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IJVS Vol.: 7; No.: 1,2 Serial No.: 16,17 Year: 2012
23
IRANIAN JOURNAL OF
VETERINARY SURGERY
(IJVS)
WWW.IVSA.IR
Ultrasonographic Findings of Most Common Surgical Disorders of
Gastrointestinal Tract in Dogs and Cats
Mohamed Gomaa∗¹’², PhD
Martin Kramer ², DVM, Diplomate ECVDI, PhD
Mohamed Taysier Samy ¹, PhD
Mohamed Sayed Ahmed Omar ¹, PhD
Nefissa Helmy Mekkawy¹, PhD
1Department of Surgery, Faculty of Veterinary Medicine, Zagazig University, Egypt.
2Department of Veterinary Clinical Sciences,
Small Animal Clinic, Justus- Liebig University, Giessen, Germany.
Abstract
Objective: To evaluate the efficiency of ultrasound for diagnosis of different gastro-
intestinal surgical affections in dogs and cats.
Design: Clinical study.
Animals: 36 dogs and 20 cats.
Procedures: Ultrasonography was performed using two real-time ultrasound machines.
The entire abdomen was examined ultrasonographically while the animal was in dorsal
recumbency. Percutaneous ultrasound-guided aspiration and microcore automated biopsy
were performed.
Results: Twelve dogs suffered from Ileus due to parasitic infestations and obstructed
foreign bodies, full stomach wall thickening in 3 dogs, 7 cases with intestinal tumors, 3
cases were ultrasonographically examined for assessing gastropexy site. 2 cases with
suspected stomach foreign bodies, 2 cases with necrosed intestine, 2 cases suffered focal
stomach lesion of which 1 case suffered gastritis and the other demonstrated ulcer with
mild thickening of the stomach wall. 1 case suffered intestinal intussusceptions, 2 cases
with perforated intestine. 1 case suffered volvulus nodosus and 1 case was
ultrasonographically normal and suffered melena. Exploratory laparotomy showed
blackish colouration of the caecum. In cats, 10 out of 20 cases were with intestinal
lymphoma, 2 cases were diagnosed with ileus. 1 case demonstrated stomach wall
thickness, 1 case suffered intestinal abscess, 1 case suffered intussusceptions, 2 cases
suffered intestinal perforation, 1 case suffered megacolon following operation for
anastomosis. The last 2 cases suffered intestinal foreign body and parasitic infestation.
Conclusions and Clinical Relevance: The incidence of ileus or obstruction of the
intestine with different foreign bodies constituted 33% from all cases. While cases with
foreign bodies in the stomach and intestine were 14 out of 36 dogs with a rate of 38.8%.
∗ Corresponding author:
Dr. Mohamed Gomaa, PhD
Department of Surgery, Faculty of Veterinary Medicine, Zagazig University Egypt.
E-mail: Gomaasurgeon@yahoo.com
IJVS Vol.: 7; No.: 1,2 Serial No.: 16,17 Year: 2012
24
In cats lymphoma (10 cases) constituted the mostly encountered affection with an
incidence rate of 50%.
Key words: Ultrasonography, Surgical Disorders, Gastrointestinal, Dogs, Cats.
Introduction
Abdominal ultrasonography provides us valuable information that lead to a definitive
diagnosis or to narrow the list of differential diagnosis obtained with other diagnostic
techniques.
Ultrasonography is more sensitive than radiographic survey for the identification of gastric
lesions in dogs. ¹ The main ultrasonographic feature of an intussusception is the appearance of
multilayered wall, concentric rings or ring sign representing the superimposed wall layers of
the intussusceptum and intussuscipiens. A very rare case of gastrogastric intussusception has
been recorded in a three-year old, intact male, Rottweiler which was ultrasonographically
revealed as gastric mass, although the accurate diagnosis was made during surgical
interference. ² GI foreign bodies greatly vary in size, shape, and echogenicity. Segmental fluid
or gas accumulation within the stomach or part of the intestinal tract is an indicator of
mechanical ileus (or obstruction). Balls are easily identified because of their characteristic
curvilinear interface. Linear foreign bodies present as bright linear interfaces, commonly
associated with shadowing and the affected bowel segment often appears plicated ³, however
for complete exploration, laparotomy was performed.4
The presence of GI parasites can mimic the appearance of linear foreign bodies.⁵ Wall
thickening is the most common finding in inflammatory diseases. Fluid accumulation can
often be seen near the perforation or dehiscence sites. GI neoplasia is often associated with
motility disturbances that produce luminal fluid accumulation, which optimizes visualization
of the lesion.4
The ultrasonographic appearance of intestinal entrapment is similar to that of intestinal
perforation or infarction by other causes.⁷ Therefore the aim of the present study was to
evaluate the efficiency of ultrasound for diagnosis of different gastro-intestinal surgical
affection as well as to survey such affections as the ultrasonographic pictures results are
sometimes controversial.
