Heineke–Mikulicz pyloroplasty for the treatment of pyloric stenosis secondary to gastro-duodenal ulcer disease in three foals

The objective of the study was to describe a modified Heineke–Mikulicz pyloroplasty for the treatment of pyloric stenosis in foals due to gastric ulceration and assess the short- and long-term outcome of foals receiving the pyloroplasty. Medical records of foals undergoing a modified Heineke–Mikulicz pyloroplasty due to gastric outflow obstruction secondary to a pyloric stenosis were included in this retrospective case series. The pyloroplasty consisted of an oral to aboral full thickness longitudinal incision on the ventral aspect of the pylorus and proximal duodenum, which was sutured closed with 0 polydioxanone in a transverse orientation, thereby, enlarging the pyloric lumen diameter. Long-term outcome was obtained from medical and race records. The pyloroplasty was successfully performed in three foals with a surgical time of 95–121 min, with immediate return to nursing and hospital stay of 4–14 days. Complications included a small intestinal volvulus and intra-abdominal adhesions in a foal that did not survive. Another foal had an incisional infection. Two of the three foals went on to race. It was concluded that the pyloroplasty procedure is an acceptable option for the treatment of pyloric stenosis and secondary gastric outflow obstruction due to gastric ulceration. The limited amount of bowel manipulation with no change in intestinal flow, along with the successful outcomes achieved, make this another surgical option available for the correction of pyloric stenosis in foals.     

Long‐term prognosis of gastrojejunostomy in foals with gastric outflow obstruction: 16 cases (2001–2006)

Reasons for performing study: It has been suggested that the success of gastric bypass surgery in foals for the treatment of gastric outflow obstruction is poor. However, few reports exist evaluating the long‐term prognosis of these cases. Objectives: To determine the long‐term success of foals, including racing records, surgically treated for gastric outflow obstruction secondary to gastroduodenal ulceration. Methods: Medical records of foals undergoing surgical treatment of gastric outflow obstruction secondary to gastroduodenal ulceration were evaluated for clinical information. Owners, trainers and race records were evaluated regarding long‐term survival and racing success. Results and conclusions: Sixteen foals were included in the study, all treated with a gastrojejunostomy. All foals survived to immediate discharge from the hospital; 8 survived to racing age, with 7 of those entering training and 3 actually racing. Foals that did not survive to racing age had various post operative complications. The success rate for these foals appears somewhat better than that previously reported. Potential relevance: Gastrojejunostomy for the treatment of gastric outflow obstruction, secondary to gastric ulceration, is a valid treatment option for foals.     

Surgical Treatment of Gastroduodenal Obstructions in Foals

Thirteen foals that ranged in age from 4 days to 4 months were presented for treatment of gastroduodenal obstruction. The site of obstruction was determined from examination of standing right lateral contrast radiographs of the caudal part of the thorax and abdomen. Depending on the site, the obstruction was bypassed by esophagogastrostomy, gastroduodenostomy, partial gastrectomy with gastroduodenostomy, duodenojejunostomy, or gastrojejunostomy followed by jejunojejunostomy. Six of the 13 foals (46%) survived. All foals with pyloric stenosis survived. Seven of eight foals with duodenal stenosis died. Deaths were due to complications unrelated to the primary gastroduodenal obstruction.     

Intermittent gastric dilatation after gastropexy in a dog.

Gastroperitoneal adhesions, which developed after tube gastrostomy in a 3-year-old dog, caused an inverted L configuration of the pyloric antrum and duodenum, resulting in periodic episodes of gastric dilatation. The dog had undergone tube gastrostomy for treatment of gastric dilatation/volvulus, but gastropexy adhesions broke down 27 months later, necessitating a second pexy procedure. Adhesions then developed, constricting gastric outflow and trapping gas in the stomach and proximal duodenum. When the ventral row of adhesions was surgically dissected, the angle between the pyloric antrum and the duodenum was straightened, facilitating flow of digesta. Gastropexy rarely causes the degree of adhesion formation and the complications reported in this dog.     

