IMAGING DIAGNOSIS—DUODENOBILIARY REFLUX OF BARIUM SULFATE DURING ESOPHAGOGASTROGRAPHY IN A DOG

A 4‐year‐old Australian cattle dog presented for regurgitation, 2 months after duodenal resection and anastomosis for a perforated duodenal ulcer. Duodenobiliary reflux of barium sulfate suspension was detected during fluoroscopic esophagogastrography. Follow‐up radiography 2 hours later demonstrated persistence of the barium in the gallbladder and biliary tree. Ultrasonography showed an open sphincter of Oddi but no other morphological abnormalities with the gallbladder or biliary system. No side effects or bloodwork abnormalities were noted. This is the first case report of duodenobiliary reflux of barium in a dog. The pathophysiology of this phenomenon and its incidence and significance in human medicine are discussed.     

What is your diagnosis? Particulate material in peritoneal fluid from a dog

9-year-old castrated male Greyhound dog was presented for evaluation of vomiting and lethargy of 1-week duration. On physical examination, the dog was febrile and dehydrated with a tense abdomen and petechial hemorrhages. Clinicopathologic abnormalities included relative polycythemia, mild lymphopenia with reactive lymphocytes, hypoalbuminemia, hypocholesterolemia, hyperbilirubinemia, increased ALP, mild hypokalemia, hyperamylasemia, hyperlipasemia, increased D-dimer concentration, and hyperfibrinogenemia. Cytologic evaluation of peritoneal fluid revealed marked suppurative inflammation with intracellular barium sulfate particles. The day before presentation, the referring veterinarian had administered oral barium sulfate in an upper gastrointestinal contrast study. Radiographs revealed free contrast material in the peritoneal cavity, consistent with gastrointestinal perforation, and leakage of contrast material. Abdominal exploratory surgery revealed a mid-jejunal perforation and a hepatic nodule. Histopathologic diagnosis of the jejunal and liver lesions was T-cell lymphoma. The patient recovered well postoperatively and received chemotherapy for treatment of lymphoma. Most commercial barium sulfate preparations contain relatively uniform, weakly birefringent, pale yellow particles <1 microm in diameter. Because barium sulfate is found occasionally in clinical specimens, cytopathologists should be familiar with its cytologic appearance.     

Extracutaneous mast-cell tumor in the dog

Three neoplasms of extracutaneous mast-cell origin, arising from the nasopharynx, oral cavity, and hepatopancreatic lymph nodes respectively, were diagnosed in three dogs. The neoplasms had histologic features similar to those of cutaneous mast-cell tumors, but had limited metastasis mostly involving the regional lymph nodes. One dog had a perforating duodenal ulcer, suggesting that duodenal ulcers can occur with extracutaneous tumors as they do with some cutaneous mast-cell tumors in the dog.     

Histopathologic findings and energy dispersive X-ray spectroscopic analysis of experimentally induced foreign-body pneumonias in rats

To document the diagnostic features of foreign-body pneumonias, four commonly used orally administered medicaments were instilled into the lungs of Sprague-Dawley rats. Rats in each group received a single 0.4 ml dose of either barium sulfate suspension (BaSO4), mineral oil, Pepto-bismol, or Kaopectate inoculated into a lung via a mainstem bronchus. The other lung served as a non-inoculated control. Rats were euthanatized on post-inoculation day 2 or 7 in order to document fully-developed acute pulmonary lesions and developing, chronic pulmonary lesions, respectively. Light microscopic features of BaSO4-inoculated lungs were distinctive from changes in mineral oil-inoculated lungs at both post-inoculation days. On post-inoculation day 2, rats inoculated with BaSO4 had pneumonia characterized by large numbers of alveolar macrophages containing green-to-brown granular material. There was minimal interstitial involvement. On post-inoculation day 2, mineral oil caused pneumonia characterized by giant cells and alveolar macrophages that had cytoplasms distended with variably-sized clear vacuoles. Lungs inoculated with BaSO4 or mineral oil had changed little on post-inoculation day 7 compared to the light microscopic features observed on day 2. On post-inoculation day 2, rats inoculated with either Pepto-bismol or Kaopectate had broncho-interstitial pneumonia with areas of necrosis and hemorrhage. On post-inoculation day 7, lungs inoculated with Pepto-bismol or Kaopectate had extensive fibrosis within alveolar lumens. Energy dispersive spectroscopy performed on sections of lung from rats given BaSO4, Pepto-bismol, and Kaopectate yielded a unique elemental spectrum for each compound in situ on post-inoculation days 2 and 7.(ABSTRACT TRUNCATED AT 250 WORDS)     

