Case of the week 1.8.2023
Publication Date: 2023-01-08
6 images
Findings
Study: Abdomen - ventrodorsal and opposite lateral radiographs are available for review.
Findings: There is a large volume of free gas in the peritoneal space. There is severely reduced peritoneal serosal margin detail.
The stomach is markedly dilated with gas and foamy soft tissue/fluid opaque material. The fundus is located in the right abdomen on the ventrodorsal projection, and the pylorus is gas filled in the mid-dorsal abdomen on the right lateral projection. Ventrally and caudoventrally, there are multiple small gas bubbles superimposed with the gastric wall.
The small intestines are caudally displaced by the stomach and predominately fluid opaque with a small amount of gas. The colon contains a moderate volume of fecal material.
The liver, spleen, kidneys, and urinary bladder are partially obscured by the gastrointestinal tract, but no overt abnormalities are identified. The caudal esophagus is markedly gas distended.
On the left lateral projection, there is a patchy unstructured interstitial to alveolar pulmonary pattern in the ventral aspect of the right middle lung lobe.
Diagnosis
- Gastric dilatation and volvulus with free peritoneal gas and effusion, consistent with GI rupture (like gastric). Gastric wall pneumatosis (such as representing wall necrosis) is suspected given the gas superimposed with the wall. Surgery is indicated.
- Ventrally distributed interstitial to alveolar pulmonary pattern may represent aspiration pneumonia or atelectasis.
Discussion
The patient underwent surgical explore. After derotation of the stomach, about 75% of the stomach wall was necrotic. Due to the poor prognosis the owner elected at that point to euthanize.
Notes
The case was originally seen by Dr. Debow
Files