Radiology Rounds – Abdominal radiography and the vomiting patient

Written on January 31, 2013 by Tonya Tromblee Hospital: MVRH

Signalment: 9.5yr SF Beagle who presented for anorexia, vomiting and lethargy of 2 days duration.  The patient otherwise has benign medical history.

Physical Exam:  Mild pain was elicited upon abdominal palpation.

Current CBC and serum biochemistry results are WNL.

Three-view abdominal radiographs were obtained.

What are your radiographic findings? 

What is your diagnosis?

 Scroll down to reveal answer……

 Radiographic Findings:  Serosal detail is normal.  Although the patient is reportedly anorexic and vomiting, amorphous, ropey substance remains in the pylorus and many segments of the small intestine.  Foreign material is confirmed in the pylorus in the VD and left lateral views. The intestines are variably distended with gas and fluid, abnormally clustered within the right abdomen, and exhibit an interrupted and angular gas pattern. No peritoneal gas or effusion is detected.

Diagnosis:  Linear foreign body obstruction.

Follow Up:  Exploratory surgery was performed. A gastrotomy and three enterotomies were  required to remove a large piece of carpet.

Discussion:  The classic radiographic features of linear foreign body (LFB) obstruction include plication or ‘bunching’ of the intestines with loss of the typical sinuous luminal gas pattern.  Intestinal gas that has an angular or tear-drop shape should raise suspicion of linear obstruction even if foreign material is not visualized within the GI tract.  Intestinal plication is often easier to recognize in dogs than in cats because the intestines of dogs are typically larger in diameter and have larger volume of gas which allows for better discrimination of intestinal segments.   Particularly in dogs, rightward deviation of the intestines (in the absence of a mass) is also a suspicious indicator of LFB.  However, this is not so in cats because intestines naturally lie to the right of midline.  LFB obstruction often does not result in significant intestinal distension as is typically seen in other causes of mechanical obstruction.  Because of this, subtle clues are easily overlooked.  In cats with LFB,  intestines may have a ‘ropey’ or corrugated appearance or the abdomen may appear to have fewer intestines than would be expected.

In all cases of vomiting, any material remaining in the stomach or intestines is abnormal and should be regarded as potential foreign body.  Pyloric and/or duodenal contents are often obscured by fluid in right lateral recumbency whereas the pylorus and proximal duodenum are typically gas-filled in left lateral recumbency.  For this reason, left lateral radiographs should be routinely obtained in vomiting patients and especially those suspected of having GI foreign body.

Canine linear foreign body obstruction with classic plicated intestinal pattern

Plicated intestines demonstrating abnormal geometric gas pattern typical of LFB

 

feline linear foreign body obstruction- ropey intestines with abnormal distribution

feline LFB - note the tight plication of the intestines, giving the SI a ropey appearance

Barium GI study - note the classic plicated pattern and linear filling defects in the intestines