Complications with non-endoscopic percutaneous gastrostomy in 31 cats and 10 does: a retrospective study

Percutaneous gastrostomy tubes were placed non-endoscopically in 31 cats and 10 dogs using either a rigid insertion tube (n=13) or an Eld gastrostomy tube applicator (n=28). Tubes were placed successfully in 38 of the 41 animals and the consequent feeding was of therapeutic benefit to 31 of the animals. Six of 41 died or were euthanased for reasons unrelated to gastrostomy. In four cases (10 per cent), gastrostomy failed with respect to correct tube placement or tube feeding. Overall complications occurred in 18 of 41 animals. Severe procedural complications occurred in two cats; a cardiorespiratory arrest during pharyngeal manipulation and erroneous tube placement through the distal oesophagus. Moderate late complications included peristomal food leakage (n=2), peristomal abscess (n=2) and pyloric outflow obstruction by a migrated tube (n=1). Complications associated with the feeding procedure, nausea and vomiting (n=3), led to aspiration pneumonia in one case.     

Endoscopically assisted nasojejunal feeding tube placement: technique and results in five dogs

Interest in noninvasive feeding tube placement in companion animals led to the adaption of a human technique utilizing endoscopy to place nasojejunal feeding tubes. Data from medical records in which nasojejunal feeding tubes were attempted were reviewed. Feeding tubes were attempted and successfully placed in five dogs within a median of 35 min. Feeding tubes remained in place for approximately 7 days. Complications included facial irritation (5/5), sneezing (5/5), fractured facial sutures (4/5), vomiting (3/5), diarrhea (3/5), crimping of feeding tube (3/5), regurgitation (1/5), epistaxis (1/5), clogging of the feeding tube (2/5), and oral migration with premature removal of the feeding tube (1/5). The deployment technique used in this study was found to be cumbersome. Despite minor complications, endoscopy can be used to rapidly and accurately place nasoenteric feeding devices.     

Clinical experience utilizing a novel fluoroscopic technique for wire‐guided nasojejunal tube placement in the dog: 26 cases (2006–2010)

Objective – To describe the clinical use of a novel, minimally invasive fluoroscopic technique for the wire‐guided placement of nasojejunal tubes (NJT) in dogs. Design – Retrospective study (September 22, 2006–October 2, 2010). Setting – University veterinary teaching hospital. Animals – Twenty‐six consecutive dogs with intolerance of, or contraindications to gastric feeding that underwent attempted fluoroscopic NJT placement. No dogs were excluded from analysis. Interventions – All dogs underwent attempted fluoroscopic NJT placement using a novel fluoroscopic wire‐guided technique. Measurements and Main Results – Patient data were collected in concert with information about the NJT placement procedure as well as the maintenance and utilization of the tube. The primary diagnosis in dogs undergoing NJT placement was pancreatitis in 60%. The ability to achieve transpyloric passage of the tube was 92.3% (24/26) and the ability to achieve jejunal access was 78.2%. In the second half of the study period, the ability to achieve jejunal access was significantly higher than in the first half of the study period suggesting that technical proficiency improves over time. Mean duration of the procedure was 35.3±20 minutes. Significant oral migration was a complication of NJT placement in some dogs. The median duration of feeding was 3.3 days (range 0.3–10.5). Conclusions – Fluoroscopic wire‐guided NJT placement is a viable method for sustained postpyloric feeding in dogs. Success in acquiring jejunal access improves with experience. The NJT may be utilized as a strategy to provide enteral nutritional support to the population of dogs with contraindications to, or intolerance of gastric feeding.     

Evaluation of laparoscopic-assisted placement of jejunostomy feeding tubes in dogs

OBJECTIVE: To evaluate feasibility of performing laparoscopic-assisted placement of a jejunostomy feeding tube (J-tube) and compare complications associated with placement, short-term feedings, and medium-term healing with surgically placed tubes in dogs. DESIGN: Prospective study. ANIMALS: 15 healthy mixed-breed dogs. PROCEDURES: Dogs were randomly allocated to undergo open surgical or laparoscopic-assisted J-tube placement. Required nutrients were administered by a combination of enteric and oral feeding while monitoring for complications. Radiographic contrast studies documented tube direction and location, altered motility, or evidence of stricture. RESULTS: Jejunostomy tubes were successfully placed in the correct location and direction in all dogs. In the laparoscopic group, the ileum was initially selected in 2 dogs, 2 dogs developed moderate hemorrhage at a portal site, and 2 J-tubes kinked during placement but were successfully readjusted postoperatively. All dogs tolerated postoperative feedings. All dogs developed minor ostomy site inflammation, and 1 dog developed bile-induced dermatitis at the ostomy site. Despite mild, transient neutrophilia, no significant difference was noted in WBC counts between groups. No dog had altered gastric motility or evidence of stricture, although the jejunopexy site remained identifiable in several dogs at 30 days. CONCLUSIONS AND CLINICAL RELEVANCE: Requirements for successful J-tube placement were met by use of a laparoscopic-assisted technique, and postoperative complications were mild and comparable to those seen with surgical placement. Laparoscopic-assisted J-tube placement compares favorably to surgical placement in healthy dogs and should be considered as an option for dogs requiring enterostomy feeding but not requiring a celiotomy for other reasons.     

