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Diagnosis and management of sand impaction of the large intestine in an

Alsatian Puppy

Article · May 2014

DOI: 10.4314/sokjvs.v12i2.10

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 Sokoto Journal of Veterinary Sciences, Volume 12 (Number 2). August, 2014

CASE REPORT
Sokoto Journal of Veterinary Sciences
(P-ISSN 1595-093X/E-ISSN 2315-6201)
Muhammad et al/Sokoto Journal of Veterinary Sciences (2014) 12(2): 57-60.
http://dx.doi.org/10.4314/sokjvs.v12i2.10
Diagnosis and management of sand impaction of the large
intestine in an Alsatian puppy
ST Muhammad1, SW Audu2, BM Jahun1, M Lawal2& DAY Adawa1
1. Veterinary Teaching Hospital, Ahmadu Bello University, Zaria-Nigeria
2. Faculty of Veterinary Medicine, Ahmadu Bello University, Zaria-Nigeria

*Correspondence: Tel.: 2348135989887, E-mail:[email protected]

Abstract
A four-month-old, male German Shepherd puppy previously (six weeks ago) managed for babesiosis and
toxocariasis was re-presented with complaints of weakness and poor growth. Physical examination revealed body
weakness, emaciation, rough hair coat and dried muzzle. Empty rectum and caudal abdominal pain with
crepitating hard masses were felt on palpation. Plane lateral thoraco-abdominal radiograph revealed gas-trapped
(impacted) radio-opaque masses in the transverse and descending colon. Oral administration of vegetable oil (total
of 300ml) given to effect was employed to soften and evacuate bowel content (within 3 hours of treatment).
Radiographic examination 14 hours post management revealed a completely empty bowel. Compounded cereal
paste-like diet was given for 5 days and the puppy was discharged 6 days after presentation.

Keywords: Colon, Sand impaction, Diagnosis, Management, Puppy

Received: 26-10-2013 Accepted: 29-05-2014

Introduction
Sand impaction may be regarded as a focal and/or coarse foreign bodies and feeding time is
accumulation of sand in the intestinal tract resulting often reduced (Radostits et al., 1994).The possible or
in the dilatation and mechanical obstruction of the common causes of intestinal blockage due to foreign
impacted intestinal segment, and it is an uncommon objects swallowed by dogs are bones, stones,
condition in dogs (Moles et al., 2010). Ingestion of marbles and buttons (Sherding & Johnson, 1994;
materials other than normal food (called Anon., 2012a), while medical conditions causing
allotriophagia or pica) varies from licking to actual intestinal obstruction include tumor, hernias,
eating and drinking, and it is due in most cases to intussusceptions and mesenteric torsion (Anon.,
dietary deficiency, either of bulk or of individual 2012b). Diagnosis of allotriophagia involves general
nutrients such as cobalt, phosphorus, etc (Radostits history, physical examination (with emphasis on
et al., 1994). Allotriophagia is considered to be a abdominal palpation) and laboratory
normal behavior in rabbits and foals (Radostits et al., (ultrasonography, radiography, complete blood cell
1994). Chronic abdominal pain or gastritis and count and serum biochemistry) evaluations of the
central nervous system disturbances are often patient (Sherding & Johnson, 1994). Both medical
accompanied by pica in animals (Radostits et al., and surgical managements of intestinal sand
1994). Pica may have serious consequences: impaction in dogs can be effective and often have a
poisoning, foreign body lodgement in the alimentary good prognosis with the medical approach being the
tract, accumulations of sand which may cause primary treatment but, surgical intervention can be
obstruction, perforation of the oesophagus, stomach employed when necessary ( Moles et al., 2010).
or intestine may result from ingestion of sharp

Case report Case history of the puppy

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 Sokoto Journal of Veterinary Sciences, Volume 12 (Number 2). August, 2014

A four-month-old male German Shepherd puppy dried muzzle and emaciation were observed. Ventral
weighing 4.5 Kg was re-presented to the Small retroperitoneal to pelvic abdominal palpation
Animal Unit of the Veterinary Teaching Hospital, elicited pain in the colon which contained a hard
Ahmadu Bello University, Zaria with complaints of crepitating mass and the rectum was empty.
weakness and poor growth. The puppy had been
presented six weeks earlier, with complaints of Laboratory Investigation
inappetance and weakness. It was then managed for A number of investigations involving:
babesiosis, where blood was transfused and ultrasonographic and radiographic examinations;
intramuscular injection of diminazene aceturate whole blood and serum for complete blood count
(R)
(Diminazene - Vetinda Pharmaceuticals Ltd, India) and serum chemistry respectively, were conducted
was administered at 4mg/Kg; and dewormed with to ascertain what went wrong (diagnosis) with the
pyrantel pamoate (Pyranthrin
(R)
- Niemath puppy. The results of the investigations were:
International Pharmaceuticals plc, Oregun, Lagos, Ultrasonographic and radiographic examinations: -
Nigeria) at 10mg/kg for toxocariosis. The puppy had Transabdominal ultrasonographic scan revealed
been vaccinated against canine distemper, hepatitis, normal abdominal organs, except for multilayered
leptospirosis, parvo virus and para-influenza (DHLPP: hyperechoic structure at the caudal abdominal
(R)
Biocan - Bioveta, a. s. Czech Republic). The vaccine region. Lateral thoraco-abdominal radiograph
was administered on second presentation (2 weeks revealed gas-trapped radio-opaque substances
prior to this presentation). impacted in the transverse and descending colons
with empty rectum (Plate I).
Physical examination Clinical pathology result - Complete blood count
0
The body temperature was 38.9 C, pulse and revealed severe anaemia (Table 1); and the blood
respiratory rates were 140 beats/min. and 40 chemistry showed azotaemia, hypophosphataemia
cycles/min. respectively. Weakness, rough hair coat, and decrease in the serum bicarbonate (Table 2).

