Double Intussusception in a Shih-Tzu Puppy: The Triple-Circle Sign

Intussusception is a common surgical disorder in puppies. Double intussusception (DI) however, is an extremely rare form of this pathology. The authors report a case of a 3-month-old, Shih-Tzu puppy referred to Veterinary Medical Center of Chungbuk National University, Korea with symptoms of abdominal discomfort, intermittent vomiting and bloody diarrhea for 5 days. Ultrasonographic examination of the left mid-abdominal region revealed a mass with a ‘triple case’ sign completely different from the classic ‘target sign’. The surgical intervention confirmed it to be an ileocecal DI in ascending colon. The case emphasizes the rare ‘triple case’ sign as a descriptive finding on ultrasonography in DI presentations.