Case of the Month

• Severe peritoneal detail loss and moderate pneumoperitoneum. Most likely consistent with a perforation of a hollow organ, likely the gastrointestinal tract, with secondary (septic) peritonitis.

• Moderate sternal lymphadenomegaly. Differentials: Metastatic/neoplastic, reactive.

• Hypovolemia.

• Emergency exploratory celiotomy after initial stabilization advised.

• Diagnostic evaluation of the abdomen limited due to the peritoneal detail loss. Due to the age of the patient and the reduced body condition a perforated neoplasia of the gastrointestinal tract is possible. Other etiologies such as perforating gastric/duodenal ulcer or other differentials not excluded.

• A diagnostic abdominocentesis was performed and a septic abdomen was diagnosed. No further follow up was provided.

• Some literature about pneumoperitoneum:

  • Accuracy of radiographic diagnosis of pneumoperitoneum secondary to gastrointestinal perforation in dogs and cats

  • The left lateral projection is comparable to horizontal beam radiography for identifying experimental small volume pneumoperitoneum in the canine abdomen

  • Sonographic Detection of Small Amounts of Free Peritoneal Gas in Beagle Dogs

Thorax and abdomen in 3 projections of a skeletally mature dog in poor body/muscular condition.

Musculoskeletal structures within normal limits besides the reduced body/muscular condition.
Thorax:
Diaphragm delineable. Thoracic volume large.
Moderate enlargement of the sternal lymph nodes. Mediastinum otherwise within normal limits.
Cardiac silhouette small/hypovolemic. Pulmonary vessels, aorta, and caudal vena cava within normal limits.
Pulmonary parenchyma within normal limits.
Abdomen:
Retroperitoneal detail maintained.
Peritoneal detail generalized severely reduced with loss of the visibility of most abdominal organs and with mild to moderate multifocal peritoneal free gas.
Liver as far as assessable not enlarged. Gastric axis steep.
Spleen not delineable.
Left kidney as far as assessable within normal limits. Right kidney not delineable. Urinary bladder not delineable.
Stomach mildly filled with gas and not distended. Visible small bowel loops mildly filled with gas and not distended. Cecum mildly to moderately filled with gas. Colon filled with formed feces. 

Severe peritoneal detail loss and moderate pneumoperitoneum. Most likely consistent with a perforation of a hollow organ, likely the gastrointestinal tract, with secondary (septic) peritonitis.
Moderate sternal lymphadenomegaly. Differentials: Metastatic/neoplastic, reactive.
Hypovolemia.

Emergency exploratory celiotomy after initial stabilization advised.
Diagnostic evaluation of the abdomen limited due to the peritoneal detail loss. Due to the age of the patient and the reduced body condition a perforated neoplasia of the gastrointestinal tract is possible. Other etiologies such as perforating gastric/duodenal ulcer or other differentials not excluded.