Intermittent gastroesophageal intussusception in a cat with idiopathic megaesophagus

An adult female domestic shorthair cat was evaluated for chronic upper respiratory disease and vomiting. A diagnosis of idiopathic megaesophagus with intermittent gastroesophageal intussusception (GEI) was made based on radiographic and endoscopic examinations. The GEI was manually reduced by use of a stomach tube during the endoscopic procedure. An incisional gastropexy was performed to prevent recurrence. Gastroesophageal intussusception is a rare condition in cats. In dogs it is usually associated with rapid progression of clinical signs, culminating in death. In this cat, the condition was associated with chronic signs, probably due to the intermittent nature of the GEI.     

Ultrasonographic and computed tomographic features of a true gastro-gastric intussusception with concurrent foreign bodies in a dog

A 2-year-old intact male Cane Corso dog was presented for acute weakness, vomiting, and diarrhea. Abdominal ultrasound revealed the stomach had severe wall edema and a target appearance. Computed tomography was consistent with a gastro-gastric intussusception and concurrent mineral-like gastric foreign bodies. After reduction of the intussusception, bilateral incisional gastropexy was performed to prevent recurrence. True gastrogastric intussusception is a rare condition and should be considered if the stomach has severe wall edema with a target sign on abdominal ultrasound. Computed tomography was useful to confirm this rare diagnosis and screen the entire abdomen for concurrent lesions.Key clinical message:This case highlights the usefulness of a CT examination to confirm this rare diagnosis, to determine the position of gastric compartments, and to detect potential concurrent lesions prior to surgery.     

Surgical diseases of the esophagus

The diagnosis and management of surgical diseases of the esophagus are discussed. Esophageal foreign bodies, strictures, esophagobronchial fistulas, diverticula, gastroesophageal intussusception, hiatal hernias, and megaesophagus are included in the discussion.     

Barrier pressure at the gastroesophageal junction in anesthetized dogs.

OBJECTIVE: To evaluate the effect of body position on barrier pressure at the gastroesophageal junction in anesthetized Greyhounds and to assess alterations in barrier pressure following gastropexy. ANIMALS: 8 adult Greyhounds. PROCEDURE: Barrier pressure at the gastroesophageal junction was measured by fast (1 cm/s) and slow (1 cm/10 s) withdrawal of a subminiature strain gauge transducer through the gastroesophageal junction in 8 anesthetized dogs. The effect of body position was measured. Each dog then was placed in right-lateral recumbency, and gastropexy was performed in the left flank. Additional measurements were obtained 1, 5, 10, 20, and 30 minutes after gastropexy. RESULTS: Barrier pressure for dogs positioned in sternal recumbency (mean +/- SEM, 1.1 +/- 0.53 mm Hg) was significantly less than for dogs positioned in right lateral or left lateral recumbency. Following gastropexy, there was a steady increase in barrier pressure. Thirty minutes after gastropexy, barrier pressure was significantly higher (13.36 +/- 3.46 mm Hg), compared with the value before surgery. CONCLUSIONS AND CLINICAL RELEVANCE: Barrier pressure in anesthetized dogs is highly variable and influenced by body position. This is most likely the result of anatomic interrelationships between the diaphragm, stomach, and terminal portion of the esophagus. Gastropexy also increases barrier pressure in the immediate postoperative period, which may be clinically relevant in terms of understanding how resolution of gastroesophageal reflux disease associated with hiatal hernia may be affected by gastropexy combined with hernia reduction.     