Materials and Methods
This study was carried out on 36 dogs and 20 cats admitted to the Small Animal Clinic Justus-
Liebig University, Giessen, Germany during the period from 2008 to 2010. They were
examined ultrasonographically for diagnosis of different gastro-intestinal surgical affections.
Twenty three different breeds were recorded among the 36 diagnosed dogs, 15 (41.6%) were
females of which 7 (46.6%) were castrated, 21 (58.3%) were males of which 10 (47.6%) were
castrated. They differ in age and ranged between 5 months to 16 years old. They differ also in
weight, ranged between 1.7 to 45 kg. Regarding the cats, fourteen (70%) out of 20 were of the
European shorthair, seven (35%) were castrated females and the rest (65%) were castrated
males. The age was between 2 and 15 years old, while the body weight was between 2.1 and
9.4 Kg BW.
Ultrasonography was performed using two real-time ultrasound machine Powervision 8000,
SSA-390A; Toshiba with an 8 to 12 MHz linear transducer and 5-7 MHz convex transducer
and LOGIQ 9 General Electric (GE) – USA, equipped with M7C (4-7 MHz) convex
IJVS Vol.: 7; No.: 1,2 Serial No.: 16,17 Year: 2012
25
transducer and M12 L (9-12 MHz) linear array transducer. The ventral abdominal wall was
clipped and acoustic gel (Sonogel; Bad Camberg) was applied. The entire abdomen was
examined ultrasonographically while the animal was in dorsal recumbency.
Percutaneous ultrasound-guided aspiration biopsies were performed using either a 22 gauge
spinal needle or a 20 gauge needle. The microcore automated biopsy was performed using a
18 gauge Tru-Cut-like needle, assisted by an automated biopsy gun and also fine-needle
aspiration biopsies (FNAB) were performed.
Results
Through study and analysis of the breed, sex, age and weight of the affected dogs and cats, it
was found that they did not play any role in the incidence of these surgical affections.
Twelve cases (33.3%) were suffered ileus or obstruction of the intestinal tract which was
dilated in the longitudinal and cross sections, also it was filled with fluids and double laminae
hyperechoic structure. In one cases the regional lymph node was enlarged and the peristaltic
movement was increased. In this case biopsy of the intestinal wall revealed parasitic
infestation with Toxocara canis (Fig.1A, B & C).
Most cases were characterized with fluid-filled loops and hyperechoic structures with clear
distal acoustic shadowing which confirmed presence of foreign bodies. When it is in the left
cranial abdomen, it is in the duodenum and while in the right side, it is in the jejunum or in
the right caudal abdomen in the cecum (Fig.2 A, B& C).
Cases suffered from foreign bodies underwent surgery for their removal through enterotomy
or end- to- end intestinal resection and anastomosis.
Sandy materials, stones, clothes, pieces of wood from a tree, peach pit and plastic were the
most detectable foreign bodies. The main ultrasonographic picture of the natural objects
(sandy materials, stones, clothes, pieces of wood from a tree, peach pit as foreign bodies)
appeared as smooth or rough hyperechoic structure with clear distal acoustic shadowing.
While synthetic objects like plastic foreign body appeared as smooth hyperechoic structures
without distal acoustic shadowing (Fig. 3 A & B).
Of the encountered cases, 3 dogs were with full stomach wall thickening. The
ultrasonographic finding revealed focal hypoechoic swelling in stomach wall, sometimes
thick stomach wall with flattened hyperechoic rugae. In one case it was inhomogenous
without demarcation of its layers and in another, the muscular layer was moderately
thickened. In all of these cases no surgical interference was undertaken. Cytological
examination demonstrated chronic fibrous gastritis in one case and the other 2 cases were not
subjected to further examination.
Seven dogs suffered gastrointestinal tumors characterized by round thick hypoechoic mass
with central hyperechoic part in the intestine. This phenomena is called target lesion, 3 of
them were with mixed echogenicity. Histopathology demonstrated carcinoma in the stomach
(Fig.4), lymphosarcoma, lymphoma (Fig.5 & 6) and sarcoma in the intestines. No surgery was
undertaken.
IJVS Vol.: 7; No.: 1,2 Serial No.: 16,17 Year: 2012
26
Figure 1 A: Ultrasound longitudinal scan
in a 7months old Germanshepherd dog,
jejunum dilated (1.6 cm in width) and fluid
filled with double laminae hyperechoic
structure (arrow) parasitic infestation
(Toxocara canis).
Figure 1 B: Ultrasound longitudinal scan
in the same dog showing enlarged
hypoechoic mesenteric lymph node
(arrow).
Figure 1 C: Laparotomy: enlarged jejunal
lymph nodes are seen (arrow). The
mesenteric vessels are prominent.
(Parasitic infestation).
Fig. 2 A: Ultrasound cross scan in 3 years old
Dalmatian dog in the right caudal abdomen:
cecal foreign body appears as hyperechoic
structure with sharp distal acoustic shadowing
(arrow).
Fig. 2 B: Surgery shows the foreign body in the
cecum after enterotomy.
