Idiopathic megaoesophagus and intermittent gastro-oesophageal intussusception in a cat

Resolution of megaesophagus after correction of a paraesophageal hernia

Case summary

A 6-year-old female Siamese cat presented with an 8-week history of vomiting and progressive hyporexia. On presentation, the cat was found to have a hypochloremic alkalosis. Imaging demonstrated hiatal hernia and megaesophagus. Exploratory laparotomy demonstrated a paraesophageal hiatal hernia. The hernia was reduced, phrenoplasty and esophagopexy were performed, and a gastrotomy tube was placed. Treatment of the hernia led to resolution of the megaesophagus.

Relevance and novel information

Megaesophagus can occur secondarily to paraesophageal hernia in the cat. In this case, correction of the paraesophageal hernia led to complete resolution of the esophageal dilation and all associated clinical signs.

Dysautonomia in two littermate kittens

Case summary

Two 6-month-old littermate Russian Blue cross kittens presented for megaesophagus, intermittent vomiting and regurgitation. The male kitten was diagnosed with aspiration pneumonia and was suspected to have a hiatal hernia on thoracic radiographs. It presented 1 month later in acute respiratory distress and was euthanized. Post-mortem examination revealed a severe gastroesophageal intussusception with approximately 90% of the stomach inverted into the distal esophagus. Histologic examination confirmed dysautonomia with marked neuronal dropout and degeneration with necrosis, satellitosis of the celiac ganglion and the myenteric and submucosal plexuses throughout the gastrointestinal tract. The less-affected littermate showed improvement on cisapride and was doing well at home at the time of writing.

Relevance and novel information

Dysautonomia is rare in cats, with only a few reports of affected littermates. Both kittens are significantly younger than the median age previously reported. Detailed descriptions of diagnostic and histopathology findings are included. Gastroesophageal intussusception is a novel complication to consider when managing feline dysautonomia.

Intermittent Gastroesophageal Intussusception in a Kitten Resolved with a Percutaneous Gastropexy

Gastroesophageal intussusception is a rare pathology characterized by an acute or intermittent invagination of the stomach into the lumen caudal to the thoracic esophagus, the pathogenesis is not well understood, although it is likely multifactorial. The mortality is high, associated with a late diagnosis and a rapid deterioration. A 4-month-old male domestic shorthair kitten presented for evaluation of intermittent respiratory distress and abdominal discomfort with two weeks of evolution. Based on clinical history, clinical sings and imaging studies a diagnosis of intermittent gastroesophageal intussusception was established. The reduction of the intussusception was performed with endoscopy maneuvers and with medical and nutritional management for some days, but this failed and finally was reduced with a percutaneous gastropexy tube to prevent recurrence with a good long-term outcome. Gastroesophageal intussusception in cats is associated with megaesophagus or hiatal hernia, and should be considered as a differential diagnosis in patients with chronic vomiting, regurgitation or respiratory disease. Survey and contrasted thoracic radiographs can be used to identify gross anatomical abnormalities, but the definitive diagnosis should be made by esophagogastroscopy with the possibility of reducing the intussusception. The use of percutaneous gastropexy provides other possible option to conventional surgery for the management of this pathology in cats.

Acute gastroesophageal intussusception in a juvenile Australian Shepherd dog: endoscopic treatment and long-term follow-up

Background

Canine gastroesophageal intussusception (GEI) is a rare and potentially fatal disease usually affecting puppies or young dogs < 3 months of age and of medium to large breeds. Surgical intervention has been advocated as the therapy of choice by most authors. Endoscopic treatment may offer an advantageous or alternative method of treatment.

Case presentation

GEI was diagnosed in a nine-week-old Australian Shepherd dog with an acute onset of vomiting and regurgitation and compatible radiographic findings on thoracic radiography. Treatment consisted of endoscopic gastric repositioning and placement of a percutaneous endoscopic gastrostomy (PEG) tube to prevent repeated dislocation of the stomach, and to allow for nutritional supplementation During a follow- up period of eight months, thoracic radiographs were obtained showing persistent esophageal dilatation in the absence of compatible clinical signs.

Conclusion

Endoscopic intervention is an effective, alternative in selected canine GEI- cases, allowing for rapid, minimally invasive confirmation of diagnosis and therapy. After initial treatment, radiographic long-term follow-up seems prudent even in asymptomatic patients.

Gastrointestinal endoscopy in the cat

Practical relevance:

Endoscopic examination of the feline gastrointestinal (GI) tract is a minimally invasive method for obtaining biopsy samples of the GI mucosa, which is often necessary for a diagnosis of chronic GI diseases. In addition endoscopy has several therapeutic indications including foreign body retrieval, oesophageal stricture dilation and placement of a percutaneous gastrostomy tube.

Clinical challenges:

Initially, practitioners must learn the subtle manipulations necessary to efficiently guide the endoscope through the GI tract to obtain biopsy samples of high diagnostic quality, and develop skills for implementing interventional procedures (eg, foreign body removal). Another challenge in mastering GI endoscopy is the ability to recognise normal from abnormal, which requires many years of practice and experience. Endoscopy is a diagnostic and interventional procedure that should be performed only in conjunction with a thorough history, physical examination, appropriate laboratory evaluation, and radiographic and/or ultrasonographic imaging.

Audience:

This review is intended to familiarize both the general and referral practitioner with GI endoscopy as a minimally invasive diagnostic and therapeutic intervention for the feline patient.

Evidence base:

The guidance contained within this article is based on a combination of the published literature, the authors’ personal experience and the experience of colleagues.

Mechanisms, causes, investigation and management of vomiting disorders in cats: a literature review

Vomiting is a common presenting complaint in feline practice. This article differs from previous reviews in that it is an evidence-based review of the mechanisms, causes, investigation and management of vomiting in the domestic cat. Published evidence was reviewed, and then used to make recommendations for clinical assessment, diagnosis, antiemetic drug treatment, dietary management and monitoring of cats presenting with vomiting. The strength of the evidence on which recommendations are made (and areas where evidence is lacking for cats) has been highlighted throughout.

Nonsurgical Treatment of Gastroesophageal Intussusception in a Puppy

A 7-week-old, female Siberian husky was presented to Murdoch University Veterinary Hospital with an acute onset of respiratory distress and regurgitation. Thoracic imaging identified an intraluminal esophageal mass with concurrent aspiration pneumonia. Esophagoscopy identified the mass as stomach, and a diagnosis of gastroesophageal intussusception was made. The intussusception was reduced endoscopically, and fixation of the stomach to the abdominal wall was performed using a tube gastropexy. Gastroesophageal intussusception is an uncommon disease in small animals and traditionally has been managed surgically. This case report describes an alternative method of treatment associated with a good outcome in this puppy.