Combined laparoscopic ovariectomy and laparoscopic-assisted gastropexy in dogs susceptible to gastric dilatation-volvulus

This prospective study describes a simple method of combining laparoscopic ovariectomy and laparoscopic-assisted prophylactic gastropexy and determines the duration of surgery, complications, and long-term outcome including prevention of gastric dilatation-volvulus (GDV). Laparoscopic ovariectomy and laparoscopic-assisted gastropexy were performed on 26 sexually intact female dogs susceptible to GDV. The mean surgery time was 60.8 ± 12.4 min. No GDV episode was seen during the study period (mean follow-up: 5.2 ± 1.4 y). All dogs had an intact gastropexy attachment assessed by ultrasonography at 1 y. Post-operative complications were minor and owners were satisfied with the procedure. Combined laparoscopic ovariectomy and laparoscopic- assisted gastropexy appears to be a successful and low morbidity alternative procedure to both ovariectomy/ovariohysterectomy and gastropexy via open ventral-midline laparotomy.     

Postoperative improvement of megaesophagus and esophageal motility in a 19-day-old puppy with gastroesophageal intussusception

Canine gastroesophageal intussusception (GEI) is a rare and life-threatening condition that requires prompt diagnosis and treatment. A 19-day-old Siberian Husky with a 4-day history of regurgitation was diagnosed with GEI based on the findings of computed tomography (CT) performed without anesthesia. Endoscopic reduction of intussusception was impossible; thus, surgical reduction by traction of the duodenum was performed. CT revealed improvement of megaesophagus 82 days postoperatively. Eleven months postoperatively, fluoroscopy showed recovery to nearly normal esophageal motility. Two years postoperatively, no clinical signs were reported. CT is useful to diagnose GEI in neonate puppies with poor abdominal fat and to assess the gastric edema and the anatomical association of stomach with other organs. Fluoroscopy is helpful for evaluating postoperative esophageal motility.     

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.     

Hiatal Hernia Repair by Restoration and Stabilization of Normal Anatomy An Evaluation in Four Dogs and One Cat

Clinical signs of esophageal hiatal hernia in four dogs and one cat included regurgitation, vomiting, hematemesis, hypersalivation, dysphagia, and dyspnea. Thoracic radiographs, esophagram, and fluoroscopy were used to demonstrate cranial displacement of the esophagogastric junction and part of the stomach through the esophageal hiatus. Other findings included megaesophagus, esophageal hypomotility, gastroesophageal reflux, and pneumonia. Medical therapy failed to resolve the clinical signs. Reduction in size of the esophageal hiatus, fixation of the esophagus to the diaphragmatic crus (esophagopexy), and a left fundic gastropexy were performed. Surgical results were considered good to excellent.     

Biomechanical Evaluation of Gastropexy Techniques in the Dog

The relative strength of adhesions created by three different gastropexy techniques in dogs was evaluated two and six months following surgery. Tube gastrostomy formed a stronger adhesion (p>.001) when compared with simple gastropexy and permanent gastropexy two months after operation. In a smaller number of animals examined at six months, no difference in strength was noted between permanent gastropexy and tube gastrostomy.     

A Comparison of Laparoscopic and Belt-Loop Gastropexy in Dogs

A simplified technique for laparoscopic gastropexy (group 1) was compared to belt-loop gastropexy (group 2) in eight adult male dogs randomly divided into two groups of four dogs each. Our hypothesis was that a satisfactory laparoscopic gastropexy would approximate the strength and operative time required for belt-loop gastropexy. Operative time, surgical complications, postoperative morbidity, gross and histological appearance, radiographic microvascularization, and maximal tensile strength were measured and compared between the two groups. All dogs recovered from surgery. No morbidity was associated with either procedure. The mean (±SD) duration of surgery was 69.75 ± 7.23 minutes for group 1 and 58.75 ± 7.63 minutes for group 2. Fifty days after surgery, the microvascular appearance of the gastropexy site was similar for both groups. Blood vessels were observed within each seromuscular flap but vascular ingrowth to the abdominal musculature was observed in only two dogs, one from each group. The maximum tensile strength at 50 days was 76.55 ± 22.78 for group 1 and 109.21 ± 22.29 N for group 2. Differences between surgical duration and maximum tensile strength were not statistically significant ( P >.05). Histologically, all gastropexies consisted of an adhesion composed of dense fibrous connective tissue. The results of this study indicate that laparoscopic gastropexy provides a minimally invasive alternative to open abdominal prophylactic gastropexy in dogs.     

