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To Cut or Not To Cut: Vomiting in a Wheaten Terrier

Jean K. Reichle, DVM, MS, DACVR, Animal Specialty & Emergency Center, West Los Angeles

Imaging

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April 2014
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Web-Exclusive

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Case: 4-year-old spayed soft-coated wheaten terrier

Clinician's Brief

History: 2-day duration of vomiting and inappetence

Physical Examination: Mild dehydration (4–5%), tachycardia (180 bpm) with abdominal distension and apparent pain on abdominal palpation were noted. 

Abdominal Radiography: Right lateral (Figure 1A, above) and VD views (Figure 1B) of the abdomen were obtained.

Radiographic Findings: The right lateral view (Figure 2) showed severe gastric distension (white double headed arrow) with granular ingesta, intermediate opacity oval structures seen in the ventral stomach on the lateral view (suggesting rubber bands or hair elastics), and various metallic structures (compatible with bra straps and hooks). The small and large intestines are displaced caudally by the gastric distension. The gas-distended small intestine (white bar) measured up to 24 mm and the height of the L5 vertebral body (black bar) was 11 mm; this gives a small intestinal to L5 ratio of 2.2, which is much greater than the upper limit of 1.6 for normal small intestine to L5 height ratio.1

Clinician's Brief

Should this dog go to surgery?
Yes!

Comments: It is tempting to see the most obvious radiographic abnormality (ie, the large amount of foreign material) but miss the more subtle abnormality, such as the small intestinal distension in this case. Measuring the distended small intestine and dividing it by the height of the L5 vertebral body (not including the canal and spinous process) can be used as a measure of normal or an abnormally distended (>1.6) small intestinal diameter.

Outcome: A midline laparotomy and gastrotomy revealed a large trichobezoar surrounding multiple pieces of undergarments (ie, a sock, a bra, rubber bands, plastic, paper). An object was palpated in the pylorus, which had a thread extending through the duodenum and proximal jejunum, causing plication. The gastric foreign material was severed from the thread and removed; a single enterotomy was made at the level of a solid object in the small intestine, removing more pieces of underwear and removing all of the thread. The patient recovered uneventfully.

References

For global readers, a calculator to convert laboratory values, dosages, and other measurements to SI units can be found here.

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