Gastric dilatation-volvulus as complication after surgical removal of a splenic haemangiosarcoma in a dog

An 8-year-old crossbreed dog presented after one episode of acute collapse due to rupture of a splenic haemangiosarcoma. Following splenectomy the dog recovered well. Two days after discharge the dog re-presented because of gastric dilatation-volvulus (GDV) that eventually led to his death. Splenectomy to remove a voluminous splenic tumour may predispose to GDV and dogs may benefit from concurrent prophylactic gastropexy.     

Prospective evaluation of laparoscopic-assisted gastropexy in dogs susceptible to gastric dilatation

OBJECTIVE: To determine long-term outcome associated with laparoscopic-assisted gastropexy in prevention of gastric dilatation-volvulus (GDV) in susceptible dogs and to evaluate use of laparoscopy to correct GDV. DESIGN: Prospective study. ANIMALS: 25 client-owned large-breed dogs. PROCEDURE: 23 dogs susceptible to GDV were referred as candidates for elective gastropexy. These dogs had a history of treatment for gastric dilatation, clinical signs of gastric dilatation, or family members with gastric dilatation. Laparoscopic-assisted gastropexy was performed. One year after surgery, abdominal ultrasonography was performed to evaluate the attachment of the stomach to the abdominal wall. Two dogs with GDV were also treated with laparoscopic-assisted derotation of the stomach and gastropexy. RESULTS: None of the dogs developed GDV during the year after gastropexy, and all 20 dogs examined ultrasonographically had an intact attachment. Another dog was euthanatized at 11.5 months for unrelated problems. Two dogs with GDV successfully underwent laparoscopic-assisted gastropexy after the stomach was repositioned. CONCLUSIONS AND CLINICAL RELEVANCE: Laparoscopic-assisted gastropexy resulted in a persisting attachment between the stomach and abdominal wall, an absence of GDV development, and few complications. Dogs with a high probability for development of GDV should be considered candidates for minimally invasive gastropexy. Carefully selected dogs with GDV can be treated laparoscopically.     

Circumcostal gastropexy for preventing recurrence of gastric dilatation-volvulus in the dog: an evaluation of 30 cases

Follow-up evaluation (mean, 13.7 months) was obtained in 30 dogs with gastric dilatation-volvulus that were surgically treated with circumcostal gastropexy. Evaluation was performed by questionnaire (29 dogs), radiographic contrast studies (23 dogs), and necropsy (6 dogs). The gastropexy was thought to be intact in all 23 dogs examined radiographically. Necropsy of 6 dogs dying from causes unrelated to gastric dilatation-volvulus (mean of 12.7 months after surgery) revealed an intact gastropexy site in each dog. Only 1 (3.3%) dog had clinical recurrence of gastric dilatation after surgery. Five additional dogs dying postoperatively were necropsied and had intact gastropexy sites.     

Evaluation of an endoscopically assisted gastropexy technique in dogs

OBJECTIVE: To evaluate the use of endoscopy in conjunction with a gastropexy technique in dogs as a potential means to aid prevention of gastric dilatation-volvulus. ANIMALS: 12 healthy adult medium- and large-breed dogs. PROCEDURES: 12 adult research dogs that had no abnormal physical examination findings each underwent an endoscopically assisted gastropexy procedure. On completion of the procedure, the dogs were euthanized and exploratory laparotomies were performed to evaluate the surgical site. Data recorded included anatomic location of the gastropexy, gastropexy length, and duration of procedure as well as any complications. RESULTS: Mean+/-SD gastropexy length was 3.3+/-0.25 cm, and mean duration of surgery was 18+/-7 minutes. In each dog, the stomach was located in its normal anatomic position and all gastropexies were sutured to the abdominal wall at the level of the pyloric antrum. The only complications during the procedure were needle bending and breakage at the time of stay suture placement. CONCLUSIONS AND CLINICAL RELEVANCE: On the basis of these findings, it appears that endoscopically assisted gastropexy is a simple, fast, safe, and reliable method of performing a prophylactic gastropexy in dogs when undertaken by a person who is skilled in endoscopy. Such a procedure maximizes the benefits of decreased morbidity and shorter duration of anesthesia associated with minimally invasive surgery. Further clinical studies are warranted to evaluate the long-term efficacy of this procedure in dogs at risk for development of gastric dilatation-volvulus.     

Gastric and intestinal surgery.

Gastric surgery is commonly performed to remove foreign bodies and correct gastric dilatation-volvulus and is less commonly performed to treat gastric ulceration or erosion, neoplasia, and benign gastric outflow obstruction. Intestinal surgery, although commonly performed by veterinarians, should never be considered routine. The most common procedures of the small intestinal tract performed in dogs and cats include enterotomy and resection/anastomosis. Surgery of the large intestine is indicated for lesions causing obstruction, perforations, colonic inertia, or chronic inflammation.     