Fig. 2 C: Surgery: foreign body (piece of wood
from a tree).
Figure 3A: A collection of Textile
foreign bodies removed from the GIT
of a 6 years old Doberman dog.
Figure 3B: Surgery enterotomy
closure in 3 parts of the jejunum of the
same dog.
IJVS Vol.: 7; No.: 1,2 Serial No.: 16,17 Year: 2012
27
Three cases were ultrasonographically examined for assessing gastropexy site, showed
hypoechoic irregular area seen between linea alba and stomach wall. Suture materials
appeared hyperechoic and different layers of stomach wall were recognized. In one case free
gas and mild postoperative hyperechoic swollen fat in the mesentery was clear, while the 3rd
case demonstrated moderate hypoechoic thickened and irregular area representing the
inflamed gastropexy site (Fig.7).
Two dogs with suspected stomach foreign bodies revealed hyperechoic structure in the
stomach with clear distal acoustic shadowing and gastrotomy was undertaken for removal of
the foreign bodies (pieces of wood).
Two cases with necrosed and abscessated intestine. In the 1st case, there was no blood supply
in the small intestine without differentiation of the intestinal layers that appeared with mixed
echogenicity. The other case was with abscessation of the intestine, revealed hypoechoic
Figure 4: Ultrasound cross scan over the
stomach in a 5 years old dog. The stomach wall
is hypoechoic with hyperechoic line (a) at the
middle and rugal folds (b) are flattened and
mildly hyperechoic. The total wall thickness in
this dog is 1.7 cm. (Histopathology: Carcinoma)
Figure 5: Ultrasound longitudinal scan in a 16
years old Dachshund dog showing a round
hypoechoic mass with central hyperechoic part
was seen on the left side. Histopathology:
Lymphosarcoma.
Figure 6: ultrasound longitudinal scan in 3
years old Pug dog with a thickened
hypoechoic muscular layer of both sides (1.1
and 1.8 cm) is seen. Lumen is represented
with a hyperechoic line (mucous pattern).
Histopathology: Lymphoma.
IJVS Vol.: 7; No.: 1,2 Serial No.: 16,17 Year: 2012
28
round structure with central hyperechoic area in the right cranial abdomen. Both cases were
operated by resection and anastomosis of the intestine.
Two cases suffered focal stomach lesion (ulcer, gastritis) revealed focal hypoechoic swelling
in stomach wall. Cytology revealed allergic or parasitic gastritis in one case and the other one
demonstrated mild thickening of the stomach wall (Fig.8).
One case suffered intestinal intussusception manifested multilayered series of concentric rings
representing wall layers of the intussusceptum and intussuscepiens. Hypoechoic mesenteric
fat was included. Intestinal resection and anastomosis was undertaken (Fig.9).
Two cases with perforated intestine showed hyperechoic free gas shadowing in right cranial
abdomen with reverberation artifact. Filamentary threads were removed from the
gastrointestinal tract, the other case showed in combination, anechoic fluid in the middle
Figure 7: Ultrasound cross scan in the left
cranial abdomen in a 7 years old Mix dog
showing the gastropexy site (arrow) 2 days
after surgery. It appears hypoechoic,
irregular and thickened.
Figure 8: Ultrasound cross scan of
stomach wall in a 12 years old dog: a
focal hypoechoic swelling in the
mucosa (1) (5 mm) is visible.
Histopathology: Ulcerative, allergic or
parasitic gastritis.
Figure 9: Ultrasound cross section in
the right mid abdomen: intussusception
in a 1 year old Jack Russel Terrier dog.
(F) is hyperechoic mesenteric fat,
multilayered series of concentric rings
representing wall layers of the
intussusceptum (thin arrow) and
intussuscipiens (thick arrow)
IJVS Vol.: 7; No.: 1,2 Serial No.: 16,17 Year: 2012
29
abdomen with mixed echogenicity of the mesentery. Surgery demonstrated perforated
intestine with presence of tree leaf and the abdominal fluid was of purulent material.
Clostridium perfringens and E coli were isolated from the pus (Fig.10 A, B &C).
One case suffered volvulus nodosus demonstrated dilated intestinal tract with anechoic fluid
and an enlarged and necrosed pattern intestinal wall which appeared hyperechoic. Therefore
paralytic ileus was suspected. Surgery revealed red to dark intestinal tract with a hole in the
mesentery, this patient was euthanized (Fig.11 A &B).
Figure 10 A: Ultrasound longitudinal scan in a 2
years old dog showing the free abdominal gas
(arrow) in right cranial abdomen with hyperechoic
shadowing (arrow) and reverberation artifact.
Perforated intestinal loop caused by a foreign body
Figure 10 B&C: Perforated intestinal loop
in the same dog with leaf foreign body (A).
