History

An 8-month-old female Beagle was evaluated for diarrhea, dysorexia, asthenia, and signs of depression that had started during a 10-day stay in a kennel. No vomiting was reported. Physical examination revealed that the dog appeared depressed and had a rectal temperature of 39.2°C (102.6°F). On abdominal palpation, a painful apple-size mass was appreciable in the middle portion of the abdomen. On CBC, neutrophilia (18.8 × 10³ neutrophils/PL; reference range, 3 to 12 × 10³ neutrophils/PL) was found. A low serum albumin concentration (2.49 g/dL; reference range, 2.8 to 3.7 g/dL) was detected on serum biochemical analysis. Results of a PCR assay for canine distemper virus as well as a fecal antigen test for canine parvovirus were negative. Survey abdominal radiography was performed and contrast abdominal radiographs (Figure 1) were obtained following oral administration of barium sulfate (30% wt/vol; 10 mL/kg [4.5 mL/lb]).

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Lateral (A) and ventrodorsal (B) survey radiographic views of the abdomen of an 8-month-old Beagle evaluated for diarrhea, dysorexia, asthenia, and signs of depression of 10 days' duration. A ventrodorsal (C) contrast radiographic view of the abdomen was obtained after oral administration of barium sulfate contrast medium.

Citation: Journal of the American Veterinary Medical Association 235, 1; 10.2460/javma.235.1.27

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Determine whether additional imaging studies are required, or make your diagnosis from Figure 1—then turn the page →

Diagnostic Imaging Findings and Interpretation

Mild dilation of a small intestinal loop without evidence of an opaque foreign body is evident on survey abdominal radiographs. A partial obstruction of the intestines is evident on the contrast abdominal radiograph proximal to the ileocolic junction causing incomplete obliteration of the intestinal lumen (Figure 2). The distal part of the jejunum is moderately dilated, and a corrugated ascending colon is seen (sometimes referred to as a thumbprinting radiographic sign).

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Same ventrodorsal radiographic image as in Figure 1C. Notice the partially obstructive lesion located proximal to the ileocolic junction with incomplete obliteration of the intestinal lumen (black arrowhead). The distal part of the jejunum is moderately dilated (black arrows), and a spastic ascending colon is evident (white arrows).

Citation: Journal of the American Veterinary Medical Association 235, 1; 10.2460/javma.235.1.27

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Symmetric hypoechoic wall thickening (measuring 7 mm) of the ileum, associated with a complete loss of the normal wall layering (Figure 3) is evident on abdominal ultrasonography. The lesion is approximately 5 cm in length. A hyperechoic linear structure with acoustic shadowing and without reverberation is apparent in the lumen of the affected intestine. Proximal to the lesion site, the intestinal loop is moderately distended with a fluid pattern. Colic lymph nodes are enlarged (thickness, 2.2 cm). Differential diagnoses on the basis of radiographic and ultrasonographic findings include intestinal neoplasia, segmental enteritis, and linear foreign body associated with a partially obstructive pattern.

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Transverse ultrasonographic image of the right side of the middle portion of the abdomen. Notice the wall thickening of the ileum (7 mm) associated with a complete loss of wall layering. A hyperechoic interface associated with strong shadowing is also evident (white arrows).

Citation: Journal of the American Veterinary Medical Association 235, 1; 10.2460/javma.235.1.27

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Comments

Luminal narrowing proximal to the ileocolic junction, dilated jejunum, and corrugated ascending colon were the main radiographic findings on gastrointestinal contrast series in this dog. Radiographically, dilation of the intestine may be detected proximal to a foreign body obstruction as well as intramural masses or extramural compression causing mechanical intestinal obstruction.¹ Furthermore, focal wall thickening as a result of severe inflammation may reduce the intestinal lumen and create a distension proximal to the site of a lesion.^1–3 Corrugation (or thumbprinting) of the intestinal wall is a radiographic finding that may be present with several intestinal and abdominal disorders²; this feature has been reported with pancreatitis, enteritis, lymphoma, and ischemia secondary to thrombosis.²

Inflammatory disease of the small intestine may create luminal narrowing secondary to muscular irritability and spasm of the circular muscle. Ultrasonography is useful when findings on survey radiographs and gastrointestinal radiographic contrast study are not conclusive. High-frequency ultrasonography is recommended for evaluation of intestinal wall thickness, wall layering, symmetry, extension, distribution of intestinal lesions, and involvement of regional lymph nodes.

Ileal wall thickening (7 mm) and the regional lymphadenopathy (thickness, 2.2 cm) of our dog are findings that overlapped the reported common features of enteritis and intestinal neoplasia.³ Intestinal foreign body has been reported to cause intestinal wall thickening and loss of layering.¹

In this dog, the linear hyperechoic interface with a strong shadowing in the lumen of the affected intestine and the presence of a fluid pattern proximal to the site of the lesion on ultrasonography were consistent with a foreign body. On exploratory celiotomy, a thickening of the ileum extending from 5 cm proximally to the ileocolic junction associated with an enlargement of the colic lymph nodes was found. A 5-cm-long linear foreign body (rubber foreign body) was found in the intestinal lumen and removed through enterotomy. No other abnormalities of the small and large intestine were found.

The dog was discharged from the hospital 5 days after surgery. Abdominal ultrasonographic examinations were performed every week for 2 months, revealing complete healing of the intestinal lesion.