SPONTANEOUS PNEUMOPERITONEUM SUBSEQUENT TO GASTRIC VOLVULUS IN TWO DOGS

In two dogs spontaneous pneumoperitoneum developed following gastric volvulus. The pneumoperitoneum resulted from splenic necrosis and Klebsiella pneumoniae peritonitis in one and from a gastric perforation near the gastroesophageal junction in the other. The first dog was successfully treated by splenectomy, abdominal lavage, and systemic antibiotic therapy; the other was treated by closure of the perforation, tube gastrostomy, abdominal lavage, and systemic antibiotic therapy. One dog was euthanized four weeks after surgery because of metastatic cancer, and the other was euthanized six weeks after surgery due to recurrence of abdominal distention and peritonitis.     

Recurrence of gastric dilatation-volvulus after incisional gastropexy in a rottweiler

An adult, castrated male rottweiler with a history of gastric dilatation-volvulus (GDV), which was treated 4 months previously by surgical gastric resection and incisional gastropexy, had a recurrence of clinical signs. Abdominal exploratory surgery revealed a 180 degrees -clockwise GDV, with a stretched adhesion at the original gastropexy site. The stomach was repositioned, and additional gastropexies were performed adjacent to the original gastropexy site and at the gastric fundus. The recurrence of GDV in this dog with an intact gastropexy suggested that a risk for volvulus remains after therapeutic incisional gastropexy.     

Partial Gastrectomy with an Automatic Stapling Instrument for Treatment of Gastric Necrosis Secondary to Gastric Dilatation-Volvulus

A gastrointestinal anastomosis stapling instrument was used to perform partial gastrectomy in nine dogs undergoing emergency surgery for gastric dilatation-volvulus. The amount of necrotic stomach resected was 20% to 50%. Permanent gastropexy was performed, and six dogs also required partial or total splenectomy. Six dogs (67%) were normal after surgery, with follow-up periods of 6 to 16 months for five dogs. One dog died and two dogs were euthanatized because of postoperative complications unrelated to the surgical technique. There were no complications involving the partial gastrectomy staple line.     

Pituitary-adrenal function in dogs with acute critical illness

OBJECTIVE: To evaluate pituitary-adrenal function in critically ill dogs with sepsis, severe trauma, and gastric dilatation-volvulus (GDV). DESIGN: Cohort study. ANIMALS: 31 ill dogs admitted to an intensive care unit (ICU) at Washington State University or the University of Pennsylvania; all dogs had acute critical illness for < 48 hours prior to admission. PROCEDURES: Baseline and ACTH-stimulated serum cortisol concentrations and baseline plasma ACTH concentrations were assayed for each dog within 24 hours after admission to the ICU. The change in cortisol concentrations (Delta-cortisol) was calculated for each dog. Morbidity and mortality data were recorded for each patient. RESULTS: Overall, 17 of 31 (55%) acutely critically ill dogs had at least 1 biochemical abnormality suggestive of adrenal gland or pituitary gland insufficiency. Only 1 (3%) dog had an exaggerated response to ACTH stimulation. Dogs with Delta-cortisol < or = 83 nmol/L were 5.7 times as likely to be receiving vasopressors as were dogs with Delta-cortisol > 83 nmol/L. No differences were detected among dogs with sepsis, severe trauma, or GDV with respect to mean baseline and ACTH-stimulated serum cortisol concentrations, Delta-cortisol, and baseline plasma ACTH concentrations. CONCLUSIONS AND CLINICAL RELEVANCE: Biochemical abnormalities of the hypothalamic-pituitary-adrenal axis indicative of adrenal gland or pituitary gland insufficiency were common in critically ill dogs, whereas exaggerated responses to ACTH administration were uncommon. Acutely ill dogs with Delta-cortisol < or = 83 nmol/L may be more likely to require vasopressors as part of the treatment plan.     