Foreign body itself (B)
Figure 11 A: Ultrasound longitudinal scan in a 9 years old dog showing a dilated intestine
with anechoic fluid (F). Intestinal wall is thickened and hyperechoic (arrow). Volvulus
nodosus. B: Surgery in the same dog showing dilated dark red intestinal loops. A hole in the
mesentery was diagnosed which facilitate the entrapment of the intestine followed with
volvulus (arrow). Dog is euthanized.
IJVS Vol.: 7; No.: 1,2 Serial No.: 16,17 Year: 2012
30
One case was ultrasonographically normal and suffered melena. During exploratory
laparotomy it showed changes in caecal colour. Typhlectomy was done. Histopathological
examination showed moderate to severe granulomatous inflammation of the jejunum, ileum
and colon.
The mostly encountered cases in cats were:
Ten cases with intestinal lymphoma as the most common clinical findings were vomiting,
anorexia and weight loss. Hematemesis and melena were uncommon findings. It is manifested
sonographically as thickened muscular layer of intestine without fully disruption of the wall
layering and reduced wall echogenicity (Fig. 12). One case was accompanied with ascites.
No surgery was adopted. Cytological examination revealed inflammatory bowel disease,
esinophilic enteritis and lack of nucleated cells. Regional mesenteric lymphadenopathy was
recorded in all cases.
Two cases out of 20 were diagnosed with ileus demonstrated dilated intestinal loop with
hypoechoic material and with hyperechoic structure or linear foreign body with distal acoustic
shadowing. Surgery was performed for removal of thread materials from the jejunum in one
case and the trichobezoar (hair ball) from the other case.
One case demonstrated stomach wall thickness, (about 8 mm) and loss of normal layering, the
enlarged mucosa is hypoechoic with a mixed echogenicity and mild gas bubbles around this
area. The condition was cytologically diagnosed as chronic gastritis (Fig.13).
One case suffered intestinal abscess manifested thick hypoechoic wall corrugated with
undifferentiated layers. Surgical finding demonstrated intestinal tumour with thickening of
intestinal wall and necrosis with abscessation of jejunum. Cytology revealed lymphoma with
Figure 12: Ultrasound longitudinal scan in
15 years old cat showing a thickened
hypoechoic to anechoic intestinal wall
(6mm). Cytology: purulent inflammation
with increasing lymphoid blast cells
suspicion of lymphoma.
Figure 13: Ultrasound cross scan in a 7 years
old cat showing a thickened wall of the
stomach (8mm) and loss of normal layering.
The enlarged inner layer is hypoechoic with a
mixed echogenicity. Gas bubbles in the lumen
are visible (a). Histopathology: Chronic
gastritis.
IJVS Vol.: 7; No.: 1,2 Serial No.: 16,17 Year: 2012
31
inflammatory cells as neutrophils, granulocytes, necrosis with bacterial infection. The case is
diagnosed as intestinal abscess caused by lymphoma.
One case suffered intussusception showed the same ultrasonographic picture as described in
dogs. Also enterectomy of the involved area was performed.
Two cases suffered intestinal perforation demonstrated also free hypoehoic abdominal fluid.
Abdominal exploration revealed purulent materials with adhesions between intestine and
abdominal wall. Also perforation of the pylorus without foreign body was clear.
Microbiological examination revealed E coli, Klebsiella, Enterococcus sp. While ascitic fluid
demonstrated cytologically septic pyogranulomatous inflammation (Fig.14 A & B).
One case suffered megacolon following operation for anastomosis as the operation site
demonstrated thickened hypoechoic area with hyperechoic suture material observed without
free gas and without free abdominal fluid. Subtotal colectomy was performed (Fig.15 A, B
&C).
Figure 14 A: Ultrasound longitudinal scan in a 6 years old cat at the right mid abdomen
showing perforated intestinal loop, showing hypoechoic free abdominal fluid (F). B: at
surgery an abscess with purulent materials was diagnosed.
Figure 15 A: Surgery showing the operation
site of subtotal colectomy in 3 years old cat. B:
Surgery showing the extirpated part of colon
distended with fecal matter. C: Ultrasound
longitudinal scan in 3 years old cat showing
hypoechoic area with hyperechoic suture
material (arrow).
IJVS Vol.: 7; No.: 1,2 Serial No.: 16,17 Year: 2012
32
The last 2 cases suffered intestinal foreign body with double hyperechoic laminae without
distal shadowing indicating parasitic infestation. No further examination was performed
(Fig.16).
Discussion
Ultrasound is an important part of modern imaging protocols and can aid greatly in the
diagnosis of most GIT disorders, of which ileus or obstruction of the intestine, functional
disorders, detection of infiltrative disease, regional lymphadenomegaly and complications
such as perforations. However, interpretation of images is highly user dependent and requires
experience. Ultrasonographic findings should be interpreted with respect to case history,
clinical signs and radiographic findings.8,9
Through study and analysis of breed, sex, age and weight of the affected dogs and cats, it was
found that they did not play any role in the incidence of such surgical affections. Twenty three
different breeds were recorded among 36 affected dogs, 15 out of 36 dogs were females of
which 7 were castrated and 21 were males of which 10 were castrated. They differ in age and
ranged between 5 months and 16 years old. They differ also in body weight and ranged
between 1.7 to 45 kg. The same was also recorded in cats except the breed, as 14 out of 20
cats were of the European shorthair and this is referred to the increased population of this
breed in Germany than the other breeds.
