Spontaneous Bowel Necrosis In A Beagle

History (Bdzula VT): A 13- year old MN Beagle dog presented with vomiting, diarrhea, inappetance, and lethargy. The clinical exam revealed 5% dehydration and mildly tender mid cranial abdomen. CBC, Chemistry, and urinalysis were normal. Folate was mildly elevated. CPL was Negative. Empirical treatment with metronidazole, cerenia, and SQ fluids produced only minor positive clinical response.

Clinical Differential Diagnosis (Lobetti BVSc, MMedVet, PhD, DECVIM): GI tract disease - obstruction (foreign body/neoplasia), IBD, infectious
(bacterial/viral), intestinal lymphoma.

	Image 1

Sonographic Imaging & Interpretation (Lindquist DMV, DABVP): Video 1: The intestine noted in the mid upper 1/3 of the screen reveals a mild mucosal prominence and is approximately twice the width of adjacent small intestine noted in the near field. Curvilinear contour is maintained even though mucosal hypertrophy is present. Video 2: Further distally along the thickened small intestine the presentation now demonstrates loss of mural detail and reactive omentum associated with the affected portion of intestine. This reactive omentum, as opposed to that associated with pancreatitis, is associated with and adhered to the serosal layer of the intestine. This indicates to the clinical sonographer that intestinal perforation may be eminent and transmural pathology is in act. The patient also displayed discomfort upon imaging of this region (+ Murphy Sign). Video 3: Close-up view of the affected small intestine reveals further loss of detail in the 4 layers of intestinal wall (hyperechoic serosa, thin hypoechoic muscularis, thin hyperechoic submucosa, and thick hypoechoic mucosa-the inner most layer that precedes the hyperechoic luminal interface). The normal well-defined curvilinear interface between these layers noted in Video 1 is now losing detail in an “echo cloud” of inflammation. Deviation from the normal curvilinear straight lines between the layers is now evident.

Sonographic Differential Diagnosis (Lindquist DMV, DABVP): Focal transmural small intestinal disease with emerging peritonitis, underlying inflammatory bowel disease, granulomatous enteritis, infectious enteritis, emerging lymphoma, mast cell disease or other neoplasia is suspected.

Sampling: Full-thickness surgical biopsy & resection of the affected bowel (Stockmal DVM). Images 4, 5, and 6 reveal reactive fat and hemorrhage (arrows) that corresponds to the reactive omentum in videos 2 & 3 noted in the sonogram. The smaller arrows in image 4 represent the transition from normal bowel thickness to that affected by the transmural pathology. Biopsy results revealed moderate, chronic, lymphoplasmacytic enteritis with severe granulomatous lymphangitis.

Outcome: (Stockmal DVM) The pet was started on prednisone and Imuran and bland diet. The pet had episodes of vomiting and bloody stool while on the prednisone. The patient was managed periodically with metronidazole, hypoallergenic diet and gastrointestinal protectants. One year later the owner reported that the pet is doing well. The pet is currently taking metronidazole 125mg SID, Dexamethazone 0.375mg EOD, tapering dose of imuran, colostrum 2 BID, and various neutrxceuticals.

Special thanks to Dr. Christine Stockmal & Staff at American Animal Hospital, Ledgewood, New Jersey, USA, for managing this case and referring for ultrasound consultation.