Featured Case

Patient Info:

Type: Canine
Breed: Shepherd
Mix Age: 7
Sex: FS

History:

Complete anorexia for 4–5 days. Cannot hold anything down. Patient will drink water but vomits. Painful abdomen.

Radiographic Examination:

4 views of the abdomen were available for review — cranial lateral, caudal lateral, cranial VD, caudal VD.

4 views of the abdomen were made to ensure that the entire abdomen was included. The anatomical boundaries of the abdomen include the entire diaphragm to the greater trochanter on both views.

Positioning is very good; the patient is straight on the lateral views, and the entire abdomen is included on the exam. Radiographic technique is good; the mild overexposure at the ventral aspect of the abdomen on the cranial lateral view is thought to be secondary to digitization rather than radiographic technique. Permanent positioning markers were not included on any view.

Radiographic Findings:

The liver is unremarkable. The head of the spleen is not definitively seen; the tail of the spleen is unremarkable. The kidneys are not definitively identified. The urinary bladder is hard to see but is thought to be mildly distended. The stomach contains a small amount of gas and fluid; ingesta is not seen. It is "empty." (Don't confuse the large amount of fecal material in the transverse colon immediately caudal to the stomach for ingesta in the stomach.) The small intestines contain gas and fluid. Many gas-filled loops are at the upper limits of normal for size; a few are larger than expected. In addition, the small intestinal loops have a "plicated" appearance and "bizarre" gas patterns. There is formed fecal material in the colon.

Radiographic Diagnosis:

1. Linear foreign body (LFB) mechanical obstruction.

Next Step:

Patient is a surgical candidate. A linear foreign body obstruction is a surgical emergency.

Abdominal ultrasound or upper GI contrast examinations are often performed in patients with suspected linear foreign bodies.

General Information:

This is a fairly "classic" presentation of a LFB — the intestinal loops are not grossly dilated. There is plication of the small intestinal loops, and there are bizarre gas patterns (not linear, tubular or circumscribed/round).

Some linear foreign body materials include string, fishing line, stockings, tinsel, thread, fabric and plastic wrap.

LFBs are sometimes "anchored" along the GI tract, under the tongue in cats and in the stomach in dogs. A cat can have a LFB and nothing is found under the tongue. It is important to identify and correct a LFB quickly, because a common complication is laceration of the GI tract by the LFB and subsequent peritonitis.

Burke RL. Ackerman N. The Abdomen. In Burke RL. Ackerman N. Small Animal Radiology and Ultrasonography. 2nd Ed. Philadelphia, Saunders Co. 1996. Riedesel EA. The Small Bowel. In Thrall, DE. ed Textbook of Veterinary Diagnostic Radiology. 4th ed. Philadelphia, Saunders Co. 2002.

Click images for a larger view:

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