Concerning the incidence of the different GIT affections in dogs it was found that ileus or
obstruction of the intestine with different foreign bodies constituted the most of such
affections with an incidence rate of 33% from all cases. While cases with foreign bodies in the
stomach and intestine were 14 out of 36 dogs with a rate of 38.8%. On the other hand
intestinal tumours (7 cases) and diffused stomach wall thickness (3 cases), constituted 27.7%
of all surgical affections. Moreover, cases suffered intestinal obstruction were 14 (12 with
ileus, 1 intussusception and 1 volvulus nodosus) with a rate of 38.8%. Other affections as
focal stomach lesions (2), necrosed or abscessiated intestine (2), intussusception (1), volvulus
nodosus (1) and perforated intestine (2) were solitary and rare. These findings are in
accordance with those reported by Tidwell and Penninck (10). In cats lymphoma (10 cases)
constituted the mostly encountered affection with an incidence rate of 50%. Other cases as
ileus (2), stomach foreign bodies (2), perforated small intestine (2), stomach wall thickness
(1), abscessation of intestine (1), intussusception (1) and colonic impaction (1) are considered
solitary and rare. Similar findings were previously observed.¹¹
Obstructive ileus may be partial or complete. Common causes are foreign bodies mostly
located in the jejunum and ileum. In cats hair balls are most common causes of intestinal
Figure 16: Ultrasound longitudinal scan
of the intestine of a 14 years old cat.
Intestinal parasites (arrow) have double
lined hyperechoic laminae without distal
shadowing in the fluid filled intestinal
tract.
IJVS Vol.: 7; No.: 1,2 Serial No.: 16,17 Year: 2012
33
obstruction. Strictures could also be the cause. Clinical findings include anorexia, vomiting,
abdominal pain, dehydration and no defecation. The intestine in such cases were mildly
dilated reaching to 1.6 cm diameter proximal to the obstruction or may even be of normal
diameter. These compact foreign bodies appeared as irregular bright interfaces with a strong,
uniform, clean distal acoustic shadowing, which has been previously observed in cases of
intestinal foreign bodies in cats and dogs.¹²,¹³
In complete obstruction, the dilatation of intestine is more severe with gases. The location of
the obstruction can be either intraluminal (foreign bodies), extraluminal adhesions, herniation,
intussusception or intramural (neoplastic wall infiltration, granulomas). More severe dilatation
of intestine is seen proximal to site of obstruction. The segment distal to the obstruction
usually appears empty and contracted due to continued peristaltic activity in the distal
segments. On the other hand, functional (adynamic or paralytic) ileus can be detected as
generalized and uniform mild intestinal dilatation due to lack of vascular or neuromuscular
abnormalities in bowel wall with inhibition of bowel motility. The obstruction is occurred due
to pooling of intestinal contents in the dependent areas of gastrointestinal tract.
Ultrasonography, the condition is characterized by decreased intestinal motility together with
generalized dilatation of the small intestine with its filling with fluids and sometimes with
gases. ¹³
Sandy materials, stones, clothes, pieces of wood from a tree, peach pit and plastic were the
most detectable foreign bodies, and the main ultrasonographic picture of the natural objects
(sandy materials, stones, clothes, pieces of wood from a tree, peach pit as a foreign bodies)
appeared as smooth or rough hyperechoic structure with clear distal acoustic shadowing while
synthetic objects like plastic foreign body appeared as smooth hyperechoic structures without
distal acoustic shadowing. These findings are in consistent with previous observations. ¹⁰
Also ultrasonographic observation of peristaltic activity may also be an important indicator of
obstruction14 as in acute stage of mechanical ileus which is characterized by generalized
increased intestinal motility while in chronic stage and in functional ileus showed generalized
decrease in intestinal motility.
On the other hand, the presence of intraluminal gas is considered to be one of the major
limitations of gastrointestinal ultrasonography as gases masks the underlying structures by the
reverberation artifact and shadowing.15,16
Abdominal radiographic survey is advised in vomiting animals suspected of having ileus, as
ultrasound alone in such instance does not allow global view of the abdomen, it is much more
time consuming and nothing of secondary abnormalities could be overlooked.17
In this respect, the mostly asked question by clinicians is whether one imaging test such as
survey radiography or ultrasonography is sufficient to make the diagnosis of suspected GIT
foreign bodies. Foreign bodies were detected by ultrasonography in all of 16 examined
animals, ¹⁸ the same as manifested in our 14 cases with small intestine and stomach foreign
bodies, which were identified by their clear distal acoustic shadowing and variable degrees of
surface reflection. The consequence of foreign body ingestion depends on the size and shape
of the object. Small foreign body may cause partial obstruction, where as complete
obstruction is usually caused by large circular bodies. Fluid and gas retention proximal to the
obstruction leads to luminal distention.