Table 1: Haematology results

Parameter Patient’s values Reference values *
Packed cell volume (%) 20 37-55
9
White blood cells count (10 /L) 8.0 6-17
9
Neutrophils (10 /L) 4.2 3-12
9
Lymphocytes (10 /L) 3.36 1-5
9
Monocytes (10 /L) 0.24 0.2-1.5
9
Eosinophils (10 /L) 0.16 0.1-0.8
9
Basophils (10 /L) 0.0 Rare
*Source: Sastry, 1983

Table 2: Results of Serum chemistry and enzymes

Parameters Patient’s Values Reference Values
Urea (mmol/L) 10.00 *6-25
Creatinine (mmol/L) 153.00 *44-138
Sodium (mmol/L) 141.00 #140-155
Potassium (mmol/L) 4.80 #3.6-5.8
Chloride (mmol/l) 101.00 #100-120
Bicarbonate (mmol/L) 12.00 #17-24
Calcium (mmol/L) 2.21 #2.0-3.0
Phosphorus (mmol/L) 0.80 *1.0-2.0
Glucose (mmol/L) 5.80 *3.9-7.8
Uric acid (mmol/L) 0.2 *0.2-0.9
Aspartate aminotransferase (mmol/L) 13 *5-55
Alanine aminotransferase (mmol/L) 4 *5-107
Alkaline phosphatase (mmol/L) 57 *10-150
Source: * Anon, 2014
# Awasum, 2010

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 Sokoto Journal of Veterinary Sciences, Volume 12 (Number 2). August, 2014

Plate I: Plane lateral radiography of thorax and Plate II: Drenching the puppy with vegetable
abdomen showing radio-opaque substance impacted (groundnut) oil
in the colon (red arrow) with gas wrapped in an empty
rectum (green arrows)

Plate III: The impacted sand particles voided Plate IV: Lateral thoraco-abdominal plane radiograph
showing clear intestinal passage to the rectum
(arrowed) 14 hours after expulsion of sand particles

Case management thoraco-abdominal radiograph was then taken 14

Three hundred milliliters of vegetable (groundnut) hours after expulsion of the impacting sand particles
oil were administered orally to effect, over a period (Plate IV). The puppy was placed on compounded
of 10 minutes (Plate II). The puppy was then walked paste-like diet (a paste composed of water,
a distance of 100 meters within 10 minutes after grounded millet and guinea corn, sugar and fried
(R)
which it was allowed to rest and observed closely in fish) for 5 days with 2.5% ciprofloxacin (CIPCON –
the intensive care unit of the outpatient department Concept Pharmaceuticals Limited, Mumbai India)
5
of the Veterinary Teaching Hospital. Three hours oral suspension at 7mg/kg x /7 and multivitamins
(R)
later, the drenched vegetable oil began to be voided (Vetzyme – Bob martin (UK) Ltd, Wemberham Lane
1
through the anus, followed by the impacted sand Yatton, North Somereset, UK) at 1400mg x /12 p.o.
particles (50 g) in a projectile form (Plate III). Lateral

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 Sokoto Journal of Veterinary Sciences, Volume 12 (Number 2). August, 2014

Discussion
The occurrence of large intestinal sand impaction in intravenous fluid therapy, gastrointestinal
dogs generally is very rare worldwide (Moles et al., protectants, analgesics and a combination of
2010). The condition is the first encounter in our laxatives and cathartics with frequent radiographic
practice and from the literature search there is no monitoring (Anon., 2012c). The vegetable
available information of such report, except that on (groundnut) oil administered was to act as
eight (experimental) dogs with small intestinal sand gastrointestinal protectant, laxative and cathartic;
impaction (Moles et al., 2010) managed surgically. the exercise (walking) was to aid relaxing the
The suggestive predisposing factor in this case that gastrointestinal tract for the oil to mix and flow
led to the puppy consuming sand particles is together with the sand; the diet was a source of
attributable to the previous medical conditions nutrient with little disturbance to the alimentary
(babesiosis and toxocariosis) that caused anemia tract; ciprofloxacin was to take care of possible
(that could have led to azotaemia) and metabolic bacterial infection in the colon; and multivitamins
acidosis because of anaerobic glycolysis following was to supplement some minerals and vitamins.
haemolysis, thereby increasing cellular production of In conclusion, the case reported here happens to be
+
hydrogen ion- H ; this results in loss of bicarbonate unique in puppies because, the available literatures
leading to reduction in the buffering capacity of the attributed the occurrence of sand impaction is in
+
body and thus allowed H to accumulate); and adult dogs (if it does) and surgical intervention had
mineral deficiency (hypophosphataemia due to been advocated (Sherding & Johnson, 1994).
prolonged inappetance) (Steven & Michael, 2008).
Complete evaluation (diagnostic techniques) was Acknowledgement
employed to ascertain the cause of the condition. We are grateful to Dr CA Awasum of the Department
Depending on the patient’s condition, medical of Veterinary Surgery and Radiology, Ahmadu Bello
management generally involves the use of University, Zaria, Nigeria for his kind assistance.

References
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