A small intestinal obstructive pattern was present given the dilated small bowel concurrently present with empty small bowel which is seen entering in view at 10 o’clock in this image (Video 3.) The dilated small bowel was not peristaltic suggestive for bowel exhaustion or mechanical ileus.

Outcome

Exploratory surgery was performed. Bowel torsion was found in the region of the bowel in question noted on the sonogram. The surgeon was able to untwist the bowel without resection and restore normal position. The patient recovered without event.

Comments

Spontaneous Bowel Torsion On Sonogram. Sonogram performed by Robyn Roberts RDMS of Mettasound Imaging, Austin, Texas, USA. (http://www.mettasound.com/) Case managed at Bryckerwood Veterinary Hospital, Austin, Texas, USA. More information regarding bowel obstructions and sonographic criteria may be found here in our abstract on this subject from ECVIM 2009, Porto, Portugal. http://www.sonopath.com/resources.html Special thanks and congratulations to Dr. Donna Henry and Dr. Gregory Biehle at Bryckerwood Veterinary Hospital, Austin, Tx, USA for the medical and surgical management of this case.

Clinical Differential Diagnosis

Upper GI tract pathology (foreign body, focal gastric/duodenal necrosis secondary to trauma, gastric ulceration); pancreatic pathology (pancreatitis); focal peritonitis.