IMAGING DIAGNOSIS—DUODENAL DIVERTICULUM IN A DOG

A young female Boxer had a history of chronic soft stool. Survey abdominal radiographs were unremarkable. A duodenal diverticulum was identified in abdominal ultrasound and barium upper-gastrointestinal contrast examinations. Before surgery a ^99mTc-pertechnetate study was performed to evaluate for ectopic gastric mucosa in the duodenal diverticulum. Focal abnormal increased radioactivity was identified in the right caudal abdominal quadrant. The diverticulum was excised. Upon histopathologic examination of the duodenal diverticulum, ectopic gastric mucosa was not identified but ectopic pancreatic tissue was found. Mild eosinophilic inflammation within the diverticulum was suspected to be the cause of the mild ^99mTc uptake seen in this dog.     

GASTRIC EMPTYING IN THE NORMAL DOG A Contrast Radiographic Technique

A total of 22 radiographic studies was made to determine comparative gastric emptying times of two different solid test meals (intact kibble food and ground kibble food mixed with barium sulfate suspension) in four mature (15-26 months) normal Beagle dogs under controlled conditions. Complete gastric emptying times of the intact kibble and ground kibble meals of a given dose (8 g/kg of dog food plus 5-7 ml/kg of the contrast agent) ranged from five to ten hours (7.6 ± 1.98 hours with intact kibble meal and 7.0 ± 1.86 hours with ground kibble meal). Feeding a halfdose of ground kibble meal (4 g/kg of dog food plus 3.5 ml/kg of the contrast agent) resulted in complete gastric emptying times of four to six hours (4.7 ± 0.67 hours). Individual dogs had repeatable gastric emptying times although the times varied among different dogs.     

Challenging diagnosis--icterus associated with a single perforating duodenal ulcer after long-term nonsteroidal antiinflammatory drug administration in a dog

A dog developed icterus, vomiting, and anorexia 2 wk after orthopedic surgery and treatment with meloxicam for approximately 1 y. Exploratory laparotomy revealed a single perforated duodenal ulcer. The most likely cause of the hyperbilirubinemia was intrahepatic cholestasis resulting from peritonitis associated with the perforation.     

Surgical treatment of perforating duodenal ulcer in a dog by use of modified choledochoduodenostomy and gastrojejunostomy

Modified choledochoduodenostomy and gastrojejunostomy were used successfully to treat extensive duodenal ulceration and perforation in a dog. Concomitant pyometra, simultaneously managed by ovariohysterectomy, may have predisposed the dog to stress ulceration. Choledochoduodenostomy was performed by transplantation of the entire common bile duct and associated major duodenal papilla to a more distal duodenal location. An indwelling choledochostomy tube was used to stent the anastomotic site, externally divert bile flow, and allow postoperative cholangiography. Early postoperative complications included presumed metronidazole-induced neurotoxicosis, choledochostomy tube obstruction, and pancreatitis, all of which resolved within 2 weeks. The dog was clinically normal and medication (ranitidine and sucralfate) was discontinued 35 months later.     

Severe gastrointestinal bleeding secondary to lornoxicam in the dog

Six dogs with lornoxicam induced severe gastrointestinal bleeding are described. The ingested dose ranged between 0.5 - 5.1?mg/kg BW (median 0.63?mg/kg BW). The severity of the bloodloss anemia was moderate to severe with PCV values ranging between 12 - 27 % (median 16 %) and serum albumin concentrations between 12 - 22 g/l (median 16 g/l). One dog had evidence of chronic thrombocytopathia over 13 days and clinicopathologic findings of gastrointestinal bleeding over 55 days. None of the dogs developed kidney injuries. The clinical condition required transfusion of blood products in 5 of 6 cases. One dog with a perforated duodenal ulcer and septic peritonitis survived until discharge but had to be euthanized later on due to recrudescent clinical signs (hematemesis, melena). The median length of hospitalisation was 12 days (5 - 14). No correlation was seen between the ingested dose and severity of clinical signs. Lornoxicam ingestion leads to severe and longlasting gastrointestinal bleeding in the dog and requires immediate intensive therapy.     

