What Is Your Diagnosis?

Abstract

HistoryA 12-year-old 7.4-kg (16.3-lb) castrated male mixed-breed dog was evaluated because of a 2-day history of vomiting, anorexia, lethargy, tenesmus, and stranguria. The dog had a history of bilateral perineal hernias. The right-sided hernia had been surgically repaired approximately 3 years ago. The left-sided hernia had been managed medically with stool softeners and periodic digital evacuation of feces prior to initial evaluation.On physical examination, the dog had a tense abdomen, with signs of pain on abdominal palpation; individual abdominal organs could not be evaluated on abdominal palpation. There was a soft, painful swelling present in the left perineal region. On digital rectal examination, a rectal diverticulum was palpable on the left side. Complete blood count revealed mild, mature neutrophilia (22,990 neutrophils/µL; reference range, 5,500 to 16,900 neutrophils/µL), monocytosis (3,030 monocytes/µL; reference range, 300 to 2,000 monocytes/µL), and thrombocytosis (579,000 platelets/µL; reference range, 175,000 to 500,000 platelets/µL). Serum biochemical analysis revealed a mildly high serum alkaline phosphatase activity (376 U/L; reference range, 23 to 212 U/L). All other hematologic parameters were within reference limits. Radiographs of the abdominopelvic area were obtained (Figure 1).Determine whether additional imaging studies are required, or make your diagnosis from Figure 1-then turn the page →