Seven dogs suffered gastrointestinal tumors or neoplasia were often associated with motility
disturbances that often produce luminal fluid accumulation which optimizes visualization of
the lesion. The primary ultrasonographic sign is the marked wall thickening with complete
loss of layering. Others were characterized with round thick hypoechoic part in the intestine,
IJVS Vol.: 7; No.: 1,2 Serial No.: 16,17 Year: 2012
34
sometimes with mixed echogenicity. The same was also in small animals as the most common
ultrasonographic findings of intestinal lymphoma are transmural thickening associated with
the diffuse loss of normal wall layering, reduced wall echogenicity, reduced localized motility
and regional lymphadenopathy.⁶ In carcinoma the most common ultrasonographic findings
are transmural thickening with a complete loss of layering. Other tumors such as
histiocytoma/ histiocytic sarcoma, mast cell tumor, hemangiosarcoma have been reported.
The lesions tend to appear as poorly echogenic masses or focal thickening with loss of
layering. No specific ultrasonographic features help in differentiating amongst the different
types of tumors. Histopathology demonstrated lymphosarcoma, lymphoma and carcinoma.
Intestinal carcinomas have been documented in dogs and cats.11,19 It shares some of
ultrasonographic features seen in intestinal lymphoma and mechanical ileus is more common
in carcinoma than in lymphoma.
On the other hand, three cases with stomach wall thickening revealed focal hypoechoic
swelling in stomach wall and sometimes thick stomach wall with flattened hyperechoic rouge.
Similar findings have been described in previous studies.6, 20
Ultrasonographic examination for assessing the gastropexy site was chosen because it has
distinct advantages compared to radiological or histological methods. As it is fast, simple and
non invasive technique without radiation hazard and it can be carried out repeatedly on live
animals. A firm and permanent adhesions has been manifested between stomach and linea
alba two months post operation.21,22
Our ultrasonography demonstrated hypoechoic irregular area seen between linea alba and
stomach wall. Suture materials appeared hyperechoic and different layers of stomach wall
were recognized.
The case with necrosed intestine was characterized by absence of blood supply in the small
intestine by Doppler without differentiation of the intestinal layers that appeared with mixed
echogenicity or inhomogenous. While the other case with abscessiation of the intestine
revealed hypoechoic round structure with central hyperechoic area. These findings are
considered to be pathognomonic.²³
Intestinal perforation was detected only ultrasonographically but not radiographically,
therefore ultrasonography alone could be used for the diagnosis as recommended by Tyrrell
and Beck.18 Foreign body and filamentary perforation may be due to precipitation of salts on
the foreign body or threads with its longstanding time with pressure atrophy and perforation
of the intestinal wall. Ultrasonographically, perforation showed hyperechoic free gas
shadowing in right cranial abdomen with reverberation artifact, while in the other case and in
combination an anechoic fluid in the middle abdomen with mixed echogenicity of the
mesentery was demonstrated which confirms ultrasonographic findings in dogs and cats with
gastrointestinal perforation.24
Cases suffered focal stomach lesions which may be ulcer, tumour, gastritis or parasitic
infestation revealed focal hypoechoic swelling in the stomach wall in one case and the other
demonstrated mild thickening of stomach wall due to gastritis as also described in previous
investigations.19,25
Intestinal intussusception was diagnosed only by ultrasonography in one dog and is
characterized ultrasonographically by multilayered series of cocentric rings representing wall
layers of the intussusceptum and intussuscepiens which is considered pathognomonic of the
condition in dogs.26,27
In cases with intestinal volvulus, the intestine rotates around the mesenteric axis causing
vascular compromise with degenerative changes and necrosis of the intestine. It revealed
dilated intestinal tract with anechoic fluid and an enlarged and necrosed intestinal wall which
IJVS Vol.: 7; No.: 1,2 Serial No.: 16,17 Year: 2012
35
appeared hyperechoic. Therefore ileus was diagnosed and confirmed through exploratory
laparotomy. The intestinal wall was of dark blue colour, thickened and reached more than 5
mm, treatment was very difficult and the animal was euthanized. The same signs and
prognosis were recorded in four clinical cases of intestinal volvulus in dogs.28
Intestinal lymphoma in cats is considered to be the most encountered GIT affection with an
incidence rate of 50%. The ultrasonographic findings are generalized thickening of the
muscular layer, associated with slight diffuse loss of normal wall layering, reduced wall
echogenicity, reduced localized motility and regional lymphadenopathy. The thickening of the
intestinal wall can widely range from 1.5- 2mm to over 4 mm. mesenteric lymphadenopathy
is a common finding of intestinal lymphoma in dogs and cats. These findings are the same as
described by several authors.19,25 Moreover, they advised ultrasound guided biopsy for
histopathological examination and accurate diagnosis.
