HISTORY / CLINICAL SIGNS: Rescued as a stray ~1 month ago. Has experienced tenesmus (difficulty defecating) with pain and vocalization since the time of rescue. Fecal matter is moderately soft and large in diameter. Reportedly happy and acting normally, otherwise. Recently dewormed, up-to-date on vaccines, HWT negative, on monthly heartworm & flea/tick preventives.
PHYSICAL EXAM FINDINGS: BAR. BCS 5/9. Due to extreme discomfort displayed by the patient, was unable to obtain a rectal temperature or perform a digital rectal exam while patient was awake. Colon palpates as somewhat distended. The remainder of the PE was unremarkable and seemingly healthy.
What is on your differential diagnosis list? What diagnostic tests would you order? Any other questions?
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DIAGNOSTIC TESTS & RESULTS:
- Fecal flotation: NOPS
- Barium study: mild/moderate distention of the colon; no other obvious abnormalities observed
- Lower GI series (endoscopy): declined
- Digital rectal exam (under sedation): No superficial stricture palpated. Prostate palpates normally. Anal glands of normal size and shape. The inner aspect of the anal mucosa palpates as thickened with irregularities; bleeds easily when gently palpated.
- Rectal & anal biopsy: mild infiltration of the mucosa with lymphocytes, plasma cells, & eosinophils; this inflammation extends into the smooth muscle underlying the mucosa
Based on this patientโs signalment, clinical signs, physical exam findings, and test results, what is your diagnosis, recommended treatment, and prognostic outlook?
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DIAGNOSIS: Lymphoplasmacytic Proctitis
This patient has inflammation of the anus (proctitis) with lymphocyte and plasma cell infiltrate (lymphoplasmacytic). This condition is overall quite uncommon, yet German Shepherd dogs tend to be predisposed; it is thought to be autoimmune. Proctitis causes defecation to be extremely painful. Due to the discomfort experienced when passing stool, this patient was holding his bowels somewhat, leading to megacolon. The colon becomes distended with feces and, due to nerve dysfunction, suffers impaired contractions that incompletely empty the colon of fecal material. The megacolon should resolve when the proctitis is treated.
TREATMENT: Azathioprine (immunosuppressive). Cisapride (pro-kinetic). Lactulose (to soften stool).
PROGNOSIS: Excellent. This patient quickly responded very well to the prescribed medications, no longer experiencing pain when defecating. He is anticipated to be weaned off of them.
Any other questions, comments, or suggestions?
Unless otherwise stated, these clinical cases are real-life cases that I have managed as a veterinarian in general small animal veterinary practice or else assisted with as a student in vet school. These cases are a great real-world learning tool for vet students and other veterinary professionals. They shall be used for learning purposes and collaboration of knowledge only. These cases are not intended to diagnose or treat any disease by pet owners. – Maranda Elswick, DVM