Canine gastric adenocarcinoma and leiomyosarcoma: a retrospective study of 21 cases (1986-1999) and literature review

This retrospective study describes the clinical course, treatment, and outcome of 21 dogs with gastric adenocarcinomas (n=19) and leiomyosarcomas (n=2). Medical records from 1986 to 1999 were reviewed for signalment, weight, diagnosis, tumor location, clinical signs, radiographic imaging procedures, surgical procedures, chemotherapy, duration of follow-up monitoring, outcome, cause of death, metastatic rate, metastatic sites, and method of detection of metastasis. Fourteen of 19 (74%) dogs with gastric adenocarcinomas had metastasis. Metastatic sites included gastric lymph nodes, omentum, liver, duodenum, pancreas, spleen, esophagus, adrenal glands, and lungs. Both cases of a gastric leiomyosarcoma had metastatic disease involving the liver (n=2) and duodenum (n=1). Surgery, consisting of either a Billroth I or a gastrojejunostomy, provided immediate relief of the gastric outflow obstruction and clinical improvement in the early postoperative period. The beneficial effects of chemotherapy alone or adjuvant chemotherapy are still unknown. Recurrence of clinical signs 3 days to 10 months after surgery caused all owners to elect euthanasia. The long-term prognosis for most cases of gastric adenocarcinomas and leiomyosarcomas is poor because of the presence of advanced disease. Surgical resection, however, does alleviate gastric outflow obstruction in the immediate postoperative period.     

Upper gastrointestinal surgery for ulcer disease in foals

The goals of surgical therapy in foal gastroduodenal ulcer disease are the elimination of abdominal pain, healing of mucosal ulcerations, and prevention of complications. Gastrojejunostomy has been used with success in both pyloric and duodenal ulcerations that have progressed to gastric outflow obstruction. Gastrojejunostomy has resulted in rapid healing of gastritis and esophagitis and resolution of aspiration pneumonia and biliary stasis without recurrence of duodenal ulceration.     

Gastroenterostomy for treatment of gastroduodenal ulcer disease in 14 foals

Gastroenterostomy was performed in 14 foals to treat gastric outflow obstruction caused by advanced gastroduodenal ulcer disease. The onset of excessive salivation and teeth grinding, without response to medical treatment, combined with endoscopic and radiographic evidence of gastric outflow obstruction, were indications for surgical intervention. Successful outcome in 5 foals was attributed to early diagnosis, patient stabilization, early surgical correction, and postoperative management including antibiotics and antiulcer medication.     

Gastroduodenal ulceration in foals

Gastroduodenal ulceration is becoming recognised as an important disease in foals during the first few months of life. Aetiopathogenesis is presumed to be similar to peptic disease in humans associated with back diffusion of hydrogen ions into the mucosa. Many factors have been incriminated as predisposing foals to ulceration but few have been proven. To date, use of non-steroidal anti-inflammatory agents has been the only documented cause of gastroduodenal ulceration in foals. The clustering of affected foals on certain farms suggests an infectious aetiology but attempts to identify a causative organism have been unsuccessful. Four clinical syndromes defined for foals with gastroduodenal ulceration include: silent ulcers, which occur most often in the non-glandular stomach along the margo plicatus and are identified as incidental findings at necropsy; active ulcers which are often manifested by abdominal pain, excessive salivation and bruxism; perforating ulcers which usually result in a severe, diffuse peritonitis; and pyloric or duodenal obstruction from a healing ulcer. General approaches to therapy of a foal with active ulceration consist of reduction of gastric acidity and enhancement of mucosal protection. Antacids and type 2 histamine receptor antagonists are used most often to neutralise or decrease acid secretion, respectively. Sucralfate, a locally active sulphated sucrose preparation, is commonly used as a cytoprotective agent. The efficacy and safety of many products used have not been evaluated adequately in foals. Perforating ulcers are usually associated with death or humane destruction of the foal because of fulminating peritonitis. Surgical intervention and bypass procedures are indicated in foals that develop pyloric or duodenal obstructions from healing ulcers.     

Abdominal surgery in foals: a review of 119 cases (1977-1994)