Surgical management of gallbladder mucoceles in dogs: 22 cases (1999-2003)

OBJECTIVES: To describe preoperative, surgical, and postoperative findings and determine prognostic indicators and treatment recommendations in dogs treated surgically for gallbladder mucocele. DESIGN: Retrospective study. ANIMALS: 22 client-owned dogs. PROCEDURES: Medical records of dogs with gallbladder mucoceles that were treated surgically were reviewed. History, clinical signs, results of selected clinicopathologic analyses and abdominal ultrasonography, surgical procedure performed, results of histologic examination of a liver biopsy specimen, and survival time were recorded. Follow-up information was obtained via telephone interview with owners and referring veterinarians. RESULTS: Dogs were 7 to 15 years of age and had non-specific clinical signs (vomiting, anorexia, and lethargy). Physical examination findings included icterus, signs of depression, and signs of discomfort on palpation of the abdomen. Sixteen dogs had a definitive diagnosis and 6 dogs were strongly suspected of having a gallbladder mucocele on the basis of results of abdominal ultrasonography. Fifteen dogs survived after surgery; 3 of these dogs had bile-induced peritonitis, and 4 had pancreatitis. One dog was euthanatized as a result of severe pancreatitis, and 1 was euthanatized because of acute renal failure; 5 dogs died as a result of pancreatitis, cholecystitis, or bile-induced peritonitis. Hepatic abnormalities were detected histologically in all dogs. CONCLUSIONS AND CLINICAL RELEVANCE: No predictors of survival were identified. No associations between outcome of surgical treatment (survival vs nonsurvival) and preoperative findings, biliary rupture, surgical procedure performed, results of histologic examination of the liver, or development of pancreatitis were found. Cholecystoduodenostomy and cholecystectomy appear to be acceptable treatments for gallbladder mucocele.     

Use of an ultrasonically activated scalpel for splenectomy in 10 dogs with naturally occurring splenic disease

OBJECTIVE:To evaluate the safety and efficacy of an ultrasonically activated scalpel for performing splenectomy, with minimal ligation, in dogs. STUDY DESIGN: Prospective clinical study. ANIMALS: Dogs (10) with naturally occurring splenic disease. METHODS: Between October 2003 and February 2004, splenectomy was performed using an ultrasonically activated scalpel and a double seal method, in 10 dogs with naturally occurring splenic disease. Time for splenectomy and number of ligatures required were recorded. Intraoperative hemostasis, device ease of use, postoperative hemorrhage, and short-term survival were evaluated. RESULTS: Mean operative time for splenectomy, exclusive of celiotomy and closure, was 18 minutes (range, 8-25 minutes). The mean number of ligatures needed to perform splenectomy was 1 (range, 0-2 ligatures). One dog hemorrhaged from the splenic vein after ultrasonic scalpel transection of a vessel >5-mm diameter and required a ligature. The ultrasonic scalpel was easy to use, with a minimal learning curve. None of the dogs had postoperative abdominal hemorrhage; 9 dogs were discharged and 1 dog was euthanatized because of septicemia. CONCLUSION: Ultrasonic activated scalpel may be used to achieve efficient and safe hemostasis of the splenic vascular pedicle in dogs with minimal need for vascular ligation. CLINICAL RELEVANCE: Ultrasonic scalpels can be used to perform splenectomy in dogs with naturally occurring splenic disease.     

Surgery of metastatic anal sac adenocarcinoma in five dogs

OBJECTIVE: To identify survival and morbidity information after surgery for metastases from apocrine gland anal sac adenocarcinomas (AGACA). STUDY DESIGN: Retrospective study. ANIMALS: Five dogs with AGACA. METHODS: Medical records of dogs that had surgery for treatment of metastatic AGACA between 1993 and 2003 were reviewed. Criteria for inclusion required that dogs had lymphadenectomy, with or without further debulking, as part of their treatment for metastatic AGACA and that the tissue was histologically confirmed as consistent with the primary AGACA. Signalment, history, physical examination findings, clinicopathologic data, imaging findings, surgical complications, number of surgeries, survival times, and cause of death were recorded. All dogs had a complete blood count, serum biochemical profile, serum electrolytes, 3-projection thoracic radiographs, abdominal radiographs and/or abdominal ultrasonography, and histologic confirmation of metastatic AGACA invading the regional lymph nodes and caudal abdomen. RESULTS: No surgical complications occurred. Three dogs were euthanatized; median survival, 20.6 months. One dog was alive for 19 months postoperatively. One dog had 5 sequential surgical procedures: 1 iliac lymphadenectomy and 4 debulking procedures of metastatic neoplastic tissue around and dorsal to the iliac vessels extending into the pelvic cavity, and was alive 54 months after initial surgery. CONCLUSION: Dogs with anal sac adenocarcinoma metastases to the iliac lymph nodes can experience long-term survival after surgical excision of the metastatic lesion. CLINICAL RELEVANCE: Lymphadenectomy may afford long-term survival to patients with metastatic anal sac adenocarcinoma.     