Medical and surgical management of severe barium aspiration in a dog

Objective– To describe the medical and surgical management of a unique case of barium sulfate aspiration pneumonia in a dog. Case Summary– A 5‐year‐old spayed female black Labrador Retriever weighing 33 kg was presented for evaluation of barium aspiration pneumonia. Approximately 200 mL of barium had been instilled into the caudal lung lobes via an improperly placed orogastric tube. Right caudal, right middle, and accessory lung lobectomies were performed, and the dog was managed intensively for 19 days in the hospital. New or Unique Information Provided– This is the first report of a complete diagnostic work‐up including bronchoscopy, bronchoalveolar lavage, culture, thoracotomy, and pulmonary histopathology for severe barium sulfate aspiration in a dog with an excellent outcome.     

Intraperitoneal Circulation and Drainage in the Dog

The patterns of dispersion and drainage of a low viscosity, oil-based contrast medium within the peritoneal cavity were examined in 12 normal dogs. Intraperitoneal injection of contrast medium was cranial or caudal and drainage was by the sump-Penrose or open peritoneal method. Radiographs were made over a 96 hour period, before and after peritoneal drainage was established. Each dog was euthanatized and necropsied. The contrast medium was dispersed throughout the peritoneal cavity 15 to 30 minutes after cranial injection and 1 to 2 hours after caudal injection. Most of the contrast medium drained within 6 hours after open peritoneal drainage and within 24 to 48 hours after sump-Penrose drainage. At necropsy, there was complete encasement of all sump-Penrose drains and partial occlusion of all open peritoneal incisions by omentum adhered to the abdominal wound edges. Peritonitis was not grossly evident, but all dogs showed histologic evidence of an acute inflammatory reaction associated with the drain or wound edge.     

THE UPPER GASTROINTESTINAL EXAMINATION IN THE CAT: NORMAL RADIOGRAPHIC APPEARANCE USING POSITIVE CONTRAST MEDIUM

The normal radiographic appearance of the feline upper gastrointestinal (UGI) examination following oral administration of barium sulfate suspensions was described. Important findings included the minimal gastric air and small bowel gas present on survey abdominal radiographs. Gastric appearance was nearly constant. A normal duodenal pattern, referred to as a "string of pearls", was described. Small bowel lumen size was consistently less than 12 mm. Small bowel mucosal patterns varied widely. The most commonly identified normal radiographic UGI patterns in this study were found consistently in a group of 26 cats thought to be without gastrointestinal disease. Because of the consistency of observation of many radiographic patterns, rapid gastric emptying, and a short small bowel transit time, normal UGI examinations in the cat present a more constant appearance than in the dog, thus making them more valuable as well as easier to conduct.     

Choledochal tube stenting for decompression of the extrahepatic portion of the biliary tract in dogs: 13 cases (2002-2005)

OBJECTIVE: To determine clinicopathologic features, surgical management, complications, and long-term outcome associated with diseases of the extrahepatic portion of the biliary tract treated via choledochal stent placement in dogs. DESIGN: Retrospective case series. ANIMALS: 13 dogs. PROCEDURE: Data were obtained from medical records, and follow-up information was obtained via reexamination or telephone interview with owners or referring veterinarians. RESULTS: 10 dogs had extrahepatic biliary obstruction (EHBO), 6 as a result of pancreatitis. Two dogs had rupture of the common bile duct associated with cholelithiasis. In 1 dog, a stent was placed prophylactically after gastroduodenostomy was performed for a perforated duodenal ulcer. Nine of 13 dogs survived the perioperative period and were discharged. No recurrence of EHBO or other complications developed in the discharged dogs while the stents were in place. Median follow-up period from surgery to last owner contact was 13.3 months. In 1 dog, the stent was removed endoscopically 10 months after surgery and EHBO recurred 9 months after stent removal because of cholangitis. In 4 of 5 dogs that were discharged from the hospital, in which the fate of the stent could be confirmed and the stent was secured to the duodenal wall with absorbable suture materials, the stents were passed in the feces 1 to 11 months after surgery. CONCLUSIONS AND CLINICAL RELEVANCE: Choledochal tube stenting is an effective method of decompression of the extrahepatic portion of the biliary tract in dogs and provides a less complex alternative to traditional cholecystoenterostomy techniques in select cases.     