The case records of 119 young horses (all less than age one year) that underwent an exploratory celiotomy during a 17 year period were examined to determine the surgical findings, short- and long-term outcome, and prevalence of small intestinal disease compared to previous reports in the mature horse. Physical and laboratory values were compared for long-term survivors vs. nonsurvivors and the frequency of post operative intra-abdominal adhesions was determined. The most common cause for exploratory celiotomy was small intestinal strangulation, followed by enteritis and uroperitoneum. Six horses died during surgery, 23 were subjected to euthanasia at the time of surgery due to a grave prognosis, and 17 horses died or were destroyed after surgery, prior to discharge from the hospital; the short-term survival was 61%. Nine horses were lost to follow-up. Forty-one horses survived long-term (at least 6 months after surgery), 15 died or were subjected to euthanasia after discharge for reasons related to the prior abdominal surgery, and 8 died or were destroyed after discharge due to unrelated reasons, making the long-term survival 45%. Fifty-three (45%) of the horses presented as neonates, and 66 (55%) presented age 3-12 months. Uroperitoneum and meconium impaction were the most common disease in the neonate. Intussusception and enteritis were the most common diseases in older foals. The overall prevalence of small intestinal disease was 44%. Significant elevations in packed cell volume, heart rate, nucleated cell counts and total protein in abdominal fluid and rectal temperature were observed in nonsurvivors compared to survivors. Nonsurvivors had significantly decreased serum bicarbonate, chloride, sodium, and venous pH values. There was no evidence that location of the lesion affected long-term survival. Horses with a simple obstruction had a higher survival percentage than those with a strangulating obstruction, and horses that underwent an intestinal resection had a lower long-term survival than those horses undergoing only intestinal manipulation. Nineteen (33%) of the foals examined after the original surgery had evidence of intra-abdominal adhesions. Nine of these (16%) had adhesions that caused a clinical problem.     

Pylorectomy and gastroduodenostomy in the dog: technique and clinical results in 28 cases

Pylorectomy and end-to-end gastroduodenostomy are surgical procedures that allow excision of abnormal pyloric tissue and provide improved gastric outflow. These techniques were used for the treatment of benign, malignant, and ulcerative conditions that were judged to be not adequately treatable with pyloromyotomies or pyloroplasties. End-to-end gastroduodenostomy was not much more difficult than a standard intestinal anastomosis; however, a thorough knowledge of the pyloric area anatomy was required to avoid serious surgical errors. In addition, gentle tissue manipulation and precise suture placement reduced the chance of iatrogenic pancreatitis, biliary obstruction, tissue ischemia, and/or suture line leakage. The results of surgery depended on the underlying disease process. Dogs with benign lesions such as chronic hypertrophic pyloric gastropathy responded favorably to treatment. Dogs with malignant disease and perforated ulcers had low long-term survival rate. Pyloric adenocarcinoma was not adequately treated with this method alone.     

Ulcerative duodenitis in foals

Seven foals aged 18 days to 3 1/2 months had either single or multiple full-circumference segments or long antimesenteric bands of necrotizing duodenitis, sharply delineated from adjacent viable duodenum. Perforation of the necrotic wall had occurred in all foals, leading to acute fibrinous peritonitis. On the mucosal surface severe diffuse, acute inflammation and ulceration involved the anterior half of the duodenum. Two further foals, aged 28 and 30 days, had lesions that are believed to be a chronic form of this disease. Both foals had a thickened duodenal wall, with large areas of mucosa replaced by granulation tissue. In addition one had several strictures associated with firm adhesions between the duodenal serosa and adjacent structures, together with ascending cholangiohepatitis and pancreatitis. Eight foals had gastric ulcers that were considered to be of less significance than the duodenal lesions. No etiologic agent could be found by aerobic or anaerobic bacterial culturing, negative contrast electron microscopy for viruses, or immunofluorescence staining for equine herpesvirus 1, equine adenovirus, or equine coronavirus. The possible involvement of non-steroidal anti-inflammatory drugs is discussed.     

Urinary Bladder Marsupialization for Treatment of Obstructive Urolithiasis in Male Goats

Objectives —To describe a surgical procedure for urinary bladder marsupialization and to report the results obtained from its use in the treatment of obstructive urolithiasis in male goats.
Study Design —Retrospective evaluation.
Animals or Sample Population—Male goats with obstructive urolithiasis.
Methods —Medical records of male goats that had urinary bladder marsupialization for the treatment of obstructive urolithiasis were reviewed. Data retrieved from the medical records included signalment, postoperative treatment, duration of hospitalization, and short-term and long-term complications. Median values for measured variables were calculated.
Results —A total of 18 of 19 goats survived. Urinary flow was re-established in all 19 goats at the conclusion of surgery. Short-term postoperative complications (bladder mucosal prolapse and death) were observed in 2 goats. Long-term postoperative complications (cystitis and fibrotic stomal closure) occurred in 2 animals. Median duration of hospitalization was 4 days. At the time of follow-up, mild urine scald was reported for all goats. Clinical signs of upper urinary tract disease or obstruction were not reported. A total of 15 of 17 owners were satisfied with the procedure.
Conclusions —Urinary bladder marsupialization provided long-term resolution of urinary outflow obstruction in all goats with acceptable morbidity.
Clinical Relevance —Urinary bladder marsupialization is a procedure that provides a good prognosis for long-term resolution of obstructive urolithiasis in male goats.     