Placement of jejunal feeding tubes for post-gastric feeding

In veterinary patients, postgastric feeding is indicated for uncontrollable gastric vomiting, gastroparesis, biliary tract disease, pancreatitis, and for patients at increased risk for aspirating secondary to decreased mentation, prolonged recumbency, or an unprotected airway. Postgastric feeding may be implemented via the placement of a jejunal feeding tube. These tubes can be placed surgically (jejunostomy tubes) or with fluoroscopic or endoscopic guidance. This article will focus on methods of jejunal feeding-tube placement, advantages and disadvantages of the methods described, and complications associated with jejunal feeding.     

A comparison of owner management and complications in 67 cats with esophagostomy and percutaneous endoscopic gastrostomy feeding tubes

Esophagostomy feeding tubes were placed in 46 cats. Percutaneous endoscopic gastrostomy (PEG) feeding tubes were placed in 21 cats. Owner management and complications and facility of use were evaluated retrospectively by review of medical records and owner survey. Both tube types were equally effective for maintenance of body weight, ease of owner management, and complication rates. All of 12 owners surveyed were comfortable with PEG tube management. Ninety-six percent of 24 owners surveyed were comfortable with esophagostomy tube management. The esophagostomy tube can be placed less invasively, without specialized equipment, making it an excellent alternative to the PEG tube.     

A new technique for insertion of esophagostomy tubes in cats

A new percutaneous insertion technique for esophageal feeding tubes in cats is presented. The technique has been successfully applied in 12 feline patients. The placement technique is relatively simple, takes approximately five minutes to perform, and requires a scalpel blade, a curved hemostat, and an applicator for the insertion of the feeding tube. In contrast to other esophageal tube placement techniques, the tube is inserted into the definitive aboral position in a one-step procedure. Because of its shoehorn shape, the applicator allows the tube to be inserted into the esophagus safely and precisely. Placement of the tube in the midcervical area does not interfere with the function of the pharynx and avoids having the animal irritated by the presence of the tube. The chosen diameter of the tube is large enough to permit feeding of diluted, blended, commercial canned food. For the patients of this study, feeding was started after recovery from anesthesia, and tubes were removed without complications once the animals had started to eat voluntarily.     

Minimally Invasive Inguinal Approach for Tube Cystostomy

Objective— To report a technique for tube cystostomy placement via a minimally invasive inguinal approach and outcome in 9 dogs and 6 cats with urinary tract obstruction or detrusor atony.
Study Design— Case series.
Animals— Dogs (n=9) and cats (6).
Methods— Medical records (January 2004–January 2008) of dogs and cats that had tube cystostomy via an inguinal approach were reviewed. Retrieved data included signalment, diagnosis, surgical technique, and complications. Access to the bladder was through a muscle splitting approach in the inguinal region with the cystostomy tube placed through a skin incision made several centimeters proximal to this incision and secured in the bladder by a purse string suture. Cystopexy during closure of the muscle layers ensured secure closure and minimized the likelihood of uroabdomen if tube dislodgment occurred.
Results— Cystostomy tubes were placed in 5 cats as an emergency procedure for treatment of acute urinary tract obstruction or urethral rupture, and as an elective procedure in 9 dogs and 1 cat. No complications occurred during cystostomy tube placement. Postprocedural complications were minor (peristomal irritation in 2 dogs with latex catheters, catheter laceration, premature removal) and only occurred when tubes were retained for >4 weeks. Urinary tract infection at catheter removal in 6 dogs resolved with antibiotic administration.
Conclusions— An inguinal approach for cystostomy tube placement facilitated rapid catheter placement into the bladder with minimal soft tissue dissection. Cystopexy during abdominal wall closure provided peritoneal protection should premature dislodgement of the cystostomy tube occur.
Clinical Relevance— An inguinal approach should be considered for rapid tube cystostomy particularly in metabolically compromised animals.     

