Clinical Differential Diagnosis
(Remo Lobetti PhD, DECVIM):
Upper GIT obstruction - foreign body
Focal gastric/duodenal necrosis secondary to trauma
Images 1, 2:
Thorax: no evidence of the historical pulmonary contusion or other evidence of traumatic thoracic lesions.
Stomach: mild gas and fluid-filled. No foreign body noted.
Small intestines: Mostly clumped caudally in the mid-caudal abdomen. Luminal dimensions of this subset are within normal limits. A second population is suspected in the mid-cranial abdomen on the lateral and ventral-dorsal projections. This subset of intestines have ill-defined serosal margins and measurements are not possible. On the lateral projection one of the loops has a crescent-shaped luminal gas bubble.
The large intestines are uniformly empty, except the terminal descending colon which has faintly mineral-opaque contents. The exact location of the cecum and the relationship o with the aforementioned small intestinal loops can not be determined.
No evidence of free peritoneal air or significant free fluid noted.
Possible segmental small intestinal dilation; mechanical obstruction (causes include lucent foreign body, intussusception, necrosis, neoplasia)
No distinct gastrointestinal foreign object noted.
No evidence of traumatic thoracic changes or aspiration pneumonia
Abdominal ultrasound and complete thoracic radiographs
Alternatively, pneumocolonography or upper GI series.
Sonographic Differential Diagnosis
(Lindquist DMV, DABVP): Focal bowel dysfunction and obstructive pattern owing to spontaneous necrosis, torsion, inflammatory or neoplastic disease. Associated mesenteric lymphadenopathy likely reactive. Potential for non-visible foreign body.
Exploratory surgery was performed. Bowel torsion was found in the region of the bowel in question noted on the sonogram. Then surgeon was able to untwist the bowel without resection and restore normal position.
The patient recovered uneventfully without further problems.