Foreign Body and Liver Shunt in a 3-Month-Old Intact Male Bernadoodle: Our Case Of the Month

Double trouble for a young Bernadoodle. An abdominal ultrasound to determine if this fuzzy guy had a gastrointestinal foreign body led to the discovery of a liver shunt, in addition to a foreign body obstruction. Shari Reffi, CVT, SDEP® certified clinical sonographer for SonoPath Mobile Veterinary Ultrasound captured the diagnostic images for this problematic case. Detailed interpretation by Eric Lindquist, DMV, DABVP, Cert. IVUSS

History

Possible intestinal foreign body, lethargy, weakness. Panting on presentation. Current meds: Cerenia, Unasyn, IVF, Barium series started at 5pm. CBC and blood chemistry from 2/15 showed: WBC 22.57, Neu 18.66, HGB 11.4, PLT 128,. Na 144, ALT 440, ALP 379, GGT 12. In house u/a- USG 1.062, 2wbc/hpf, no bacteria, crystals unclassified 1-5/hpf. U/A pending.

Comments

*Chick Weisse, VMD, DACVS can be found at the Animal Medical Center in New York City.

DX

Distal small intestinal foreign body obstruction with concurrent intrahepatic right-divisional shunt.

Image Interpretation

Gastrointestinal: The gastric wall was thickened. The distal small intestine revealed a shadowing foreign body with upper intestinal stasis. The dilated small intestine was followed by the obstructed foreign body, which was followed by empty small intestine that created an obstructive pattern. The obstructed foreign body measured approximately 1.5 cm.

Liver: Microhepatica was present. An intrahepatic right divisional shunt was noted in this patient. The shunt connected the right branch to the portal vein to the vena cava. The shunt measured 1.3 cm at its maximum diameter. The portal vein to vena cava ratio at the portal hilus was 1:1.

UA Specific Gravity Range

1.062

Outcome

The immediate issue is the intestinal obstruction. The ability to metabolize anesthetic will be significantly decreased. Propofol and Isoflurane will likely be the best option for surgical intervention. Medical management for intrahepatic shunt is warranted post surgery with eventual vascular plug placement at Animal Medical Center *Dr. Weisse would be the most appropriate specialist to perform this procedure in the immediate region. Bile acid profile would be warranted, yet it is suspected to be significantly high. I recommend rapid surgery in this patient for the intestinal obstruction under the protocol recommended with followup treatment for the intrahepatic shunt. This is a congenital anomaly. The breeding line should be evaluated for intrahepatic shunting. There is a mild potential that the small intestinal foreign body could pass into the colon, yet was fully obstructed at the time of the sonogram. This appears to be a hard foreign body such as plastic or similar material.
The patient underwent surgery for the foreign body. An enterotomy was performed by Dr. Cattiny and Dr. Giammanco on 2/16/21. There were multiple, unidentifiable large foreign objects with strings attached that were removed from his intestines in addition to a sock. “The small intestines were noted to have large amount of necrosis in the descending duodenum and proximal jejunum. Adhesions present in the abdominal wall. Evidence of linear foreign body present in the pylorus/duodenum. Multiple foreign bodies present. Multiple large foreign objects removed with strings attached. The intestines were severely necrotic and ecchymotic.” The patient had an uneventful recovery and experienced no complications. He was released from the hospital 2 days post-op. and owner reports he is doing excellent at home.