Case of the week 9.17.18
Publication Date: 2018-09-17
History
8 year old male castrated Weimeraner. 2 day history of vomiting. Lethargic. Prior splenectomy and gastropexy
6 images
Findings
Opposite lateral and VD projections of the abdomen are available for interpretation
The serosal margin detail is normal.
There is generalized moderate gas dilation of the small intestine. There is excessive fluid to soft tissue distention of a small intestinal segment in the mid ventral abdomen which is curved and extends in a cranioventral to caudodorsal fashion. An accumulation of numerous pinpoint mineral opaque foci are noted within this distended intestinal segment consistent with a gravel sign. An ill-defined, rounded, mixed soft tissue and gas opaque granular structure is also noted within this segment.
The spleen is absent, consistent with prior splenectomy. The liver is normal in size and sharply marginated. Numerous pinpoint to fine linear branching mineral opacities are noted in the plane of the liver.
A curvilinear accumulation of pinpoint mineral opaque foci is noted in the cranial ventral aspect of the liver, likely within the gallbladder. The kidneys and urinary bladder are normal.
Two metal opaque ballistic projectiles are again noted in the left caudal abdomen and ventral to the right coxofemoral joint, and are unchanged.
Diagnosis
- Gravel sign with two population of small intestines is most consistent with at least partial small intestinal mechanical ileus. Exploratory laparotomy is recommended.
- Cholelithiasis and intrahepatic bile ducts mineralization may represent an incidental finding or may be secondary to chronic inflammatory disease (such as cholecystitis or cholangiohepatitis).
- Absent spleen, consistent with prior splenectomy.
Discussion
The patient underwent exploratory laparotomy. At the level of ileum there was impacted obstructive gritted material. The patient is doing well.
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