September's Case of the Month
Sonographic Findings of an Obstructive Jejunal Foreign Body
Dr. Tyler Anderson
Patient Information:
Age: 3 years
Gender: Male Neutered
Species: Canine
Breed: Boston Terrier
History:
An abdominal ultrasound was recommended due to a recent onset of acute vomiting, anorexia, and hind-limb paresis. Vomiting was not responsive to anti-emetic (Cerenia). Patient has a history of two exploratory laparotomies for bowel obstruction. Owner reported a piece of missing deer antler, not observed on survey abdominal radiographs.
Image Interpretation
Abdominal sonographic findings:
The stomach, duodenum, and proximal jejunum are moderately to severely dilated with flocculent fluid and gas. In the right cranial abdominal quadrant is a loop of jejunum with a tubular piece of foreign material that casts a dark acoustic shadow, measuring ~ 4.5cm in length. The bowel distal to the foreign material is collapsed and empty with normal wall layering and thickness. No evidence of perforation is observed - ascites, hyperechoic mesentery, or intestinal wall defects.
Diagnosis and Sonographic Analysis:
The patient was taken to surgery for a exploratory laparotomy. Numerous adhesions were noted within the jejunum anchoring the site of obstruction in the right cranial abdominal quadrant adjacent to the liver. A piece of deer antler was removed from the jejunum. The bowel appeared viable intra-operatively and therefore, no resection and anastomosis was required.
Dilated Pyloric Antrum: Flocculent fluid is noted in the gastric fundus and pyloric antrum. The Pyloric sphincter can be visualized with no evidence of obstruction.
A tubular piece of foreign material is seen in the mid-jejunum casting a dark acoustic shadow. The bowel proximal to the site of obstruction (Duodenum and Proximal jejunum are severely dilated with gas and fluid.
The bowel just distal to the foreign body is collapsed and empty, confirming intestinal obstruction.
Special Thanks to Norbeck Animal Clinic for the interesting case and follow-up!