Inferomedial placement of a single-entry subpalpebral lavage tube for treatment of equine eye disease

The objective of this study was to describe method of placement, and frequency and severity of complications associated with a subpalpebral lavage system placed in the medial aspect of the equine inferior eyelid. The inferomedial subpalpebral lavage (ISPL) tube is positioned deep in the medial aspect of the inferior conjunctival fornix so that the footplate lies flat between the lower eyelid and the anterior surface of the nictitans. Retrospective data from the placement of 92 ISPL systems placed in 86 horses during a 31-month period were examined. Tube placement was performed using sedation and regional anesthesia only in 59% of horses. The median duration of tube placement was 19 days (range: 1-61 days). Seventy-one horses were treated for up to 55 days following discharge from hospital with an ISPL tube in place. No complications were reported with 59% of ISPL systems. Non-ocular complications were found in 38% of ISPL systems and included tube displacement from the conjunctival fornix (18%), suture loss requiring resuturing of the system to the horse's head (14%), and damage necessitating replacement of the injection port (6%). Ocular complications were recorded in 3% of horses and were limited to inferior eyelid swelling. Vision was retained in 88% of horses. The ISPL system is easily and safely placed, and well tolerated for extended periods. It appears to be associated with infrequent and minor complications when compared with placement of subpalpebral lavage tubes in the superior eyelid.     

Can spleen aspirations be safely used for the parasitological diagnosis of canine visceral leishmaniosis? A study on assymptomatic and polysymptomatic animals

The purpose of this study was to evaluate the safety of spleen aspiration as a sampling technique for the parasitological detection by culture and microscopy of Leishmania (chagasi) infantum. Two hundred and nine domiciled dogs from an endemic area for visceral leishmaniasis in Bahia State, Brazil, were studied. Most dogs (87%) were seropositive for anti-L. chagasi antibodies by ELISA. Clinical signs of disease were recorded and the animals monitored during and after spleen puncture in order to detect possible complications associated with the procedure. From a total of 257 splenic punctures in the 209 animals, only three minor events occurred, with no significant consequence for the animals and no association with risk factors. Leishmania was isolated from 149/180 (83%) seropositive dogs, and from 6/26 (23%) seronegative animals. The procedure did not cause adverse side effects or unnecessary suffering and confirmed the diagnosis in a large percentage of dogs. We conclude that spleen aspiration can be considered an effective and safe procedure for the definitive diagnosis of canine visceral leishmaniosis.     

Outcome of and complications associated with tube cystostomy in dogs and cats: 76 cases (1995-2006)

OBJECTIVE: To determine indications for cystostomy tube use in dogs and cats, complications associated with their use, and outcome of dogs and cats in which cystostomy tubes had been inserted. DESIGN: Retrospective case series. ANIMALS: 37 dogs and 39 cats. PROCEDURES: Information was obtained from medical records. Long-term follow-up information was obtained by use of a client questionnaire. RESULTS: Indications for cystostomy tube placement were bladder dysfunction, urinary tract rupture, obstructive urinary tract neoplasia, urinary diversion following urogenital surgery, obstructive urolithiasis, and feline lower urinary tract disease. Median time tubes were in place was 11 days, but duration of tube use was significantly longer for animals with bladder dysfunction than for animals with urinary tract trauma, urinary diversion, or urinary tract obstruction. Thirty-seven (49%) animals had tube complications. Development of complications was not significantly associated with species, age, body weight, duration of tube use, or tube type, except that animals were significantly more likely to develop complications following long-rather than short-term use. In 42 animals, the underlying condition resolved and the tube was removed; 22 animals died or were euthanatized with the tube in place. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that cystostomy tubes may be used for animals with various conditions related to problems with urine outflow. Nearly half the animals in the study developed complications related to the cystostomy tube, suggesting that potential complications should be discussed with owners prior to tube placement. However, most complications were easily resolved.     

Limited approach to the right flank for placement of a duodenostomy tube

A new enterostomy tube placement technique is described for provision of nutrients into the duodenum. Placement of the duodenostomy tube (d-tube) is performed through a limited right flank approach under sedation and local anesthesia. Seven client-owned animals (three dogs and four cats) requiring enteral nutritional support were selected for d-tube placement. Patients were fed via the d-tube for two to 28 days. Complications included discomfort when manipulating and exteriorizing the duodenum, discomfort with bolus feedings, local cellulitis, and tube site infection. All complications resolved without further incident. This technique should be considered in patients that are not good candidates for prolonged general anesthesia or esophageal or gastric feeding, or patients being mechanically ventilated.     

