NZ Bowel Obstruction · PDF file Mechanical vs. Paralytic Ileus Mechanical Usually two...
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Transcript of NZ Bowel Obstruction · PDF file Mechanical vs. Paralytic Ileus Mechanical Usually two...
Donald E Thrall, DVM, PhD
School of Veterinary Medicine
Basseterre, St. Kitts
Important for patient that we be
Seasoned radiologists sometimes
Many times patient not
obstructed…in my practice anyway
No preparation advised
LL, RL, VD
Take advantage of gas as contrast medium
Analog: Hi mAs, low kVp
• Maximizes contrast Digital: Technique less critical
Checklist Learn normal anatomy
Are there enlarged bowel
Roughly height of L2
2x height of central
part of L4 in cats, or
These are guidelines!
Is it colon?
Distribution of enlarged
Are there normal
Gas and solids
Bowel gas pattern?
Free peritoneal gas?
Hallmark sign is enlarged bowel
Is the enlarged bowel small intestine?
Is the problem due to mechanical vs.
paralytic bowel obstruction?
Mechanical vs. Paralytic Ileus
Usually two populations of bowel
• Normal and Enlarged Enlargement usually greater in mechanical
• Leads to stacking Usually fluid and gas in lumen
• Sometimes foreign material in mechanical – Cloth
– Gravel sign
• Often just gas in paralytic ileus
These are only guidelines and there is overlap
PARALYTIC ILEUS (peritonitis)
PARALYTIC ILEUS (endotoxemia)
Two Populations The presence of some small bowel segments that are normal in diameter and
others that are significantly larger…2-3X
Gravel Sign Opaque ingested particulate matter
to look for
MECHANICAL: foreign material in S.I.
MECHANICAL: foreign material
MECHANICAL: stacking Stacking
Vomiting for one week
2 sets of radiographs declared normal
except for fecal accumulation
Emergency radiographs declared “no
evidence of obstruction”
•Enlarged bowel segment
•Gas and solids
What is this?
Normal bowel •Two Populations
Problem started when small bowel
misidentified as colon
Small bowel can have fecal-like contents
Anatomy was misinterpreted
German shepherd, 8y
3 day history of anorexia
One day history of vomiting
Taken to rDVM
Referring radiograph report: Foreign material (bone) and intestines seemed displaced
Given fluids and sent home
Vomiting continued; went back to rDVM
Dog is indiscriminant eater (paper, cans)
Mostly an indoor dog
Staffordshire, 2y Began vomiting 4d ago after shredding
and eating a sock
Became anorexic the following day
Currently vomiting approximately 4 to 5 times daily
Evaluated by local veterinarian 1d ago and no diagnostics were performed
Now has intractable vomiting
• Plication and crescents
Courtesy Dr. W.R.Widmer
Labrador retriever, 7y
Acute anorexia and vomiting for one day
Vomited brown fluid on way to ER
Mildly resents palpation
No overt organomegaly or masses
No obstruction seen with US WOW!!!
Septic effusion on peritoneal tap
Surgery Jejunal perforation
Foreign material but no obstruction
Learning points None
Would call obstruction again
Progressive weight loss over
Seems to vomit when fed
Abdomen not painful
No obstruction apparent with
Biopsy dx: Lymphoplasmocytic and
No abdominal pain
No bowel fluid
What to do if
Get Both L and R lateral
After 4-24 hrs.
Obstruction…can’t be sure.
Signs have not abated
O refused US; took dog
to rDVM for xlap;
Upper GI Examination
Rarely done or done well in practice
Not enough barium
Wrong type of barium
Stopping too soon
Anti-motility drugs on board