Importance de la démarche diagnostique en cas de troubles digestifs chroniques : illustration à partir d'un cas de lymphangite lipogranulomateuse

Recurrent and chronic digestive disorders are a regular clinical presentation in small animal practice. Several complementary exams are available in veterinary medicine to help reduce the differential diagnosis such as blood analysis, medical imaging, endoscopy and surgery. When such digestive disorders are present, a systematic approach is necessary to progressively reduce the hypothesis and find the underlying cause. Abdominal ultrasonography is a first row complementary tool in the exploration of chronic digestive disorders. Nevertheless, the veterinary practitioner must follow the right sequence of the complementary exam and not overinterpret a clinical presentation, an ultrasound image or even a macroscopic aspect. Lipogranulomatous lymphangitis is an inflammation of the intestinal lymphatic vessels and surrounding tissues that can be seen in patients with lymphangiectasia and protein-losing enteropathy. The objectives of this work are to enhance the importance of a systematic approach in dogs with chronic digestive disorders and discuss about lipogranulomatous lymphangitis that should be considered as a possible differential diagnosis in dogs with an intestinal mass. We report here the case of a 6-year French Bulldog with ultrasonographic evidence of a focal small intestinal mass and a diagnosis of focal lipogranulomatous lymphangitis based on histopathological analysis.