A six-year-old male neutered mixed-breed dog was presented to the Cornell University Hospital for Animals emergency service for muscle fasciculations, stiffness, acute anorexia, and lethargy. The patient had a history of non-steroidal anti-inflammatory drug (NSAID) use for severe wounds. He was treated with antibiotics and oral meloxicam at 0.1mg/kg for approximately two weeks. On presentation, the patient had a kyphotic posture, and was mildly febrile and tachycardic. Physical exam revealed a tensed abdomen and tarry fecal material was evident on rectal palpation. Gastrointestinal-focused abdominal ultrasound identified thickening of the gastric wall as well as free fluid and gas in the abdomen. These findings along with a history of NSAID administration led to a presumptive diagnosis of gastrointestinal perforation.