Gastrojejunostomy without partial gastrectomy to manage duodenal stenosis in a dog

Feline Gastrointestinal Eosinophilic Sclerosing Fibroplasia and Duodenal Perforation in a 1-Year-Old British Shorthair Cat

OBJECTIVE

To provide a case description, including perioperative management, of a young cat with feline gastrointestinal eosinophilic sclerosing fibroplasia that presented with septic peritonitis.

CASE SUMMARY

A 1.5-year-old male castrated British Shorthair was presented with an acute history of vomiting, inappetence, and periuria. On presentation, the patient was in shock and was apparently painful on abdominal palpation. Abdominal radiographs identified a mass effect within the stomach, pneumoperitoneum, and a mild lack of serosal detail consistent with scant peritoneal effusion. Exploratory laparotomy confirmed a mass affecting the pylorus and proximal duodenum, which was ruptured at the level of the major duodenal papilla. Mass resection with concurrent gastroduodenostomy and cholecystojejunostomy was performed, and feline gastrointestinal eosinophilic sclerosing fibroplasia (FGESF) was diagnosed histopathologically. The cat was discharged 4 days postoperatively. Two weeks after surgery, treatment with prednisolone was initiated, and a hypoallergenic diet was recommended. Short-term medical management was challenged by poor owner compliance, and the patient was lost to follow-up 7 months after surgery.

NEW OR UNIQUE INFORMATION PROVIDED

To the authors' knowledge, this is the first report of FGESF as a cause of gastrointestinal perforation and septic peritonitis. FGESF should be considered a differential for perforated gastrointestinal masses in cats.

Primary repair of nonsteroidal anti-inflammatory drug-associated full thickness gastrointestinal ulcers in 11 dogs

OBJECTIVE

To report the outcomes of dogs that underwent primary repair of gastroduodenal perforations associated with the administration of nonsteroidal anti-inflammatory drugs (NSAID). A secondary objective was to identify clinicopathological findings that predisposed dogs to postoperative death.

STUDY DESIGN

Retrospective study.

ANIMALS

Eleven dogs with complete gastric or duodenal perforation related to administration of an NSAID that underwent primary surgical repair.

METHODS

Medical records were reviewed for dogs that presented with peritonitis due to a complete gastroduodenal perforation while receiving NSAIDs between November, 2011 and January, 2021. Data collected included patient characteristics, clinical signs, clinicopathological results, surgical details, and postoperative management and outcome.

RESULTS

All dogs were large breeds (mean weight 42 kg; range 22-75 kg), with a mean age of 7.35 years. Nine dogs from a total of 11 (82 %) received a concurrent corticosteroid and NSAID, or a higher dose/frequency/length of NSAID administration than recommended by the manufacturer. All gastroduodenal perforations were found in the upper gastrointestinal tract. Eight of 11 (73%) dogs survived to discharge. The median postoperative duration of follow up was 444 days (range 2-1460 days). No association was detected between ulcer size or location and mortality.

CONCLUSION

Most dogs who underwent primary repair of complete gastroduodenal ulcers survived. Gastroduodenal perforations were generally due to the administration of higher or longer doses of NSAIDs, or concurrent administration of another NSAID or corticosteroid.

CLINICAL SIGNIFICANCE

Primary closure may be associated with a high success rate in dogs with full thickness gastroduodenal ulcers.

Billroth II procedure for the treatment of spontaneous gastrointestinal perforation in two cats

CASE DESCRIPTION

A 9-year-old castrated male domestic shorthair cat (cat 1) and a 10-year-old castrated male Maine Coon cat (cat 2) were presented for recurrent feline lower urinary tract disease after receiving outpatient care from their primary veterinarians.

CLINICAL FINDINGS

Physical examination findings for both cats were initially within reference limits. After a short period of hospitalization, both cats developed peritoneal effusion; results of cytologic analysis of a sample of the fluid were consistent with septic peritonitis. During exploratory laparotomy, perforation of the pylorus or proximal portion of the duodenum secondary to ulceration was identified.

TREATMENT AND OUTCOME

Both cats underwent partial duodenectomy, partial gastrectomy (pylorectomy), and gastrojejunostomy (Billroth II procedure). The cats recovered from surgery and returned to a normal quality of life; however, each had mild episodes of anorexia but maintained a stable body weight. Cat 2 required additional surgery for trichobezoar removal 7 weeks later but recovered quickly. At 7 months after trichobezoar removal, cat 2 developed intermittent vomiting, but clinicopathologic, abdominal ultrasonographic, and upper gastrointestinal tract endoscopic findings were within reference limits. At 9 (cat 2) and 13 (cat 1) months after the Billroth II procedure, both cats were reported to be in good general health and without gastrointestinal signs.

CLINICAL RELEVANCE

In both cats, the Billroth II procedure was technically straightforward and associated with a full recovery and good medium- to long-term quality of life. A Billroth II procedure could be considered for treatment of cats with large mural lesions in the pyloroduodenal region.