Partial Gastric Obstruction Caused by Cajarana (Spondias cytherea Sonn) in Puppies - Imaging Techniques for Diagnosis

Abstract

Background: Ingestion of foreign bodies is one of the most common cases seen among puppies of dogs in the medical clinics of small animals which may be related to their curious behavior. The diagnosis is based on the patient’s history, clinical signs, and complementary diagnostic imaging tests. The present case report describes the use of complementary imaging tests, showing a partial gastric obstruction caused by cajarana (Spondias cytherea Sonn) in a puppy.Case: At the Veterinary Hospital of the Federal Rural University of the Semi-Arid Region, a 4-month-old male Yorkshire dog was treated. The guardian reported having witnessed the ingestion of a cajarana stone by the animal. During the physical examination, the animal was active, with good nutritional status, normocorated mucosae, and a moderate degree of dehydration, besides a slight pain on palpation in the epigastric region. Hematological examinations included blood counts, blood urea, creatinine, and alkaline phosphatase. A moderate degree of polycythemia was observed, which may be explained by the dehydration caused by the episodes of vomiting. The patient had frequent episodes of vomiting after the reported event and was then referred to the diagnostic imaging sector. During the sonographic examination, a concave echogenic interface associated with a posterior acoustic shadowing was observed in the region of the stomach. The animal was sent for simple radiographs and positive contrast based on barium sulfate due to the suspicion of the presence of a foreign body. On simple radiography, in the left laterolateral view, a little radiopaque structure of circular format with poor definition was observed in the pyloric region. After the simple radiography, approximately 10 mL of barium sulfate contrast was administered orally followed by a new left lateral radiographic imaging. On performing sequenced radiographs, a discrete barium contrast contour, oval in structure, located in the pyloric region was observed, even after gastric emptying for about 1 h, reinforcing the clinical suspicion of cajarana stone ingestion. In view of these results, the animal underwent a gastrostomy for the removal of cajarana, which measured about 2.5 cm in diameter. After the surgical procedure, the animal had a good clinical recovery.Discussion: The history of the animal along with clinical signs and imaging tests are of great assistance in the investigation of gastric foreign bodies. The most common type of foreign bodies found in the gastrointestinal tract of small animals are bones, but other atypical structures may also be found, as shown in this report. Radiography (simple and with contrast) is an imaging method widely used in veterinary medicine because of its low cost and clinical accessibility. It is important for the investigation of gastrointestinal obstructions, being of fundamental importance in the management of this case. Ultrasound examination also provides crucial information when foreign bodies are suspected since the formation of intense posterior acoustic shadow (described in this case) is one of the characteristic findings of this condition. Finally, the associated radiography and ultrasonography as diagnostic imaging for the investigation of foreign bodies in the gastrointestinal tract complement each other. Depending on the nature of the foreign body, a single imaging examination may not be satisfactory to suggest the presence of a foreign body with certainty.