History
A 1-year-old castrated male ferret was evaluated because of an acute onset of vomiting mucus and respiratory distress. Physical examination at the time of admission revealed that the ferret was lethargic and mildly dehydrated, had an increased respiratory effort, and was hypothermic (37.1°C [98.7°F]). Abdominal palpation elicited signs of pain and revealed splenomegaly. Results of serum biochemical analysis revealed that the ferret was hyperglycemic, hyponatremic, and hypokalemic. Radiographs of the abdomen were obtained (Figure 1).
Right lateral (A) and ventrodorsal (B) radiographic views of the abdomen of a 1-year-old castrated male ferret evaluated because of acute vomiting and respiratory distress.
Citation: Journal of the American Veterinary Medical Association 241, 1; 10.2460/javma.241.1.45
Right lateral (A) and ventrodorsal (B) radiographic views of the abdomen of a 1-year-old castrated male ferret evaluated because of acute vomiting and respiratory distress.
Citation: Journal of the American Veterinary Medical Association 241, 1; 10.2460/javma.241.1.45
Right lateral (A) and ventrodorsal (B) radiographic views of the abdomen of a 1-year-old castrated male ferret evaluated because of acute vomiting and respiratory distress.
Citation: Journal of the American Veterinary Medical Association 241, 1; 10.2460/javma.241.1.45
Determine whether additional imaging studies are required, or make your diagnosis from Figure 1—then turn the page →
Radiographic Findings and Interpretation
The stomach is severely distended with gas and ingesta, and the gastric axis is rotated, with the pylorus located in a dorsal and cranial position (Figure 2). Additional findings include loss of intra-abdominal contrast and an enlarged, malpositioned spleen located along the right abdominal wall. The radiographic findings are compatible with gastric dilatation-volvulus (GDV) with secondary peritoneal effusion and splenic congestion or torsion. Differential diagnoses for peritoneal effusion include peritonitis, hemorrhage, lymphatic obstruction, hypoalbuminemia, and neoplasia. Alternative differential diagnoses for splenomegaly include extramedullary hematopoiesis, neoplasia (ie, lymphoma or mast cell disease), and inflammation.
Same radiographic images as in Figure 1. Notice the gas- and ingesta-filled pylorus (arrow) cranial and dorsal to the fundus. Additionally, notice the loss of intra-abdominal contrast (asterisk) and the enlarged, malpositioned spleen along the right abdominal wall (arrowhead).
Citation: Journal of the American Veterinary Medical Association 241, 1; 10.2460/javma.241.1.45
Same radiographic images as in Figure 1. Notice the gas- and ingesta-filled pylorus (arrow) cranial and dorsal to the fundus. Additionally, notice the loss of intra-abdominal contrast (asterisk) and the enlarged, malpositioned spleen along the right abdominal wall (arrowhead).
Citation: Journal of the American Veterinary Medical Association 241, 1; 10.2460/javma.241.1.45
Same radiographic images as in Figure 1. Notice the gas- and ingesta-filled pylorus (arrow) cranial and dorsal to the fundus. Additionally, notice the loss of intra-abdominal contrast (asterisk) and the enlarged, malpositioned spleen along the right abdominal wall (arrowhead).
Citation: Journal of the American Veterinary Medical Association 241, 1; 10.2460/javma.241.1.45
The ferret was initially managed with IV administration of fluids, buprenorphine, and famotidine. Despite supportive care, the ferret continued to appear severely depressed; recheck abdominal radiographs were obtained (Figure 3), which supported the diagnosis of GDV.
Right lateral radiographic view of the abdomen of the same ferret as in Figure 1 that was obtained 10 hours after the initial set of abdominal radiographs. The pylorus is abnormally located in a dorsocranial position (arrow), and the stomach is more severely distended with gas and ingesta. There continues to be a loss of intra-abdominal contrast and splenomegaly.