Vaginal resection and anastomosis for treatment of vestibulovaginal stenosis in 4 dogs with recurrent urinary tract infections

CASE DESCRIPTION-4 dogs were evaluated because of recurrent urinary tract infections. CLINICAL FINDINGS-All dogs had recurrent urinary tract infections and similar clinical signs; 3 dogs had urinary incontinence. Digital vaginal examination revealed vestibulovaginal stenosis in all dogs, which was confirmed by results of contrast vaginourethrography. From image measurements, the vestibulovaginal ratio (ratio of the height of the vestibulovaginal junction to the maximum height of the vagina on a lateral vaginourethrogram) was calculated for each dog. Three dogs had severe stenosis (vestibulovaginal ratio, < 0.20; severe stenosis is defined as a vestibulovaginal ratio < 0.20), whereas the fourth dog had moderate stenosis (vestibulovaginal ratio, 0.24; ratio range for moderate stenosis is 0.20 to 0.25). TREATMENT AND OUTCOME-All dogs were anesthetized for surgical correction of the vestibulovaginal stenosis. Vaginal resection and anastomosis of the stenosis was performed in all 4 dogs, with 1 dog also undergoing episioplasty. Complete resolution of clinical signs was apparent in 3 dogs; 1 dog had postoperative complications including pollakiuria and stranguria, which resulted in rectal and vaginal prolapse. This dog underwent ovariohysterectomy, after which clinical signs resolved. All dogs had resolution of urinary tract infections at the time of follow-up (6 to 8 months after surgery). CLINICAL RELEVANCE-Resection and anastomosis may resolve recurrent urinary tract infections in dogs with severe or moderate vestibulovaginal stenosis. Episiotomy was not necessary for success of surgical treatment, and overall, that procedure increased morbidity, the severity of intraoperative hemorrhage, and duration of surgery.     

Prevalence of gastric ulcers in show horses.

OBJECTIVE: To determine prevalence and risk factors for gastric ulcers in show horses. DESIGN: Field survey. ANIMALS: 50 horses in active training that had been transported to at least 1 event in the 30 days prior to endoscopy. PROCEDURE: Interview of owner, physical examination, serum biochemical analysis, CBC, and gastric endoscopy were performed. RESULTS: Gastric ulceration was detected in 58% of the horses. Horses with a nervous disposition were more likely to have ulceration than quiet or behaviorally normal horses. Horses with gastric ulceration had significantly lower RBC counts and hemoglobin concentrations than those without ulceration. CONCLUSIONS AND CLINICAL RELEVANCE: Show horses have a high prevalence of gastric ulceration. Lower RBC counts and hemoglobin concentrations may be the result of chronic gastric ulceration.     

Zollinger-Ellison syndrome and myelofibrosis in a dog

Zollinger-Ellison syndrome and myelofibrosis were diagnosed concurrently in a 10-year-old neutered female Brittany Spaniel. Documentation of gastric ulceration, hypergastrinemia, and gastrin-secreting islet cell tumor with splenic metastases facilitated the diagnosis of Zollinger-Ellison syndrome. Patchy long-bone medullary sclerosis, nonregenerative anemia and thrombocytopenia, multiple acellular bone marrow aspirates, marked splenic extramedullary hematopoiesis, and acellular core bone marrow biopsy with areas of necrosis and fibrosis supported the diagnosis of myelofibrosis. Despite the medical and surgical management attempted, the dog was euthanatized because of signs of severe intractable bone pain. Myelofibrosis has been documented in association with canine and human neoplastic disease. A direct causal relationship between gastrinoma and myelofibrosis was not clearly established in this instance.     

Gastric ulceration in horses: 91 cases (1987-1990).

Gastroendoscopy was performed on 111 horses (1 to 22 years old) that had signs of abdominal discomfort of variable duration and severity. At least 1 episode of colic had been observed within 48 hours of examination in 31 horses. Recurrent episodes of colic were observed in 28 horses within 2 to 10 days of examination, 31 horses within 11 to 30 days, 12 horses within 31 to 60 days, and in 9 horses at more than 60 days after the initial examination. Gastric ulceration was found in 91 of 111 horses examined. Other abnormalities involving the gastrointestinal tract or other abdominal viscera were not found on examination in 57 of 91 horses with gastric ulcers. The most frequent concurrent abnormalities found in the remaining 34 horses with gastric ulcers were impaction of the large colon (n = 6), colonic tympany (n = 6), peritonitis (n = 6), gastric impaction (n = 4), ileocecal intussusception (n = 3), small-colon impaction (n = 4), and proximal enteritis (n = 2). Thirteen horses with gastric ulceration underwent abdominal surgery, and in 5 horses, lesions were not found at surgery. Gastric ulceration was determined to be the primary cause of colic in 31 horses on the basis of the lack of other abnormalities, clinical response to treatment with histamine type-2 receptor (H2) antagonists, and confirmation of improvement or resolution of gastric ulceration via endoscopy. Gastric ulceration was the suspected cause of colic in 26 other horses on the basis of the lack of other abnormalities, severity of lesions, and clinical response to treatment with H2 antagonists.(ABSTRACT TRUNCATED AT 250 WORDS)     