Other demonstrated GIT surgical affections in cats as ileus, foreign bodies, stomach wall
thickening, intussusception, perforated small intestine showed the same ultrasonographic
picture as described in dogs.
However, the case suffered intestinal foreign body with double hyperechoic laminae without
distal shadowing indicated parasitic infestation and is considered to be pathognomonic.
Moreover, the cat which suffered Megacolon following operation for anastomosis, the
operation site demonstrated thickened hypoechoic area with hyperechoic suture material, the
same findings was described by Nick et al.29
Acknowledgments
The authors would like to acknowledge all members of Pathology Departments of (Justus-
Liebig University) Giessen, Germany for achievement and diagnosis of different biopsy
specimens for confirmation.
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هﺪﻴﻜﭼ
ﻪﺘﻓﺎﻳﻮﻧﻮﺳاﺮﺘﻟوا يﺎﻫهﺪﻌﻣ تﻻﻼﺘﺧا ﻦﻳﺮﺘﻟﻮﻤﻌﻣ ﻲﻓاﺮﮔ-هدورﮓﺳ رد ﻲﺣاﺮﺟ ﻪﺑ ﺮﺠﻨﻣ ياﻪﺑﺮﮔ و ﺎﻫﺎﻫ
ﺎﻣﻮﮔ ﺪﻤﺤﻣ
1و2
ﺮﻣاﺮﻛ ﻦﻴﺗرﺎﻣ،
2
ﺗ ﺪﻤﺤﻣ ،ﺎﺮﻳﺰﻳﻲﻣﺎﺳ
1
ﻤﻋ ﺪﻤﺣا ﺪﻳﺎﺳ ﺪﻤﺤﻣ ،ﺮ
1
يوﺎﻜﻣ ﻲﻤﻠﻫ ﺎﺴﻴﻔﻧ ،
1
1
ﺮﺼﻣ ،ﮓﻳزﺎﮔاز هﺎﮕﺸﻧاد ،ﻲﻜﺷﺰﭙﻣاد هﺪﻜﺸﻧاد ،ﻲﺣاﺮﺟ هوﺮﮔ
2
سﻮﺘﺳﻮﺟ هﺎﮕﺸﻧاد ،ﻚﭼﻮﻛ ماد ﻚﻴﻨﻴﻠﻛ ،ﻲﻨﻴﻟﺎﺑ مﻮﻠﻋ هوﺮﮔ- ﮓﻴﺒﻴﻟنﺎﻤﻟآ ،ﻦﺴﻴﮔ ،.
فﺪﻫ- هﺪﻌﻣ تﻻﻼﺧا ﺺﻴﺨﺸﺗ ياﺮﺑ ﻲﻓاﺮﮔﻮﻧﻮﺳاﺮﺘﻟوا ﻲﻳارﺎﻛ ﻲﺑﺎﻳزرا-هدورﮓﺳ رد ﻲﺣاﺮﺟ ﻪﺑﺮﺠﻨﻣ ياﻪﺑﺮﮔ و ﺎﻫﺎﻫ
حﺮﻃ ﻪﻌﻟﺎﻄﻣ- ﻲﻨﻴﻟﺎﺑ ﻪﻌﻟﺎﻄﻣ
تﺎﻧاﻮﻴﺣ- 36 و ﮓﺳ هدﻼﻗ10 ﻪﺑﺮﮔ هدﻼﻗ
شور رﺎﻛ- ﻲﻓاﺮﮔﻮﻧﻮﺳاﺮﺘﻟوا ﺪﺷ مﺎﺠﻧا يﺪﻌﺑود شور زا هدﺎﻔﺘﺳا ﺎﺑ . ﺖـﺸﭘ ﻪـﺑ ناﻮﻴﺣ ﻪﻜﻴﻟﺎﺣ رد ـﺑ ﻢﻜـﺷ ﻞـﻛ دﻮـﺑ هﺪـﻴﺑاﻮﺧ ﺎ
اﺪﺷ ﻲﺑﺎﻳزرا ﻲﻓاﺮﮔﻮﻧﻮﺳاﺮﺘﻟو .آنﻮﻴﺳاﺮﻴﭙﺳ ﺪﻳدﺮﮔ مﺎﺠﻧا ﺪﻧﻮﺳاﺮﺘﻟوا ﺖﻳاﺪﻫ ﺎﺑ.