Prevalence and type of splenic diseases in cats: 455 cases (1985-1991).

Retrospective data on the type and prevalence of splenic disease in cats were evaluated in a large number of feline splenic tissues (n = 455) submitted as surgical and necropsy specimens from private veterinary hospitals in California during a period of approximately 5.5 years. Primary and metastatic neoplasia accounted for 37% of all feline splenic lesions. Mastocytoma, lymphosarcoma, myeloproliferative disease, and hemangiosarcoma, in that order, accounted for the bulk of neoplasia. Submission of accessory splenic tissue from either the omentum or pancreas accounted for 4% (17/455), whereas hyperplastic nodules, hematomas, and the combination of these changes in the spleen accounted for 4% (19/455). Splenitis was found in 2% (8/455) of submissions. Thromboembolism with regional splenic infarction accounted for 1% (4/455) of splenic lesions in cats. The remaining splenic lesions each accounted for less than 1% of total splenic submissions, and as such, were considered incidental and of questionable clinical importance.     

Evaluation of the zoonotic potential of Giardia duodenalis in fecal samples from dogs and cats in Ontario

This study determined the distribution and zoonotic potential of Giardia duodenalis assemblage types among canine and feline fecal samples from Ontario. The effectiveness of Giardia assemblage typing methods by sequencing the genes of small subunit ribosomal RNA (ssu-rRNA), β-giardin (bg), glutamate dehydrogenase (gdh), and triose phosphate isomerase (tpi) was evaluated simultaneously. From 2008 to 2010, 118 canine and 15 feline Giardia positive fecal samples were tested. The ssu-rRNA sequencing method typed 64% (75/118) and 87% (13/15) of the Giardia-positive canine and feline samples, respectively. Among the typeable samples, 68% (51/75) of canine samples contained G. duodenalis assemblage D and 31% (23/75) contained G. duodenalis assemblage C (both non-zoonotic assemblage types). Only 1% (1/75) of the typeable canine samples contained a potentially zoonotic assemblage B. In contrast, 100% (13/13) of the typeable feline samples contained potentially zoonotic assemblages A (n = 12) or B (n = 1).     

Use of propofol for anesthesia in cats with primary hepatic lipidosis: 44 cases (1995-2004)

OBJECTIVE-To determine morbidity and fatalities in cats with hepatic lipidosis that received propofol to facilitate placement of a feeding tube. STUDY DESIGN-Retrospective case series. ANIMALS-44 Cats with presumed primary hepatic lipidosis anesthetized for placement of a feeding tube. PROCEDURES-Medical records from January 1995 through December 2004 were reviewed to identify cats that matched the inclusion criteria (histologic confirmation of hepatic lipidosis, anesthetized for placement of feeding tube, complete intensive care unit [ICU] records, and recorded outcome). Data extracted included age, body weight, sex, anesthetic drugs, drug dosages, type of feeding tube, duration of anesthesia, number of hours in ICU, administration of blood products, and survival until discharge from ICU. RESULTS-44 Cats (21 females and 23 males) were included in the analysis. Age range was 3 to 15 years (median, 8 years), and body weight ranged from 1.8 to 9.0 kg (4.0 to 19.8 lb), with a median of 4.8 kg (10.6 lb). Twenty-seven cats were administered propofol. There was no significant association between the use of propofol or the dosage of propofol and any risk factor, need for blood products, number of hours in the ICU, or survival. There was no significant difference between cats that received propofol and cats that did not receive propofol with regard to interval until discharge from the ICU. CONCLUSIONS AND CLINICAL RELEVANCE-The use of propofol did not increase morbidity or fatalities in cats with primary hepatic lipidosis. Thus, propofol can be used in these cats for placement of a feeding tube.     

Subcutaneous emphysema, pneumoperitoneum, and pneumoretroperitoneum after gastrostomy tube placement in a cat

A 17-year-old spayed female domestic shorthair cat developed subcutaneous emphysema, pneumoperitoneum, and pneumoretroperitoneum during endoscopic placement of a gastrostomy feeding tube after gastric insufflation and cannula insertion. The cat underwent exploratory laparotomy to investigate the possibility of gastric rupture but only a 2- to 3-mm defect was found in the gastric fundus at the site of cannula insertion. Pasteurella multocida and Enterobacter spp were cultured aerobically from the peritoneal cavity. The cat recovered without complications.     

