German shepherd Dog • Female • 3 months of age • 2 weeks ago ate lots of grapes, was apathic and vomiting for some days. • After 10 days was presented with diarrhea and tenesmus. • Radiographs of the abdomen were taken. Ventrodorsal (left) and left lateral view of the abdomen Radiographic changes
- There is a very poor abdominal detail with lack of definition of the abdominal organs.
- The intestinal tract contains gas and there are two populations of small intestinal loops. Multiple dilated intestinal loops are visible in the cranial and middle abdomen (arrows). A second population with a small diameter is visible in the middle and caudal abdomen (empty arrows).
The radiologic diagnosis is mechanical ileus and surgery was recommended. Mild abdominal effusion was suspected. Before surgery in order to gain more information about the intestinal obstruction, the dog underwent to ultrasonographic examination. Radiographic changes Close up of the leC lateral view of the abdomen: Two populations of small intestinal loops are visible Ultrasonographic examination Transverse view (left) and longitudinal view (right) of the intestinal loop at the level of the colon descendens.
- There is an intestinal loop with a‚ bull‘s-eye target‘, telescoping effect and concentric layers of intestinal walls.
- This appearance is patognomic for in intussusception, consisting in a concentric ring paUern with an eccentric ovoid hyperechoic region. The central ring (arrow) represent the intussusceptum. The eccentric hyperechoic material (empty arrow) is insussuscepted mesenteric fat. In the longitudinal view, a small intestinal loop (arrow) is visible within the lumen of the colon (arrow head).
Comment
- The small intestine lumen can be occluded and result in mechanical ileus by foreign objects, intussusception, mass from the wall of the bowel (intramural obstruction) or extramural lesions that compress the bowel.
- Intussusception can be initiated by many events including mobility disorders, inflammatory wall lesions, neoplasia or idiopathic causes.
- Although intussusceptions can occur anywhere along the digestive tract, the majority occur in the small intestinal tract and at the ileocolic or cecocolic junction.
- The radiographic appearance is considerably influenced by the completeness of the occlusion caused by it. Many distal intussusception result in generalised severe distention of the small intestine.
- In surgery, the intussusception involved great part of the jejunum and ileum.
- In combination to the history of diarrhea, an enteropathy was suspected and has been postulated as predisposing factor.
