Presentation
Vomited once yesterday, with several episodes of diarrhea yesterday and today. Lethargic and anorexic.
Patient Data
The duodenum plus additional small intestine are dilated with gas. On the right lateral projection, there are normally sized small intestinal loops visible.
Additionally, there is soft tissue opacity foreign material in the pylorus on the left lateral projection. It is suspended in the pylorus and surrounded by air.
Impression:
Small intestinal mechanical obstruction.
Four days after discharge, the dog presented with fever and lethargy. Abdominal ultrasound showed peritoneal free fluid with gas bubbles and enlarged, hypoechoic lymph nodes.
Impression:
Post-operative peritonitis.
Case Discussion
Foreign body in stomach and jejunum (corn cob). The jejunal segment proximal to the foreign body was devitalized, so a resection and anastomosis was performed. The gastric foreign body was removed by gastrotomy. Postoperatively, suppurative inflammation without bacteria was present in the peritoneum. The gas bubbles may have been from prior surgery or due to infection.
The foreign material in the stomach on radiographs was indicative of a foreign body obstruction. The dilated small intestine was due to the more distal jejunal piece of corn cob. Pyloric obstruction often results in a more dilated and fluid filled stomach, except if the animal has been vomiting or there is a partial obstruction.
Free peritoneal gas is very subtle on ultrasound, and appears as small hyperechoic flecks in the fluid, which may float dorsally to the abdominal wall.
The key to diagnosing the obstruction is in observing the two distinct populations of small intestine; enlarged greater than 1.5x the height of a vertebral body, and more normal appearing intestine.
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