Presentation
Presented with 3-week history of vomiting and lethargy.
Patient Data
In the abdomen there is a severe segmental distention of a small intestinal loop with approximately 3 x 3 cm granular foreign material identified in the immediate area. There is moderate remodeling of the articular facets in the caudal thoracic and lumbar spine. Spondylosis is identified at the LS space.
Small intestinal obstruction most likely secondary to chronic partial obstruction. Ultrasonographic examination and surgery is indicated. Degenerative joint disease of the articular facets. Spondylosis deformans.
There is marked distention of several small intestinal loops with fluid contents. The jejunal wall is thickened and ill-defined. There is an area of stenosis and annular wall thickening with poor wall layering in the jejunum. The regional lymph nodes are enlarged and hypoechoic.
Impression: Intramural jejunal mass most likely neoplastic (carcinoma) in origin, with secondary chronic partial intestinal obstruction. Probable lymph node metastasis, although reactive hyperplasia is is also possible.
Case Discussion
On necropsy, the jejunal mass was a mucinous adenocarcinoma causing a stricture and proximal dilation of the jejunum. There was also lymph node metastasis.
Intestinal adenocarcinoma tends to be a mass that is low in volume but high in fibrous tissue and causes a stricture with secondary obstruction. In contrast, other masses such as round cell neoplasia tend to form a larger mass with a lesser degree of obstruction. The small area occupied by the adenocarcinoma makes it more difficult to recognize on ultrasound. Loss of wall layering is a feature, as is the narrowing of the lumen.
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