Successful management of saltwater submersion injury in a dog using mechanical ventilation

Objective– To describe successful management of saltwater near-drowning in a dog using mechanical ventilation. Case Summary– A 7-year-old spayed female Golden Retriever weighing 37 kg was referred for mechanical ventilation after saltwater submersion injury. The dog had a history of rare seizures characterized by pre-ictal agitation. On the morning of the event, the dog became agitated and ran toward Puget Sound. The owners discovered the dog unconscious in approximately 25.4 cm (10 in) of water, with her head submerged. The owners estimated that the dog was submerged for approximately 30 seconds. The dog was presented immediately to the nearest emergency facility where initial diagnostic testing and treatment included venous blood gases, nasal oxygen, and IV fluids. The dog was dyspneic despite nasal oxygen administration and was referred for mechanical ventilation. Upon arrival the patient was cyanotic with an arterial partial pressure of oxygen of 38 mm Hg (reference interval 85–100 mm Hg) and oxygenation saturation of 62% (reference interval >95%). Thoracic radiographs were taken and revealed severe, bilateral pulmonary infiltrates. The patient was ventilated for 70 hours and was discharged 4 days later. Complications included pneumonia and phlebitis at the site of a cephalic IV catheter. Follow up thoracic radiographs 10 days after discharge were within normal limits and the owners report a full recovery at 1 year. New or Unique Information Provided– Submersion injury can result in acute respiratory distress syndrome in dogs. Mechanical ventilation provided critical support during pulmonary recovery in this dog.     

Eumycotic mycetoma caused by Pseudallescheria boydii in the abdominal cavity of a dog

An abdominal eumycotic mycetoma with multiorgan dissemination was diagnosed in a 2-year-old dog. Clinical signs included fever, vomiting, diarrhea, weight loss, and a palpable abdominal mass. The dog developed disseminated intravascular coagulation and died. Pseudallescheria boydii was isolated from the abdominal mass, liver, and peritoneal fluid. Relevant history included an ovariohysterectomy when the dog was 6 months old, which was complicated by dehiscence of the incision site and evisceration. It appears that P boydii has a propensity for establishing itself in the abdominal cavity of the dog, subsequent to surgical dehiscence.     

Intracapsular Prostatic Omentalization: A New Technique for Management of Prostatic Abscesses in Dogs

Twenty dogs with abscessation of the prostate gland were treated by celiotomy, drainage, and digital exploration of the gland through bilateral capsulectomy wounds. Omentum was introduced through the capsulectomy wounds and packed into the abscess cavities around the prostatic urethra. Most dogs were discharged from the hospital within 48 hours of the surgery. Long-term resolution of the problem (no recurrence within 12 months) was achieved in 19 dogs. One dog had recurrent abscessation that was managed by the placement of dependant Penrose drains. Temporary tube cystostomy was performed postoperatively in one dog for the management of transient dysuria. One dog with septic peritonitis resulting from preoperative abscess rupture was managed by concurrent open peritoneal drainage. Intracapsular prostatic omentalization was a simple and effective means of managing prostatic abscessation with minimal requirement for postoperative hospitalization of the patient. The frequency of serious complications, including postoperative urinary incontinence, was low.     