Trichophytobezoar duodenal obstruction in New World camelids

OBJECTIVE: To describe clinical findings, surgical treatment, and outcome associated with trichophytobezoar duodenal obstruction in New World camelids. STUDY DESIGN: Retrospective study. ANIMALS: Alpacas (7) and 1 llama. METHODS: Historical and clinical data were obtained from the medical records of New World camelids with a diagnosis of trichophytobezoar duodenal obstruction confirmed by surgical exploration or necropsy. RESULTS: Seven camelids were <1 year old. Abnormal clinical findings included anorexia, reduced fecal output, recumbency, colic, abdominal distension, regurgitation, decreased serum chloride concentration, increased serum bicarbonate concentration, and/or elevated first gastric compartment chloride concentration. Survey abdominal radiographs obtained (4 animals) revealed gastric distension (4) and/or visualization of the obstruction (2). Diagnosis was confirmed at necropsy (1) or surgery (7). Right paracostal celiotomy was performed on all animals and duodenotomy (3) or retropulsion of the trichophytobezoar combined with third compartment gastrotomy (4) was used to remove the obstruction. Six animals survived to discharge and 5 were healthy at follow-up, 8-20 months later. The remaining discharged alpaca was healthy at 12 months but subsequently died of unrelated causes. CONCLUSIONS: Diagnosis of trichophytobezoar duodenal obstruction should be considered in juvenile New World camelids with abdominal distension and hypochloremic metabolic alkalosis. Right paracostal celiotomy can be used for access to the descending duodenum and third gastric compartment for surgical relief of obstruction. CLINICAL RELEVANCE: Duodenal obstruction from bezoars should be considered in New World camelids <1year of age with abdominal distension and hypochloremic metabolic alkalosis. Surgical relief of the obstruction by right paracostal celiotomy has a good prognosis.     

Significance of the Heineke-Mikulicz Pyloroplasty in the Treatment of Gastric Dilatation-Volvulus A Prospective Clinical Study

Twenty-six dogs with gastric dilatation-volvulus (GDV) were stabilized medically, followed by tube gastrostomy and gastropexy. In 13 dogs, a Heineke-Mikulicz pyloroplasty was also performed. Complications and recurrences were monitored during the immediate postoperative period and for 5 to 31 months thereafter. Barium gastrograms and contrast radiographs of the stomach were evaluated at week 1 and months 5 to 31. Significantly fewer dogs without pyloroplasty had complications during the immediate postoperative period. There were no differences in the long-term complication rates. Radiographic evaluations of the width of the pylorus, the size of the stomach, and the rate of gastric emptying showed no differences between dogs with and without pyloroplasty at any evaluation period. The Heineke-Mikulicz pyloroplasty increased the immediate postoperative complication rate after surgical fixation of the stomach for the treatment of GDV. It did not appear to influence the long-term outcome of the surgical treatment of this disease. The Heineke-Mikulicz pyloroplasty is not recommended in the treatment of GDV unless pyloric outflow obstruction can be demonstrated.     

Gastrojejunostomy as a treatment for gastric outflow disorders in four adult horses

Four adult horses with histories of moderate abdominal pain and inappetence were diagnosed with delayed gastric emptying and gastric impaction attributed to pyloroduodenal obstruction (three cases) or duodenitis (one case). A stapled side-to-side gastrojejunostomy was performed on all horses. Two horses returned to work and survived ≥3 years. One horse was euthanased 6 months post-surgery due to recurrent abdominal pain, and one was found dead 5 months postsurgery after an unattended foaling.     

Idiopathic gastroesophageal reflux disease in an adult horse

Chronic gastroesophageal reflux disease was diagnosed in a 22-year-old female Tennessee Walking Horse that had signs of bruxism and ptyalism. Esophageal ulceration was detected via endoscopy. Compared with the damage to the proximal portions of the esophagus, the severity of the ulceration increased toward the gastroesophageal junction. Esophageal ulceration attributable to chronic gastric acid reflux is usually secondary to pyloric outflow obstruction in horses. In the horse of this report, there was no evidence of either a chronic pyloric or duodenal obstruction that could have resulted in esophageal ulceration. Esophageal ulceration in this horse was attributed to gastroesophageal reflux disease, a common condition in humans in which the underlying abnormality is functional incompetence of the gastroesophageal junction. Treatment is directed at decreasing gastric acidity and protecting the ulcerated mucosa. In the horse of this report, treatment was unsuccessful and the horse was euthanatized; a physical cause of gastroesophageal reflux disease was not identified during an extensive postmortem examination.     

