Clinical Differential Diagnosis
GI tract - neoplasia, foreign body, IBD
Pancreas - chronic pancreatitis, neoplasia
Abdominal mass - neoplasia/cyst/granuloma of intestine, spleen, liver.
Image 2: Split screen of stomach (right) and duodenum (left) that revealed upper GI stasis. Image 3: A distinctly shadowing intestinal foreign body is seen (arrow) with mural thickening and loss of layering of the affected intestinal wall (measurement). Images 4 & 5: The 6 cm shadowing foreign body is visible with adjacent stasis followed by empty small intestine finalizing the obstructive pattern defined in our prior study (Sonographic Criteria for the Diagnosis of Gastrointestinal Obstruction in 39 Dogs and Cats, ECVIM 2009, http://www.sonopath.com/resources/articles). A minor amount of ill-defined surrounding fat is noted adjacent to the intestinal wall in the near field indicative of transmural disease process in act indicating a surgical emergency before further breakdown of the intestinal wall occurs.
Sonographic Differential Diagnosis
Obstructive foreign body with likely underlying mural disease and minor regional omental inflammation.
Exploratory surgery with enterotomy, gastric and intestinal biopsies were recommended. Guarded prognosis depending on underlying histopathology whether concurrent intestinal neoplasia is present versus inflammatory related mural hypertrophy.
Patient had exploratory surgery with solid foreign body removal (Image 6) that revealed an underlying monkey toy (Image 7) (plastic monkey from barrel of monkeys). Intestinal biopsy revealed fibrosing enteritis/peritonitis adjacent to the intestinal wall without evidence of neoplasia.
The patient recovered well and is gaining weight readily. (Image 8).