Screen Shot 2021-02-24 at 1.00.18 PM.png — **Investigation of anorexia after inconclusive barium study**

Dr. Emily Evans

PATIENT INFORMATION:

Age: 10y 10m old

Gender: Male

Species: Canine

Breed: Pitbull

Weight: 62lbs

HISTORY:

Patient presented for several days of inappetence. Vomited once a week before examination and since has been eating very little and not defecating much. Routine lab work was all normal. Barium study showed dilation of duodenum that was consistent in multiple views with otherwise normal passage of ingesta.

SIGNIFICANT ULTRASOUND FINDINGS:

The stomach contained a mild-moderate amount of non-shadowing ingesta with mildly increased wall thickness. (5.1mm). The pylorus appeared free obstruction. There was a mild amount of digest in the duodenum but no significant distention or focal lesions. The jejunum became severely plicated and corrugated with increased wall thickness(up to 6.6mm) and irregular wall layering detail. The plicated area was traced to a severely hyperechoic thin linear structure creating a strong acoustic shadow(foreign material). Intestine around the structure was bunched and folded.
A mild amount of anechoic free fluid was seen throughout the abdomen. Mesentery around the plicated loops and the loop containing the foreign material was severely hyperechoic.

The prostate was found to be moderately-severe enlarged with hyperechoic coarse echogenicity and multifocal anechoic small cysts. No mineralization or focal lesions were noted.
The left testicle was atrophied and contained three hypoechoic nodules(0.9x0.5cm, 1.2x0.8cm, 0.5x0.4cm). The right testicle was a normal size, shape and echogenicity with no focal lesions. (Testicular size - Lt/Rt: 2.7x1.0/4.1x1.9cm)

The medial iliac lymph nodes were mildly plump and both had a few severely hypoechoic rounded nodules in the parenchyma

Multiple mesenteric lymph nodes are mildly enlarged with rounded shape having homogeneous hypoechoic echogenicity.

SONOGRAPHIC ANALYSIS:

Ultrasound findings were suggestive of a partially obstructive intestinal foreign body which was linear in appearance with no obvious anchoring. Free fluid, irregular folding and hyperechoic mesentery created concern for possible perforation(s) and/or adhesions.
Incidentally, significant left testicular atrophy and nodules were noted with concern for possible metastatic lesions in local lymph nodes. Associated benign prostatic hyperplasia was also identified.
Exploratory laparotomy and neuter(with biopsies of the left testicle) were recommended.

CASE OUTCOME:

Patient was taken to surgery for neuter and exploratory laparotomy. An affected loop of intestine had adhered to the dorsal body wall, the adhesions were broken down, intestinal perforations repaired and a corndog stick was removed with a single enterotomy site.
The patient has recovered from surgery and continues to do well at home. Biopsy of the testicle was declined. Recheck ultrasound is recommended in 60-90 days to assess prostate and lymph nodes.