RADIOGRAPHIC AND ULTRASONOGRAPHIC EVALUATION OF THE PATELLAR LIGAMENT FOLLOWING TIBIAL PLATEAU LEVELING OSTEOTOMY

KARA L. MATTERN, CLIFFORD R. BERRY, JEFFREY N. PECK, JACEK J. DE HAAN

Background
This report documents a rare case of true gastrogastric intussusception (GGI) in an 18-month-old male mixed-breed dog, presenting with acute vomiting and hematemesis. True GGI, defined as the invagination of the gastric fundus into the gastric body, is extremely rare and distinct from pylorogastric and duodenogastric intussusceptions commonly described in veterinary and human medicine. The study aims to emphasize diagnostic findings and clinical considerations in identifying this condition.

Methods
The dog underwent clinical evaluation, radiographic imaging, ultrasonography, and post-mortem computed tomography (CT). Imaging identified thickening of the gastric walls and abnormal invagination patterns consistent with GGI. Histopathological analysis and necropsy were performed to confirm imaging diagnoses.

Results
Diagnostic imaging revealed a well-defined soft-tissue opacity within the gastric lumen. Ultrasound detected marked thickening of the invaginated gastric wall without disruption of wall layering. CT and necropsy confirmed the invagination of the gastric fundus into the body, accompanied by ischemia, infarction, and hemorrhage. Histopathology showed extensive mucosal necrosis, hemorrhage, and bacterial infiltration. No evidence of gastric neoplasia was found, and hookworms in the intestines were noted as a possible contributing factor.

Limitations
The study was limited by the lack of antemortem surgical intervention or endoscopic confirmation due to the owner's decision for euthanasia. Additionally, CT was performed post-mortem without contrast, potentially affecting imaging resolution. The condition's rarity limits generalizability.

Conclusions
This case represents the first reported antemortem diagnosis of true GGI in veterinary medicine using radiographic, ultrasonographic, and CT modalities. Clinicians should consider GGI in dogs presenting with acute vomiting, abdominal pain, and characteristic imaging findings. Early surgical intervention is recommended when GGI is suspected.

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