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.     

A Laparoscopic‐Sutured Gastropexy Technique In Dogs: Mechanical and Functional Evaluation

Objective— To describe a laparoscopic‐sutured gastropexy technique in dogs and evaluate the tensile strength of the adhesion and effects on gastric function. Study Design— Experimental study. Animals— Female beagle dogs (n=7). Methods— A laparoscopic‐sutured gastropexy technique was evaluated by ex vivo tensile distraction tests 10 weeks after surgery. The effect of the adhesion on gastric emptying, mucosal permeability, and systemic inflammation were evaluated by monitoring the C‐reactive protein (CRP) and sucrose permeability, and by radiographic evaluation of gastric emptying 2 weeks before and 10 weeks after surgery. Results— Mean (±SD) tensile force to disrupt adhesions was 51.1±16.4 N. There was no significant postoperative increase in CRP concentration or change in sucrose permeability. The area under the curve representing the postprandial decrease in gastric radiographic area increased by 11% after gastropexy. Conclusions— This laparoscopic gastropexy technique had appropriate mechanical and functional characteristics with limited morbidity. Clinical Relevance— This laparoscopic‐sutured gastropexy provides adhesion strength comparable with other gastropexy techniques tested at 10 weeks postoperatively. Only minor changes in gastric emptying were observed 10 weeks after surgery.     

Esophageal hiatal hernia and megaesophagus complicating tetanus in two dogs

Two dogs with tetanus developed transient megaesophagus and hiatal hernia associated with gastroesophageal reflux and regurgitation. The megaesophagus and hiatal hernia were diagnosed radiographically and resolved with resolution of the tetanus. These 2 cases, plus previously reported cases, indicate that tetanus can cause megaesophagus and esophageal dysfunction. Therefore, thoracic radiography should be included as part of the diagnostic evaluation of dogs suspected of having tetanus.     

Ultrasonographic evaluation of adhesions induced by incisional gastropexy in 16 dogs

A study was undertaken to evaluate the use of ultrasonography to assess the gastropexy site for permanent adhesion in clinical cases. Two groups, each comprising eight dogs, were studied, all 16 cases undergoing decompression, anatomical repositioning of the stomach and an incisional gastropexy after gastric dilatation-volvulus (GDV). Group 1 was set up as a prospective group in which ultrasonographic examinations were performed three times (mean three, 12 and 67 days) after surgery to evaluate the gastropexy region. The gastropexy site was assessed ultrasonographically at only one stage (mean 449 days after surgery) in the group 2 dogs. Criteria used to assess the usefulness of the ultrasonographic evaluation included the ability to identify the gastropexy site, to obtain measurements of the length and thickness of the site and to assess the ultrasonographic appearance of the different gastric wall layers. The average number of peristaltic contractions and degree of gastric filling were also evaluated. The fixation between the stomach and the abdominal wall was easily detected in all 16 cases. Ultrasonography proved to be a simple and non-invasive technique to assess the permanency of the gastropexy. The Incisional gastropexy was relatively easy to perform and induced permanent adhesions in all 16 dogs, without recurrence of GDV.     

