Атлас по рентгенологии травмированных собак и кошек / an-atlas-of-radiology-of-the-traumatized-dog-and-cat

212 Radiology of Abdominal Trauma

Case 3.6

3

Signalment/History: “Grace” was a 10-month-old, female

DSH cat with a history of vomiting for a period of seven days.

Radiographic procedure: Radiographs were made of the abdomen because the length of the clinical history suggested an obstructive type lesion.

Radiographic diagnosis: A mid-abdominal metallic foreign body was associated with enlarged, fluid-filled small bowel loops. The lack of visualization of definite serosal margins suggested the possibility of an associated peritonitis.

Treatment/Management: Surgical removal of the metallic “can-opener” required a bowel resection. Unfortunately “Grace” had a complicated recovery and died in the clinic twelve days after surgery. Necropsy located a small bowel abscess at the site where the intestinal anastomosis was performed.

Small bowel foreign bodies 213

Case 3.7

3

Signalment/History: “Shannon”, a 1-year-old, female Siamese cat, had a history of having swallowed thread a week earlier. On presentation, she was vomiting and had been anorectic for the previous five days.

Physical examination: The abdomen was painful on palpation and multiple bowel loops felt thickened, suggesting a linear foreign body.

Radiographic procedure: Studies of the abdomen were made.

Radiographic diagnosis: The small bowel loops were thickened, clumped together on the right side of the abdomen and contained small pockets of air (arrows). A radiographic pattern of this type would be expected in a patient with a small bowel linear foreign body causing a partial obstruction.

Treatment/Management: What was initially a partial small bowel obstruction became complete after the inflammatory changes caused by the linear foreign body cutting through the bowel wall resulted in an adhesive mass. The surgical treatment involved bowel resection, but was not successful.

Comments: Because the bowel wall essentially heals itself as the string “cuts” through it, the peritonitis in such cases remains focal in location and a widespread inflammatory process in the peritoneal cavity is not typically a part of this syndrome.

214 Radiology of Abdominal Trauma

Case 3.8

3

Signalment/History: “Chamois” was a 2-year-old, female Labrador Retriever with a four-day history of vomiting. Diarrhea was noted during the previous 24 hours.

Physical examination: Dilated small bowel loops were palpated.

Radiographic procedure: Abdominal studies were made.

Radiographic diagnosis: A single distended gas-filled small bowel loop was visible indicative of obstructive bowel disease (arrows). Note that the gastrointestinal tract both cranial and caudal to the site of obstruction was empty. Separation of the distended small bowel from the larger colon was difficult; however, the appearance of the bowel walls made identification of the loops possible. The small bowel wall was smooth, while the colonic wall had a typical corrugated appearance. Also, the small bowel loop was dorsal to the colon and far to the right. In comparison, the colon was far to the left on the DV view in a more normal location.

Note on both views the fluid dense mass within the lumen of the distended loop that represents the foreign body.

Comments: A single loop (“sentinel loop”) syndrome is typical of an early complete bowel obstruction that is often the result of an intraluminal mass (foreign body); however, a bowel wall tumor can cause a similar pattern radiographically, if it should quickly develop into an obstructive lesion.

Peritoneal fluid 215

3.2.3Peritoneal fluid

Case 3.9

3

Signalment/History: “Bonnie”, a 2-year-old, female Great

Dane, had a bullet wound in her left flank.

Physical examination: The abdomen was painful on palpation.

Radiographic procedure: Radiographs were made of the abdomen searching for the bullet tract.

Radiographic diagnosis: The metallic bullet lay within the retroperitoneal space on the midline just ventral to L6–7. The abdomen had lost contrast probably due to accumulation of peritoneal fluid. The pattern of gas within the abdomen did not follow that seen normally with bowel gas and free peritoneal air was suspected. The retroperitoneal space had lucent linear shadows suggesting free air in this location also. One airfilled bowel loop was greatly distended suggesting the possibility of an ileus.

Treatment/Management: The metallic fragment was typical for a rifle bullet that has struck only soft tissue and as a consequence was only slightly malformed. An abdomen with the appearance of free fluid and air strongly suggests the likelihood of a ruptured bowel.