ﺞﻳﺎﺘﻧ-12 ﻞﮕﻧا ﻢﺟﺎﻬﺗ ﻞﻴﻟﺪﺑ سﻮﺌﻠﻳا زا ﮓﺳ هدﻼﻗﻲﻣ ﺞﻧر ﺎﻫدﻮﺑ هﺪﺷ دﺎﺠﻳا داﺪﺴﻧا و ﺪﻧدﺮﺑ .ﺴﺟﻲﺟرﺎﺧ ﻢ ﺶﻳاﺰﻓا و ﺖﻣﺎﺨـﺿ
رد هﺪﻌﻣ3 ﮓﺳ هدﻼﻗ ﺪﺷ هﺪﻫﺎﺸﻣ، رد 7 درﻮﻣ هدور رﻮﻣﻮﺗ وﺟﺖﺷاد دﻮ و 3 درﻮﻣ ﻲـﺴﻜﭘوﺮﺘﺳﺎﮔ ﻞﺤﻣ ﻲﺑﺎﻳزرا ياﺮﺑ ـﺳﻲﻓاﺮﮔﻮﻧﻮ
ﺪﻧﺪﺷ .2 ،هﺪﻌﻣ رد ﻲﺟرﺎﺧ ﻢﺴﺟ ﻪﺑ كﻮﻜﺸﻣدرﻮﻣ رد درﻮـﻣ ود ،هدور زوﺮـﻜﻧ2 زا درﻮـﻣ ﻚـﻳ ﻪـﻛ هﺪـﻌﻣ ﻲﻌـﺿﻮﻣ ﻪﻌﻳﺎـﺿ درﻮـﻣ
ﻲﻣ ﺞﻧر ﺖﻳﺮﺘﺳﺎﮔﻮﻳد ﺖﻣﺎﺨﺿ ﺶﻳاﺰﻓا ﺎﺑ هاﺮﻤﻫ هﺪﻌﻣ ﻢﺧز يﺮﮕﻳد و دﺮﺑداد نﺎﺸﻧ ار هﺪﻌﻣ هرا. 1 هدور ﻲﮕﺘﻓر ﻢﻫﻮﺗ ﺮﻴﮔرد درﻮﻣ ﺎﻫ
ﺪﻳدﺮﮔ هﺪﻫﺎﺸﻣ هدور ﻲﮔﺪﺷ خارﻮﺳ درﻮﻣ ود رد و دﻮﺑ هﺪﺷ .1 ـﺳاﺮﺘﻟوا ﺎـﻨﻠﻣ دﻮـﺟو ﺎـﺑ درﻮـﻣ ﻚﻳ و ﺶﺧﺮﭼ رﺎﭼد درﻮﻣ ﻲﻓاﺮﮔﻮﻧﻮ
ﺮﻧﺖﺷاد لﺎﻣ . ،ﻪﺑﺮﮔ رد10 زا هدﻼﻗ ﺎﺗ20 ،هدور ﻪﺴﺑآ درﻮﻣ ﻚﻳ ،ﺪﻨﺘﺷاد هدور مﻮﻛرﺎﺳﻮﻔﻨﻟ1هدور ﻲﮕﺘﻓر ﻢﻫﻮﺗ درﻮﻣ ،ﺎـﻫ2 درﻮـﻣ
ﺷ خارﻮﺳهدور ﻲﮔﺪ و ﺎﻫ1 ﻤﻋ ﺐﻗﺎﻌﺘﻣ نﻮﻟﻮﻛﺎﮕﻣ درﻮﻣﺪﻨﺘﺷاد زﻮﻣﻮﺘﺳﺎﻧآ ﻞ .2 ﻴﮔرد ﻢﻫ هدﻼﻗﺮ ﻲـﻠﮕﻧا ﻢﺟﺎـﻬﺗ و ﻲﺟرﺎـﺧ ﻢـﺴﺟ
ﺪﻧدﻮﺑ.
ﻪﺠﻴﺘﻧيﺮﻴﮔ و دﺮﺑرﺎﻛ ﻲﻨﻴﻟﺎﺑ- هدور داﺪﺴﻧا ﺎﻳ سﻮﺌﻠﻳا عﻮﻗو ﻞﻣﺎﺷ ﻲﺟرﺎﺧ ﻢﺴﺟ ﺎﺑ33
دﻮﺑ دراﻮﻣ ﻞﻛ زا ﺪﺻرد . ﻪـﻜﻴﻟﺎﺣ رد
هدور و هﺪﻌﻣ رد ﻲﺟرﺎﺧ ﻢﺴﺟ دراﻮﻣ14 زا درﻮﻣ36 عﻮﻗو ناﺰﻴﻣ ﺎﺑ ﮓﺳ هدﻼﻗ8/38 دﻮـﺑ ﺪﺻرد . ﻪـﺑﺮﮔ رد ﺎﻣﻮﻛرﺎـﺳﻮﻔﻨﻟ ﺎـﻫ)10
درﻮﻣ ( عﻮﻗو ناﺰﻴﻣ ﺎﺑ50 ﺪﺻرد داد صﺎﺼﺘﺧا دﻮﺧ ﻪﺑ ار درﻮﻣ ﻦﻳﺮﺘﺸﻴﺑ.
ﺪﻴﻠﻛ نﺎﮔژاو- ا ،ﻲﺣاﺮﺟ تﻻﻼﺘﺧا ،ﻲﻓاﺮﮔﻮﻧﻮﺳاﺮﺘﻟوهﺪﻌﻣ- هدور ﮓﺳ ،ياﻪﺑﺮﮔ،ﺎﻫﺎﻫ
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