Screen Shot 2020-07-29 at 9.17.59 AM.png — Sonographic Findings of Retained Surgical Gauze Sponge and Intestinal Foreign Body in a Canine.

Dr. Shadawn Salmond-Jimenez

PATIENT INFORMATION:

Age: 3 years
Gender: Spayed Female
Species: Canine
Breed: German Shepherd

HISTORY

Patient presented for intermittent vomiting, hyporexia, and weight loss of two weeks duration. Patient had minimal response to supportive care.
Per owner no exposure to the garbage and all toys and chews were accounted for. The other dog in the house was showing no symptoms. Patient has eaten socks and underwear as a puppy, but everything she ate passed without issue or intervention. She has had no other health issues and was not on any medications chronically.

ULTRASOUND FINDINGS

One large segment of mid-jejunum is moderately distended with flocculent fluid up to a poorly defined irregular foreign body casting a strong distal acoustic shadow. The small intestines are then collapsed aboral to the foreign body. A large asymmetrically severely thickened mass is seen in the mid-abdomen (~2.5cm in thickness and ~6.2cm in length) with irregular, lobular shape and heterogeneous hypoechoic walls. Strong blood flow is detected within the focal mass wall with color doppler evaluation. There is echogenic fluid with a small foreign body seen centrally casting a strong distal acoustic shadow in the lumen of the mass. The mass is closely associated with the surrounding intestinal loops.

ABDOMINAL ULTRASOUND INTERPRETATION

Intestine (Jejunum) – DDx: the finding is severe – Obstructive intraluminal intestinal foreign body.

The mass containing a second foreign body was thought to be jejunal in origin, however sonographic interrogation of the mass did not demonstrate a direct communication with the intestinal loops.

CASE OUTCOME

The patient was immediately sent for exploratory laparotomy and a large mass associated with adhesion to the mesentery was found and excised. A retained surgical gauze sponge was found within the mesenteric mass. The sponge was likely from the ovariohysterectomy performed when the patient was adopted as a puppy. A second large foreign body that could not be moved was found within the lumen of the mid-jejunal loop. The intestinal loop containing the foreign body was resected and an intestinal resection anastomosis performed. The patient recovered without incident and is doing well several months following surgery.

The large heterogeneous hypoechoic thick walled mid-abdominal mass is outlined by the blue arrows. The foreign material (gauze sponge) can be seen centrally casting a strong distal acoustic shadow.

Strong blood flow is detected with color doppler evaluation of the mid-abdominal mass. Blood flow is not detected within the center of the mass where the foreign body is present. — Strong blood flow is detected with color doppler evaluation of the mid-abdominal mass. Blood flow is not detected within the center of the mass where the foreign body is present.

A poorly defined irregular foreign body casting a strong distal acoustic shadow is seen within the lumen of the mid-jejunal segment (blue arrow). There is moderate flocculent fluid distention of the intestines oral to the foreign body (as seen to th… — A poorly defined irregular foreign body casting a strong distal acoustic shadow is seen within the lumen of the mid-jejunal segment (blue arrow). There is moderate flocculent fluid distention of the intestines oral to the foreign body (as seen to the right of the foreign body in the image above).

A special thanks to the staff at Veterinary Housecall Service as well as the emergency surgical team at AAVEC for this interesting case and patient follow-up information.