Radiographic Case Review: Linear Foreign Body Obstruction in a Young Bernese Mountain Dog Mix
Meet the Bernese Mountain Dog at the center of a challenging GI case involving vomiting, anorexia, and abdominal pain.
Clinical Presentation:
A 3-year-old spayed female Bernese Mountain Dog mix was evaluated for acute onset of vomiting, anorexia, and abdominal discomfort. The patient had a recent history of corticosteroid administration for otitis externa. On physical examination, moderate cranial abdominal pain was elicited, and clinical signs of dehydration were noted.
Hematologic abnormalities included: mild hypochloremia and modest elevations in total protein, alanine aminotransferase (ALT), and alkaline phosphatase (ALP), raising concern for gastrointestinal or hepatobiliary pathology. Abdominal imaging was pursued for further evaluation.
Radiographic Assessment:
Image 1: Left Lateral View (A)
Image 2: Left Lateral View (B)
Stomach: Moderately distended with gas and fluid, with visible gas in the pylorus. A soft tissue opaque linear structure appears to extend through the pyloric outflow tract.
Proximal Duodenum: The duodenal loop is abnormally dilated with a fragmented and heterogeneous gas pattern. Early plication is evident.
Caudal Thorax: The caudal vena cava is narrow and the cardiac silhouette is small, consistent with hypovolemia or dehydration.
Image 3: Right Lateral View
Stomach: Confirmed moderate gas and fluid accumulation; the pyloric region is less gas-distended, aligning with a typical gas/fluid redistribution between lateral views.
Small Intestine: Loops show classic signs of plication—crowding, bunching, and mixed echogenicity with pockets of gas and fluid.
Mid-abdomen: Loop overpopulation suggests a central anchor point with resulting tension on mesenteric borders, supporting a diagnosis of linear foreign body obstruction (LFBO).
Image 4: Composite of all views
This image collage provides a comprehensive overview:
Cranial abdomen: Visible linear soft tissue structure crossing the pylorus in multiple views.
Mid- and caudal abdomen: Fragmented gas patterns, dilated segments, and intestinal bunching.
VD view (bottom right): Consolidation of bowel loops midline with variation in loop diameter.
Interpretation and Differentials:
Radiographic findings are highly suggestive of:
Linear foreign body anchored in the pylorus
Proximal small intestinal plication
Gas and fluid accumulation in the stomach and small intestine
Evidence of volume depletion (small cardiac silhouette, narrow CVC)
These findings confirm a linear foreign body obstruction (LFBO) with classic radiographic features. The foreign material is likely anchored at the pylorus, causing downstream plication and bowel dilation. The dog underwent surgery shortly after imaging, confirming the diagnosis.
Educational Notes for Clinical Practice:
Key Radiographic Signs of LFBO:
Plication of small intestine: "stacked" or "accordion-like" loops, especially in the mid-abdomen.
Fragmented intraluminal gas: Discontinuous or speckled lucencies.
Soft tissue linear opacity crossing the pylorus or duodenum.
Narrowed caudal vena cava and small heart: indicators of dehydration or hypovolemia.
Differential Diagnosis Tips:
Foreign body obstruction with discrete, non-linear objects may lack plication and show single-loop dilation.
Enteritis can cause diffusely gas-filled loops but usually lacks plication and anchoring signs.
Always evaluate both lateral views: fluid/gas layering in the stomach helps localize the pylorus and foreign body position.
Follow-Up and Management:
Surgical intervention is standard for pylorically anchored LFBO.
Preoperative stabilization: IV fluids to address hypovolemia, electrolytes, and pain management.
Consider ultrasound if the diagnosis remains equivocal.
Conclusion:
This case highlights a classic presentation of linear foreign body obstruction in a young dog. The pyloric anchoring, duodenal plication, and fragmented gas patterns underscore the importance of recognizing radiographic hallmarks of LFBO. Early surgical referral is essential for a successful outcome.