Congenital Esophageal Hiatal Hernia in the Chinese Shar-Pei Dog

Esophageal hiatal hernia was diagnosed in 11 young Chinese Shar-Pei dogs between October 1985 and July 1991. The dogs ranged in age from 2 to 11 months and included 3 females and 8 males. The most common clinical signs were regurgitation, vomiting, and hypersalivation. Physical examination was normal in 6 dogs; abnormal physical examination findings in the other 5 dogs included fever, dehydration, hypersalivation, and pulmonary wheezes and crackles. Laboratory evaluation was significant only for neutrophilia in 5 dogs. A diagnosis of hiatal hernia was made on the basis of survey thoracic radio-graphic and/or barium esophagram findings of displacement of the esophagogastric junction and stomach into the thoracic cavity; the diagnosis was confirmed by surgery in 9 dogs and at necropsy in 2 dogs. Megaesophagus (n = 7), gastroesophageal reflux (n = 4), and esophageal hypomotility (n = 1) were additional findings in some dogs. Aspiration pneumonia was diagnosed in 7 of the dogs. Medical therapies formulated for the therapy of presumed reflux esophagitis generally failed to resolve the clinical signs associated with the hiatal hernia. Hiatal herniae were surgically repaired in 9 of the Shar-Peis by various combinations of diaphragmatic crural apposition, fixation of the esophagus to the diaphragmatic crus (esophagopexy), and left fundic tube gastropexy. Eight of the animals survived surgery, six of which have been asymptomatic since surgery (19 to 36 months). The megaesophagus, esophageal hypomotility, and bronchopneumonia resolved in all of these dogs. (Journal of Veterinary Internal Medicine 1993; 7:210–215. Copyright © 1993 by the American College of Veterinary Internal Medicine.)     

Gastropexy with an automatic stapling instrument for the treatment of gastric dilatation and volvulus in 20 dogs

Surgical stapling equipment was used to create a gastropexy in 20 dogs undergoing emergency surgery for gastric dilatation and volvulus (GDV). The technique involved creation of a tunnel between the seromuscular layer and the submucosa of the pyloric antrum, and a matching tunnel beneath the right m. transversus abdominis. The arms of a gastrointestinal anastomosis stapling device were introduced into the tunnels, and the device was fired to create the gastropexy. One dog died of systemic sequelae of GDV during the early postoperative period. None of the remaining 19 dogs developed a recurrence of GDV during follow-up periods ranging from 5 to 43 months. In 11 dogs, the integrity of the gastropexy was evaluated by abdominal ultrasonography and either negative contrast gastrography or double contrast gastrography; in these dogs, the radiographic and/or the ultrasonographic findings were suggestive of an intact gastropexy. There were no complications involving the gastropexy staple line. The results of this study indicate that an effective and consistent permanent gastropexy can be created, using surgical stapling equipment.     

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.     

Surgical correction of gastro‐oesophageal intussusception with bilateral incisional gastropexy in three dogs

Three dogs presented for evaluation of acute onset tachypnoea and dyspnoea following episodes of vomiting and/or regurgitation. Thoracic radiographs were suggestive of a gastro‐oesophageal intussusception in all three dogs; one dog also showed evidence of aspiration pneumonia. All three dogs underwent surgical correction with a bilateral incisional gastropexy. All dogs recovered from anaesthesia uneventfully and were discharged from the hospital 3 days after presentation. Persistent megaoesophagus was evident in all three dogs, and they are being chronically managed with a strict feeding regime and pro‐motility agents.     

Gastric emptying of nondigestible radiopaque markers after circumcostal gastropexy in clinically normal dogs and dogs with gastric dilatation-volvulus.

Using radiopaque particles mixed with food, gastric emptying was assessed in healthy dogs not subjected to surgery, in healthy dogs 9 to 35 days after circumcostal gastropexy, and, in dogs 1 to 54 months after surgical treatment and recovery from gastric dilatation-volvulus (GDV). Circumcostal gastropexy surgery did not alter the 90% gastric emptying time for radiopaque particles in healthy dogs. However, 90% gastric emptying time was significantly (P less than 0.05) increased after circumcostal gastropexy in dogs with GDV, compared with healthy dogs after the same surgical procedure and recovery period. These results imply that dogs with GDV have delayed gastric emptying of solid particles. Whether delayed gastric emptying of markers detected in affected dogs after surgical treatment and recovery was the result or the cause of GDV was not determined. Results indicate that circumcostal gastropexy could be recommended as a prophylactic procedure for GDV in large breeds with deep thorax, because delayed gastric emptying of markers secondary to the surgical procedure is unlikely.