Intestinal leiomyoma in a dog

33 Intestinal leiomyoma in a dog



Case contributed by Carolina Urraca del Junco




Initial presentation


Intermittent melaena


Signalment: 12-year-old neutered male, English springer spaniel, body weight 19.8 kg



Case history


The dog presented to the hospital for investigation of 2 to 3 weeks of intermittent melaena, lethargy and pale mucous membranes. His faeces were formed, but varied in colour from dark brown to tarry and black. There was no bright red blood or mucus present in the faeces and the dog did not have an increase in urgency of defecation. The dog’s appetite had recently decreased, although he was still eating. He was thought to have lost weight, although the amount was not known. He had not been vomiting.


The dog’s usual diet was a high quality commercial dry dog food. He was not fed scraps or extra treats and did not have a history of scavenging. He was current on his vaccinations and had been de-wormed 5 months prior to presentation.



Physical examination


On presentation, the dog was quiet, but alert and responsive. His body condition score was 5/9. His oral mucous membranes were very pale, but capillary refill time was normal. His mucous membranes were moist and he appeared to be well hydrated. His heart rate was mildly elevated at 134 beats per minute and his respiratory rate was also slightly elevated at 36 breaths per minute. The rectal temperature was within normal limits at 38.2° C. Auscultation of the thorax and abdominal palpation were unremarkable and his peripheral lymph nodes felt normal.



Problem list and discussion of problems


The dog’s main problems were the lethargy, pale mucous membranes and intermittent melaena. Pale mucous membranes can be caused by either poor perfusion or anaemia. The dog had no evidence of cardiovascular disorders and was well hydrated. The lethargy and likely anaemia (confirmed by packed cell volume (PCV)) were thought to be due to intestinal blood loss resulting in the melaena.



Differential diagnosis


Differential diagnoses for melaena in this case included:


• Swallowed blood from oral, nasal, pharyngeal or respiratory system disorders (melaena)

• Oesophageal disorders, e.g. ulcer or neoplasia

• Internal parasites, e.g. hook worms

• Gastrointestinal neoplasia, e.g. adenocarcinoma, mast cell tumour, gastrointestinal lymphoma, multiple myeloma, gastrinoma, leiomyoma, leiomyosarcoma

• Inflammatory bowel disease with ulceration

• Sharp or penetrating gastrointestinal foreign body

• Vascular disorders, e.g. colonic vascular ectasia, although it would have to be in the proximal colon as there was no haematochezia

Other less likely differential diagnoses include:


• Hepatopathy (no other consistent clinical signs)

• Uraemia (no polyuria present)

• Pancreatitis (unlikely with no vomiting or evidence of abdominal pain)

• Disseminated intravascular coagulopathy (unlikely)

• Coagulopathies, e.g. vitamin K deficiency, thrombocytopenia, von Willebrand’s disease (less likely as no signs of bleeding elsewhere and no previous history of bleeding)

• Drugs, e.g. NSAIDs, corticosteroids (no history of drug administration)

• Toxins, e.g. caustic agents, heavy metals, Amanita (magic) mushrooms (no known history of ingestion of toxins)


Case work-up



Minimum data base


Routine haematology revealed a severe anaemia with a PCV of 0.11 l/l (reference range 0.39–0.55 l/l, with moderate red blood cell regeneration (corrected reticulocyte count 2.76%). There was a low mean corpuscular volume (MCV) of 56 fl (reference range 60–77 fl) and low mean cell haemoglobin concentration (MCHC) of 30.2% (reference range 32–36%). The microcytosis and hypochromia were consistent with iron deficiency anaemia. Blood smear evaluation revealed marked microcytic hypochromic anaemia with moderate numbers of polychromatophils and small numbers of normoblasts. There was a moderate RBC anisocytosis and mild hypochromia. The platelet number appeared adequate. There was a moderate mature neutrophilia and a mild monocytosis, with a few reactive lymphocytes.


As the dog had a history of melaena, the regenerative anaemia was thought to be likely to be secondary to gastrointestinal blood loss, although haemolysis was possible. A slide agglutination test was negative and Coombs tests for IgG, IgM and complement were also not consistent with immune mediated haemolysis. The haematological parameters were consistent with an iron deficiency anaemia, also likely due to gastrointestinal blood loss.


The dog was dog erythrocyte antigen (DEA) 1.1 blood type positive on an in-house test, which also showed no evidence of auto-agglutination (Fig 33.1).


image

Fig 33.1 In-house blood typing showing a DEA 1.1 positive sample.

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Sep 22, 2016 | Posted by in SMALL ANIMAL | Comments Off on Intestinal leiomyoma in a dog

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