Presentation
Two-day history of vomiting and anorexia, progressively worsening.
Patient Data
There is foreign material within an enlarged bowel loop in the right cranial abdomen. This is most likely duodenum as fecal material is present in the colon near the pelvic inlet superimposed on this loop. The gas-filled cecum is also medial to the duodenum supporting this diagnosis. The foreign material is also visible in the pylorus on the left lateral projection. The remainder of the small intestine is normal in size.
Impression:
Duodenal and pyloric foreign material causing mechanical obstruction, possible linear foreign body component.
The second set of radiographs were taken 12 hours later. The foreign material is still present in the duodenum though the pylorus appears empty.
Case Discussion
A large amount of plastic, hair and thread were removed from the descending duodenum. The stomach was empty at the time of surgery.
The foreign material mimics fecal material in the ascending colon at first glance. Locating the colon is an important step in diagnosing a small intestinal obstruction. In the first set of radiographs, some segments of colon are identifiable, most completely on the ventrodorsal projection. A pneumocolon would be another option to localize the colon. On the later projections, the duodenum can also be traced from the pylorus to the caudal duodenal flexure.
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