Resolution of severe thrombocytopenia in two standard Poodles with surgical correction of splenic torsion

Objective: To describe the diagnosis and treatment of 2 cases of severe thrombocytopenia associated with splenic torsion and to discuss the pathophysiologic mechanisms underlying the thrombocytopenia. Summary: We report 2 cases of severe thrombocytopenia associated with splenic torsion. Each dog presented with non‐specific clinical signs, radiographic evidence of an intra‐abdominal mass, and platelet counts of less than 25,000 platelets/μL. The diagnosis of splenic torsion was made with abdominal ultrasonography and was confirmed during exploratory laparotomy. Both dogs recovered rapidly following splenectomy. The cause of thrombocytopenia associated with splenic torsion is not fully elucidated, but may be because of either platelet sequestration within the torsed spleen, platelet consumption in disseminated intravascular coagulation, or a combination of both. New information provided: This report provides previously unreported evidence that the degree of thrombocytopenia associated with splenic torsion may be of a severity at which primary hemostasis is compromised, and resolution of thrombocytopenia occurs after splenectomy.     

Acute hepatic failure and coagulopathy associated with xylitol ingestion in eight dogs

CASE DESCRIPTION: 8 adult dogs were evaluated for treatment of lethargy and vomiting after ingestion of xylitol, a sugar alcohol used as a sweetener in various products. CLINICAL FINDINGS: In addition to vomiting and lethargy, 5 of the dogs had widespread petechial, ecchymotic, or gastrointestinal tract hemorrhages. Common clinicopathologic findings included moderately to severely high serum activities of liver enzymes, hyperbilirubinemia, hypoglycemia, hyperphosphatemia, prolonged clotting times, and thrombocytopenia. Necropsies were performed on 3 dogs and severe hepatic necrosis was found in 2. In the third dog, histologic examination revealed severe hepatocyte loss or atrophy with lobular collapse. TREATMENT AND OUTCOME: Treatments varied among dogs and included IV administration of fluids; plasma transfusions; and, if indicated, administration of dextrose. Three dogs were euthanatized, 2 dogs died, 2 dogs made a complete recovery, and 1 dog was recovering but was lost to follow-up. CLINICAL RELEVANCE: Although xylitol causes hypoglycemia in dogs, hepatic failure after ingestion has not previously been reported. Because an increasing number of consumer products contain xylitol, clinicians should be aware that ingestion of xylitol can have serious, life-threatening effects.     

Ventricular pneumocephalus and septic meningoencephalitis secondary to dorsal rhinotomy and nasal polypectomy in a dog

CASE DESCRIPTION: A 4-year-old sexually intact female French Bulldog was evaluated because of lethargy, anorexia, and chronic rhinitis-sinusitis. The dog had nasal discharge of 18 months' duration; dorsal rhinotomies were performed 3 months and 2 weeks prior to referral. CLINICAL FINDINGS: On initial evaluation, intraventricular pneumocephalus and sinusitis were diagnosed; CSF analysis revealed high total protein concentration and mononuclear pleocytosis. The dog's condition improved with treatment. Two weeks after discharge, it was treated by a local veterinarian because of upper airway obstruction; 3 days later, the dog was referred because of seizures. Computed tomography revealed a large fluid-filled, left lateral ventricle and a soft tissue mass protruding through a cribriform plate defect. The mass was histologically consistent with brain tissue. Findings of clinicopathologic analyses were unremarkable. Results of cytologic examination of a CSF sample were indicative of septic, suppurative inflammation, and bacteriologic culture of CSF yielded Escherichia coli. TREATMENT AND OUTCOME: Amputation of the herniated olfactory bulb and antimicrobial treatment resolved the septic meningoencephalitis, but neurologic deficits recurred 6 weeks later. Definitive correction of the cribriform plate defect with bone and fascial grafts was attempted. Postoperative rotation of the bone graft resulted in cerebral laceration and hemorrhage, and the dog was euthanized. CLINICAL RELEVANCE: Findings suggest that following dorsal rhinotomy and nasal polypectomy surgery, the dog developed herniation of the left olfactory bulb, intra-ventricular pneumocephalus, and septic meningo-encephalitis because of a cribriform plate defect. Care must be taken to prevent rotation of bone grafts used in cribriform defect repair.