Deployment morbidity among search-and-rescue dogs used after the September 11, 2001, terrorist attacks

OBJECTIVES: To determine characteristics, variables associated with deployment morbidity, and injuries and illnesses of search-and-rescue dogs associated with the Sept 11, 2001, terrorist attacks. DESIGN: Historical cohort study. ANIMALS: 96 dogs. PROCEDURE: Data collected included previous medical or surgical history, physical attributes of dogs, type and number of years of training, site of deployment, shift and hours worked, and number of days deployed. Combined morbidity was defined as 1 or more abnormalities of body systems, including traumatic injuries. RESULTS: Handlers of 96 of the 212 dogs responded to the surveys. Fifty-nine dogs were deployed by the Federal Emergency Management Agency, 10 by police forces, and 27 as members of other search-and-rescue teams. Sixty-five dogs (incidence rate, 17 events/1,000 dog search hours) had combined morbidity during deployment. System-specific morbidity rates included gastrointestinal tract signs (5 events/1,000 dog search hours), cuts and abrasions mostly on the feet (5 events/1,000 dog search hours), fatigue (6 events/1,000 dog search hours), change in appetite (6 events/1,000 dogs search hours), dehydration (5 events/1,000 dog search hours), respiratory tract problems (2 events/1,000 dog search hours), heat exhaustion (2 events/1,000 dog search hours), and orthopedic or back problems (2 events/1,000 dog search hours). Dogs deployed to the World Trade Center were 6.6 times more likely to have combined morbidity, compared with dogs at the Pentagon. CONCLUSIONS AND CLINICAL RELEVANCE: Injury and illnesses occurred in most dogs and affected several organ systems, but all were minor.     

Diagnosis and treatment of peritonitis caused by a larval cestode Mesocestoides spp., in a dog.

Infection of the peritoneal cavity with cestode larvae, presumptively diagnosed as tetrathyridia of the genus Mesocestoides, was found by exploratory celiotomy in a dog with clinical signs consisting of episodic anorexia, vomiting, and depression. Lymphopenia and hypoalbuminemia were associated clinicopathologic abnormalities. Dystrophic calcification and midline duodenal displacement were found on abdominal radiographs. Therapy with mebendazole was instituted after recurrence of the initial episodic clinical signs postoperatively. Daily use of mebendazole for intermittent periods of up to 3 months led to remission of gastrointestinal signs for 30 months. However, 17 months after the initial diagnosis, infection of the vaginal tunic of the testicle with similar cestode larvae necessitated castration and removal of the vaginal tunic to the inguinal ring. Mebendazole therapy was reinstituted and continued for 31/2 months postoperatively. The dog was free of clinical signs of infection during and for the 16 months since this period of treatment.     

Salicylate-induced seizures in a dog

A 10-year-old, mixed-breed, castrated male dog was examined because of acute onset of vomiting followed by severe generalized seizures. The dog had been on a treatment regimen that included a salicylate-containing drug, and the owners unknowingly supplemented aspirin. Supportive treatment utilizing sodium bicarbonate resulted in return to normal within 24 hours. Blood salicylate concentrations were determined to be in the range toxic to human beings.     

Use of a point-of-care urine drug test in a dog to assist in diagnosing barbiturate toxicosis secondary to ingestion of a euthanized carcass

Objective – To describe a case of barbiturate toxicosis in a dog secondary to ingestion of a previously buried euthanized goat carcass and to discuss the utility of urine drug testing in diagnosing barbiturate toxicosis.
Case Summary – A 6-year-old neutered male Border Collie was presented to a university veterinary teaching hospital for evaluation of ataxia and acute collapse. Past pertinent history included Addison's disease that had been managed for 1 year. A companion dog was seen 12 hours earlier chewing on the partially decomposed head of a goat that had been euthanized 47 days previously and buried on the owner's property. The dog was laterally recumbent, unresponsive to stimuli, and hypothermic on physical examination. Initial blood work revealed hyponatremia and hyperkalemia, with a Na/K ratio of 18.5. The dog was volume resuscitated and received an injection of dexamethasone sodium phosphate due to a suspected Addisonian crisis. Despite this treatment, the dog remained laterally recumbent and unresponsive to stimuli. A urine drug screen was performed and was positive for barbiturates. A diagnosis of barbiturate toxicosis secondary to ingestion of a euthanized goat carcass was made. The dog was treated supportively over 12 hours with IV fluids and activated charcoal. The dog was able to walk 11 hours after presentation and was subsequently discharged from the hospital.
New or Unique Information Provided – Urine drug testing is a fast, easy, and point-of-care test that may be useful in dogs to assist in the diagnosis of barbiturate intoxication. Proper disposal of euthanized animals is necessary to prevent toxicosis and possible death of companion animals and wildlife.