Citation: Journal of the American Veterinary Medical Association 241, 1; 10.2460/javma.241.1.45
Right lateral radiographic view of the abdomen of the same ferret as in Figure 1 that was obtained 10 hours after the initial set of abdominal radiographs. The pylorus is abnormally located in a dorsocranial position (arrow), and the stomach is more severely distended with gas and ingesta. There continues to be a loss of intra-abdominal contrast and splenomegaly.
Citation: Journal of the American Veterinary Medical Association 241, 1; 10.2460/javma.241.1.45
Right lateral radiographic view of the abdomen of the same ferret as in Figure 1 that was obtained 10 hours after the initial set of abdominal radiographs. The pylorus is abnormally located in a dorsocranial position (arrow), and the stomach is more severely distended with gas and ingesta. There continues to be a loss of intra-abdominal contrast and splenomegaly.
Citation: Journal of the American Veterinary Medical Association 241, 1; 10.2460/javma.241.1.45
Comments
Laparotomy revealed a large amount of blood-tinged peritoneal effusion and torsion of the stomach along its longitudinal axis. After the stomach and spleen were rotated to a normal position, extensive clotting was noted in the splenic vasculature and the stomach appeared necrotic. The condition of the patient started to worsen intraoperatively; because of the poor prognosis, the owners elected to have the ferret euthanized.
Gastric dilatation-volvulus, also referred to as gastric torsion, is a condition in which the stomach becomes rotated on its mesenteric axis and severely distends with gas or fluid. Generally, the stomach rotates clockwise between 90° and 360°.1 In the human literature,2 gastric volvulus is defined as rotation of the stomach > 180° resulting in complete obstruction, whereas gastric torsion is defined as partial obstruction and rotation of the stomach < 180°.
Primarily, GDV occurs in large and giant breeds of dogs1; however, it has also been reported for cats3 and guinea pigs.4 Predisposing factors contributing to GDV may include family history, stress, increased thoracic depth, exercise, diet, and concurrent disease.1 To our knowledge, there are no reports documenting GDV in ferrets.
Abdominal radiographs, particularly the right lateral projection, are helpful in differentiating GDV from simple gastric dilation. Knowledge of gastric radiographic anatomy is important in the diagnosis of GDV. On radiographic evaluation the pylorus will normally be located ventral and to the right of the fundus; in right lateral and dorsoventral projections, the pylorus will be fluid filled. In a patient with GDV, the pylorus will typically be in a dorsocranial location to the left of midline; it will appear gas filled in right lateral and dorsoventral projections of the abdomen. Splenic torsion can occur in conjunction with GDV; radiographic findings may include splenic malposition, splenomegaly, and splenic emphysema.5 If available, Doppler ultrasonographic examination can be used to characterize blood flow in the splenic veins and thereby aid in the diagnosis of splenic torsion.6 Additional radiographic findings in a patient with GDV may include pneumoperitoneum and loss of intra-abdominal contrast.5
1. Hedlund CS, Fossum TW. Surgery of the digestive system. In: Fossum TW, ed. Small animal surgery. 3rd ed. Philadelphia: WB Saunders Co, 2007;339–530.
2. Cribbs RK, Gow KW, Wulkan ML. Gastric volvulus in infants and children. Pediatrics 2008; 122:752–762.
3. Formaggini L, Schmidt K, Lorenzi DD. Gastric dilatation-volvulus associated with diaphragmatic hernia in three cats: clinical presentation, surgical treatment and presumptive aetiology. J Feline Med Surg 2008; 10:198–201.
4. Mitchell EB, Howkins MG, Gaffney PM, et al. Gastric dilatation-volvulus in a guinea pig (Cavia procellus). J Am Anim Hosp Assoc 2010; 46:174–180.
5. Graham JP, Berry CR, Thrall DE. Technical issues and interpretation principles relating to the canine and feline abdomen. In: Thrall DE, ed. Textbook of veterinary diagnostic radiology. 5th ed. Philadelphia: WB Saunders Co, 2007;626–644.
6. Saunders HM, Neath PJ, Brockman DJ. B-mode and Doppler ultrasound imaging of the spleen with canine splenic torsion: a retrospective evaluation. Vet Radiol Ultrasound 1998; 39:349–353.