“Bonnie” was returned to the referring clinician for surgery and was lost to follow-up.

216 Radiology of Abdominal Trauma

Case 3.10

3

Signalment/History: “Regulus”, a 10-month-old, male DSH cat, was presented with a history of vomiting after being absent from home for several days.

Physical examination: The abdomen was painful on palpation.

Radiographic procedure: Radiographic studies of the abdomen were made.

Radiographic diagnosis: A diffuse pattern of peritoneal fluid was noted throughout the abdomen, but principally surrounding the body of the stomach. Scattered pockets of air were indicative of pneumoperitoneum. The air-filled, distended small bowel was indicative of a paralytic ileus. Note how the bowel loops appear to “float” on the surface of the peritoneal fluid. Feces remained within the distal colon.

Peritoneal fluid 217

3

A positional study using a horizontal beam was made with the dog in right lateral recumbency. This permitted movement of the peritoneal air to a pocket just caudal to the body of the stomach (arrow).

Treatment/Management: A perforated jejunum was located at surgery, which required a bowel resection. The cat was discharged following a recovery period in the clinic. The specific cause of the perforation was not determined.

218 Radiology of Abdominal Trauma

Case 3.11

3

Signalment/History: “Freya” was a 5-month-old, female mixed-breed dog who had been hit by a car and was presented in shock.

Physical examination: The examination was limited; however, palpation indicated that bones in the dog’s forelimb were fractured. Pelvic fractures were suspected as well.

Radiographic procedure: Radiographs were made of the thorax. Following their evaluation, it was determined that additional studies of the caudal abdomen/pelvis, and the right forelimb could be made without risk to the patient.

Radiographic diagnosis (thorax): Lung contusion was minimal, though it was more severe caudally on the left in association with minimal pleural effusion. Fractures of the right 9th (arrow), 11th, 12th, and 13th ribs near the costovertebral joint were difficult to diagnose. Both the cardiac silhouette and the pulmonary vessels were smaller than expected, probably due to shock.

Peritoneal fluid 219

3

Radiographic diagnosis (caudal abdomen): Loss of contrast between the abdominal organs was due to peritoneal fluid. A sacral fracture, left sacroiliac fracture/luxation, and right acetabular fracture were present. A distal femoral fracture on the left was almost overlooked on the radiographic evaluation.

Radiographic diagnosis (right forelimb): Transverse fractures of the right radius and ulna were noted on additional studies.

Treatment/Management: The study of the abdomen was limited to the pelvic region. The cause of the peritoneal fluid and the severity of the shock were not evaluated. The dog died four hours following the radiographic studies after an attempt at controlling the intra-abdominal hemorrhage was unsuccessful.

In this patient, the absence of extensive injury to the thorax did not match the severity of the abdominal and skeletal injuries.

220 Radiology of Abdominal Trauma

3.2.4Inguinal hernias

3

Case 3.12

Signalment/History: “Blackie” was a 4-year-old, female DSH cat who had been hit by a car eight days earlier and was referred because the cat did not have the full use of its pelvic limbs.

Physical examination: The pelvis palpated abnormally with a suggestion of crepitus bilaterally. A full feeling in the inguinal region suggested a soft tissue injury.

Radiographic procedure: Abdominal radiographs were made followed by a retrograde urethrogram.

Radiographic diagnosis (abdomen): Small bowel loops filled with air extended across the abdominal wall into the inguinal region indicating an inguinal hernia. The abdominal wall could not be identified on the right on the DV view. The air-filled bowel loops extended laterally far beyond the limits of the abdominal cavity. The urinary bladder could not be identified. The bilateral sacroiliac luxations were noted with a cranial displacement of the pelvis.

Inguinal hernias 221

3

Retrograde urogram

Radiographic diagnosis (retrograde urogram): The contrast medium leaked into the peritoneal cavity indicating a tear in the urethra or bladder wall. The tip of the catheter had been placed in the bladder limiting the information relative to the urethral injury.

The hip joints could be studied more clearly on the VD view and showed bilateral arthrosis, probably secondary to hip dysplasia.

Treatment/Management: At surgery, a rupture in the vaginal wall was repaired in addition to an urethral tear and the inguinal hernia.