Cytologic evaluation of inflammation in canine liver aspirates

Abstract: Liver aspiration cytology has been used routinely for more than a decade for the evaluation of canine and feline liver disease. However, the value of liver cytology in detecting inflammatory liver disease is poorly defined. We retrospectively reviewed 51 canine liver cytology reports and compared the conclusions with those from concurrent surgical biopsy reports. Overall sensitivity of cytology for diagnosis of inflammatory liver disease was 93% and specificity was 96%. For suppurative hepatitis (n = 14), the sensitivity of cytologic diagnosis was 100% and the specificity was 95%. For chronic active hepatitis (n = 13), the sensitivity of cytologic diagnosis was 100% and the specificity was 93%. For lymphocytic hepatitis (n = 3), the sensitivity of cytologic diagnosis was 33% and the specificity was 100%. We conclude that canine liver aspiration cytology is a highly sensitive test for the detection of suppurative and chronic active inflammation; however, it is insensitive for the detection of lymphocytic hepatitis.     

Immunohistochemical analysis of cyclin A, cyclin D1 and P53 in mammary tumors, squamous cell carcinomas and basal cell tumors of dogs and cats

The involvement of cyclin A, cyclin D1 and p53 proteins in canine and feline tumorigenesis was analyzed immunohistochemically. In the present study, a total of 176 cases were examined, among which there were 108 canine cases (75 mammary lesions, 16 squamous cell carcinomas and 17 basal cell tumors) and 68 feline cases (43 mammary lesions, 20 squamous cell carcinomas and 5 basal cell tumors). Speckled nuclear staining for cyclin A was observed in 19/38 (50%) canine malignant mammary tumors and 18/37 (48.6%) feline mammary carcinomas, while this was not seen in benign mammary tumors of either dogs or cats. Marked intense nuclear cyclin A staining was seen in 7/16 (43.8%) canine squamous cell carcinomas and 18/20 (90.0%) feline squamous cell carcinomas. Only 3/17 (17.6%) canine basal cell tumors showed slight and scattered staining for cyclin A. Expression of cyclin D1 was very rare in both canine and feline tumors. Nuclear staining of p53 was found in 7/37 (18.9%) feline mammary carcinomas. Intense immunoreactivity for p53 was found in 6/16 (37.5%) canine squamous cell carcinomas and 8/20 (40%) feline squamous cell carcinomas. These results suggest that cyclin A may have a role in the proliferation of canine malignant mammary tumors, feline mammary carcinomas and squamous cell carcinomas of dogs and cats, and p53 may associate with the tumorigenesis of feline mammary carcinomas and squamous cell carcinomas of dogs and cats.     

Molecular cloning and phylogenetic analysis of a cDNA encoding the cat (Felis domesticus) Ig epsilon constant region

A feline splenic cDNA library was screened with a (32)P-labelled cDNA probe encoding the canine IgE epsilon heavy chain subunit. A cDNA sequence of 1614 nucleotides encoding the complete feline IgE heavy chain, as well as a portion of a variable region, was identified. A search of the GenBank database revealed an identity of 82% at the nucleotide level and 76% at the amino acid level between the feline epsilon heavy chain sequence and the canine homologue. In a separate study, feline genomic DNA, isolated from whole feline embryo cells, was subjected to PCR amplification using primers based on known partial genomic DNA sequences for the feline C epsilon gene. Following removal of an intron from the 683 bp PCR product, the coding sequence yielded an ORF of 506 bp. The DNA sequence of this PCR clone differed by a single nucleotide from the cDNA clone. This difference is silent, and therefore the proteins encoded by the two sequences are identical over the regions cloned and sequenced. Phylogenetic analysis of the constant regions of nine immunoglobulin epsilon genes revealed that the feline cDNA is most similar to the canine homologue.     

Clinical Experience With Jejunostomy Feeding Tubes In 47 Small Animal Patients

The medical records of 39 dogs and 8 cats which had jejunostomy feeding tubes placed using modifications of a previously described surgical technique were retrospectively reviewed. Modifications included the addition of a suture to anchor the feeding tube to the jejunum, the use of a continuous circumferential suture to pexy the jejunum to the abdominal wall, and the placement of a skin suture that penetrated deep into the abdominal wall fascia. All tubes were placed during surgical treatment of a primary intraabdominal disease. Tubes were used for feeding from 1 to 41 days (average 9.7 days). Sixteen patients (34%) developed mild to moderate complications such as chewing at the tube, inadvertent tube removal, tube obstruction, and cellulitis around the ostomy site. Three patients (6%) developed severe complications associated with breakdown of the surgical site. The modified jejunostomy technique was effective for placement of jejunostomy tubes as a complementary procedure to exploratory celiotomy.