Pyloric obstruction after toggle-pin fixation of left displaced abomasum in a cow

One potential complication of blind abomasopexy techniques, including the toggle-pin technique, is the possibility of creating pyloric outflow obstruction. Cows that have had left displaced abomasum corrected by this method should be observed closely for the first 48 postsurgical hours for signs of deterioration. If pyloric obstruction is suspected and the securing sutures are cut before fibrous adhesions have formed, permanent damage may be minimized.     

Surgical treatment of colic in the miniature horse: a retrospective study of 57 cases (1993-2006)

REASONS FOR PERFORMING STUDY: It has been suggested that the rate of post operative abdominal adhesions in miniature horses is higher than that for other breeds. However, few reports exist in the veterinary literature describing complications and long-term survival following surgical treatment of colic in these horses. OBJECTIVES: To determine the prevalence of surgical lesions in miniature horses with acute abdominal disease in terms of clinical signs, surgical management, post operative treatment and complications, as well as short- and long-term survival. METHODS: Medical records of 57 American Miniature Horses undergoing surgical treatment for acute abdominal pain at the Michigan State University Large Animal Veterinary Teaching Hospital 1993-2006 were evaluated for clinical information. Owners and trainers were contacted to gain information regarding long-term survival. RESULTS: The most common surgical lesion was a faecalith (38/57 cases) located primarily within the descending colon and most frequently diagnosed in horses age <6 months (19/38 cases). Short-term survival to hospital discharge for horses recovered from anaesthesia was 98% (55/56) with the most common post operative complications being diarrhoea and inappetance. Intra-abdominal adhesions were identified in 2/8 horses requiring a second celiotomy. Long-term follow-up was available for 45 horses and 87% (39/45) were alive at least 12 months after surgery. CONCLUSIONS: As previously reported, faecalith obstruction is a frequent surgical lesion in the miniature horse and is most common in miniature horses age <6 months. The incidence of adhesion formation may be lower than previously reported.     

Outcome of surgical correction of meconium impactions in 8 foals

Meconium impactions are only rarely refractory to medical therapy. The purpose of this paper is to examine the outcome of 8 foals that required an exploratory celiotomy to correct a meconium impaction. Between 1984 and 1992, 24 foals were referred with a primary diagnosis of meconium impaction. All foals were treated medically prior to and following referral. Of the 24 foals, 8 had impactions requiring surgical intervention. Exploratory celiotomies were performed, and the impaction was reduced manually or by enterotomy. Follow up information was available on 7 foals. All survived surgery and were discharged. Four of the 8 foals matured and raced. Two foals were euthanatized due to extensive serosal adhesions and one foal was euthanatized due to an unrelated orthopedic condition. Our results support the decision for an exploratory surgery only after aggressive medical therapy has failed. Several treatment options have been developed in recent years that have reduced the number of foals that may require surgery.     

Esophageal disorders in 61 horses. Results of nonsurgical and surgical management

Obstructive esophageal disorders in 61 horses included feed or foreign body impaction (27 horses), strictures (18 horses), perforations (11 horses), and diverticula (5 horses). Horses with feed impaction were treated nonsurgically (25 horses) or by esophagotomy (2 horses). Survival to discharge was 78%, and 37% of these had persistent chronic obstruction at home. Long-term survival was 52%. Long-term survival of nine horses treated nonsurgically for esophageal strictures was 22%; for nine horses treated surgically it was 44%. Long-term survival of horses treated nonsurgically was significantly better in acute than chronic strictures. Surgical repair of esophageal mural strictures was more successful than repair of annular or mucosal strictures. One third of the horses with strictures were foals. Long-term survival for horses with strictures was 33%. Long-term survival was higher for the horses with perforations managed surgically (2 of 4) than nonsurgically (0 of 7). Long-term survival for this group was 18%. One esophageal diverticulum was managed nonsurgically, and four were treated surgically; all horses survived long term. Complications of obstructive esophageal disorders included aspiration pneumonia, chronic obstruction, esophageal mucosal ulceration, postoperative infection, pleuritis, laminitis, laryngeal paralysis, and Horner's syndrome.