Intestinal perforation with associated peritonitis in a dog

2 year old miniature dachshund

2-years-old, Miniature Dachshund. Presented with vomiting and diarrhea, having lost a significant amount of weight. An abdominal CT-scan was performed.

2 year old miniature dachshund

Description

All the peritoneal fat is mildly diffusely increased in attenuation throughout the entire abdomen (orange arrows). There is a very mild amount of fluid attenuating non-contrast enhancing material spreading between the small intestine (blue arrows).

dog, CT, abdomen, intestine
dog, CT, abdomen, intestine
dog, CT, abdomen, intestine

At the most distal aspect of the descending duodenum/beginning of the jejunum (located at the level of the left mid-abdomen), there is a focal area of complete disruption of the intestinal wall, with a small hypoattenuating defect (orange arrows). This region connects with a fistulous tubular tract that extends along the peritoneum connecting the intestinal loop with the abdominal wall at the level of the left mid/caudal abdomen (red arrows) and connecting with a cavitated lesion that extends along the left abdominal wall and subcutaneous tissues (green arrows).

dog, CT, abdomen, duodenum and jejunum
dog, CT, abdomen, duodenum and jejunum

Saggital and transverse planes

The fistulous tract shows a thin soft tissue wall with homogeneous post-contrast enhancement, and it contains fluid attenuating, non-contrast enhancing material and gas. In addition, the fistulous tract seems to extend cranially located between the abdominal wall and the splenic tail finishing at the level of the cranial/mid-abdomen, immediately caudal to the last rib (blue arrows). In the left abdominal wall, there is a moderate diffuse thickening of the muscles of the wall. Between the muscles of the abdominal wall and extending into the subcutaneous tissue, extending from the region immediately caudal to the last rib up to the inguinal region, there is a cavitated lesion with irregular and ill-defined margins, containing fluid attenuating, non-contrast enhancing material and gas (green arrows). There is an area of disruption of the abdominal muscles connecting with the subcutaneous tissue within this lesion (pink arrows). There is no evident foreign material visible within the affected intestinal loop, fistulous tract or cavitated lesion in the abdominal wall/subcutaneous tissues.

dog, CT, abdomen, spleen
dog, CT, abdomen, spleen
dog, CT, abdomen, spleen

Dorsal, sagittal and transverse planes

dog, CT, abdomen, spleen
dog, CT, abdomen, spleen

Dorsal planes

Diagnosis

  • Changes at the most distal aspect of the descending duodenum/proximal jejunum, consistent with intestinal perforation with complete disruption of the intestinal wall, connecting with a fistulous tract that extends along the peritoneal cavity, connecting with the left abdominal wall. The intestinal perforation could be caused by a penetrating and migrating foreign material considering the history, even if the foreign material is not clearly visible on the CT vs penetrating wound caused by the foreign material.
  • The fistulous tract has a path that goes into the left abdominal wall and another branch, extending cranially between the abdominal wall and the spleen, finishing caudal to the last rib. Adherences with the spleen cannot be ruled out based on the CT.
  • Cavitated lesion affecting the left abdominal wall and adjacent subcutaneous tissues, extending from the caudal aspect of the last rib up to the left inguinal region, consistent with an abscess, containing gas and fluid. There is no evident foreign material, although this cannot be completely ruled out based on the CT.
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Chronic hepatitis with hepatic cirrhosis and portal hypertension in a dog

7-year-old mixed dog

7-years-old, mixed dog. Presented with vomiting, weight loss and decreased appetite. An abdominal CT-scan was performed.

7-year-old mixed dog

Description

The liver is severely reduced in size, with markedly rounded margins, especially on the left side. The left medial and lateral liver lobes are severely reduced in size, with rounded margins, and homogeneous pre- and post-contrast attenuation (orange arrows). The remaining liver lobes are also decreased in size, although less severely, with a nodular appearance, showing slightly heterogeneous soft tissue attenuation and post-contrast enhancement, with multiple ill-defined hypoattenuating areas (blue arrows).

dog, CT, abdomen, liver lobes
dog, CT, abdomen, liver lobes

The portal vein, at its extra and intrahepatic portions, and the hepatic veins are surrounded by a hypoattenuating halo/region, which is quite severe in the cranial abdomen and less severe in the remaining portions, consistent with severe perivascular oedema (green arrows). 

dog, CT, abdomen, portal vein
dog, CT, abdomen, portal vein
dog, CT, abdomen, hepatic and renal vessels

Adjacent to the hepatic vessels, in the left cranial abdomen, there is a small network of tortuous vessels, without being able to follow its path, consistent with gastroesophageal varices (purple arrows). In addition, there is a small network of tortuous vessels in the region surrounding the cranial mesenteric artery and renal vessels, medial to the left kidney, consistent with gastrophrenic varices (red arrows).

dog, CT, abdomen, hepatic and renal vessels
dog, CT, abdomen, hepatic and renal vessels

The pancreas is slightly prominent with a hypoattenuating halo and multiple hypoattenuating stripes consistent with pancreatic oedema (orange arrows).

dog, CT, abdomen, pancreas

Some of the mesenteric lymph nodes (hepatic, splenic and colic lymph nodes – blue, orange and green arrows respectively) are slightly prominent, decreased in attenuation and with reduced post-contrast enhancement

dog, CT, abdomen, mesenteric lymph nodes
dog, CT, abdomen, mesenteric lymph nodes
dog, CT, abdomen, mesenteric lymph nodes

There is a scant amount of peritoneal fluid surrounding the abdominal organs, visible between the intestinal loops (green arrows). In addition, the peritoneal fat has a diffusely and slightly increased attenuation, with presence of fat stranding (blue arrows).

dog, CT, abdomen, intestinal loops
dog, CT, abdomen, intestinal loops

Diagnosis

  • Severely reduced in size liver (left side>right) with nodular appearance, with rounded margins and areas of heterogeneous attenuation. These changes are most likely consistent with hepatic cirrhosis, most likely secondary to chronic hepatitis. Associated with these changes, there are changes consistent with portal hypertension:
    • Very severe perivascular oedema surrounding the portal vessels and hepatic vein.
    • Pancreatic and mesenteric oedema.
    • Presence of gastrophrenic and gastroesophageal varices, consistent with acquired portal collateral circulation.
    • Scant amount of peritoneal effusion.
  • Mild mesenteric lymphadenopathy, which could be reactive associated with the hepatic abnormalities vs edematous lymph nodes secondary to portal hypertension cannot be excluded.
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