Pancreatic abscess in 36 dogs: a retrospective analysis of prognostic indicators

Perioperative outcomes in dogs and cats undergoing pancreatic surgery: 81 cases (2008-2019)

OBJECTIVES

To identify and describe the type and frequency of perioperative factors in dogs and cats undergoing pancreatic surgery under referral care.

METHODS

Medical records from a small animal surgical referral practice were retrospectively reviewed to identify dogs and cats that underwent pancreatic surgery between 2008 and 2019. Inclusion criteria included complete medical record, histopathology results and follow-up of at least 14 days postoperatively or until death. Variables collected included signalment, history, presenting complaint, preoperative diagnostic results, intraoperative complications, surgical findings/procedures, postoperative complications and histopathology results. Cases were excluded if pertinent information or a histopathology report was missing from the medical record. The frequency of these variables was reported.

RESULTS

There were 81 client-owned animals identified that met the inclusion criteria (57 dogs and 24 cats). The most common pancreatic procedure performed in dogs was partial pancreatectomy 63.2% (36/57) and in cats was pancreatic biopsy 62.5% (15/24). The most common histologic diagnosis in dogs was pancreatic islet cell carcinoma 50.9% (29/57) and in cats was pancreatitis 41.7% (10/24). The overall mortality rate was 13.6% (11/81), with a 10.5% (6/57) mortality rate in dogs and a 20.8% (5/24) mortality rate in cats.

CLINICAL SIGNIFICANCE

In this series of dogs and cats, pancreatic surgery under referral care carried a low to moderate mortality rate.

New insights into the etiology, risk factors, and pathogenesis of pancreatitis in dogs: Potential impacts on clinical practice

While most cases of pancreatitis in dogs are thought to be idiopathic, potential risk factors are identified. In this article we provide a state‐of‐the‐art overview of suspected risk factors for pancreatitis in dogs, allowing for improved awareness and detection of potential dog‐specific risk factors, which might guide the development of disease prevention strategies. Additionally, we review important advances in our understanding of the pathophysiology of pancreatitis and potential areas for therapeutic manipulation based thereof. The outcome of pathophysiologic mechanisms and the development of clinical disease is dependent on the balance between stressors and protective mechanisms, which can be evaluated using the critical threshold theory.

Medical and surgical management of pancreatic fluid accumulations in dogs: A retrospective study of 15 cases

BACKGROUND

Limited data exist on the diagnosis and successful medical management of suspected pancreatic abscessation, and the appropriate terminology of this condition.

HYPOTHESIS/OBJECTIVES

To describe the diagnosis and management of pancreatic fluid accumulations in dogs where pancreatic fluid cytology results were available, to describe those medically and surgically managed at the same institution, and reconsider the terminology describing acute pancreatitis with pancreatic fluid accumulation.

ANIMALS

Fifteen dogs treated for suspected pancreatic abscessation at a university teaching hospital between January 2010 and March 2020.

METHODS

Retrospective descriptive study.

RESULTS

Ultrasonographic findings described pancreatic fluid accumulations as hypoechoic in 10/15 and anechoic in 2/15 cases, ranging between 1.6 and 7 cm in diameter (median, 3.5 cm). No complications were documented after ultrasound guided fine-needle aspiration. Cytologically, all samples revealed a predominantly neutrophilic inflammation. 11/15 samples yielded a negative culture (9/11 received antimicrobials before sampling) and in 4 cases culture was positive. 7/15 were initially managed surgically including all 4 infected cases. 4/7 surgically managed cases were discharged, including 2 infected cases. The remaining 3/7 surgically managed cases were euthanized due poor quality of life. 8/15 cases were managed medically; 7/8 were discharged, 1 died. 3/7 then represented, and underwent successful surgical intervention after recrudescence of clinical signs, and all were discharged. The remaining 4 medically managed cases did not require further therapeutic intervention, with no clinical deterioration on reassessment.

CONCLUSIONS AND CLINICAL IMPORTANCE

Medical management is a viable treatment option for some dogs with pancreatic fluid accumulation, or as a prequel to surgical management. Subclassifications of pancreatic fluid accumulations using diagnostic findings could enable more tailored management approaches and accurate prognostication.

Advances in the diagnosis of acute pancreatitis in dogs

In the last 20 years, the diagnosis of pancreatitis has become more frequent as a result of improved diagnostic modalities such as abdominal ultrasound examination, advanced imaging, and immunoassays for the measurement of pancreatic lipase. Our aim is to provide a state‐of‐the‐art overview of the clinical diagnosis of acute pancreatitis (AP) in dogs with a particular focus on pancreatic lipase assay validation and clinical performance, in addition to advanced imaging modalities. We also discuss the potential indications for cytology and histopathology in dogs with suspected AP.

Laparoscopic omentalization of a pancreatic cyst in a cat

CASE DESCRIPTION A 15-year-old spayed female domestic shorthair cat was examined because of a 1-year history of daily vomiting, which was not associated with food intake. CLINICAL FINDINGS Initial physical examination findings and serial hematologic and serum biochemical results were unremarkable except for the presence of a grade 2/6 left-sided heart murmur and persistent mild azotemia. A well-defined multilobulated cystic structure located between the spleen and left kidney was identified by abdominal ultrasonography. TREATMENT AND OUTCOME Laparoscopic exploration revealed that the cystic structure originated from the left pancreatic limb. With laparoscopic guidance, the structure was percutaneously drained and underwent omentalization. Then, a partial cystectomy was performed to obtain a tissue specimen for histologic evaluation. The vomiting resolved for a short period immediately after surgery and then gradually resumed over 6 months, albeit with less frequency than prior to surgery. The histologic diagnosis was pancreatic cyst. Abdominal ultrasonography performed 6 months after surgery revealed that the original cyst had completely resolved but multiple smaller cysts had developed. The serum feline pancreas-specific lipase activity was not measured before surgery but remained increased from the reference limit following surgery, and chronic pancreatitis was considered the most likely cause of pancreatic cyst formation. CLINICAL RELEVANCE Laparoscopic-guided drainage and omentalization of a large pancreatic cyst resulted in a satisfactory outcome for the cat of this report and can be considered an alternative to percutaneous ultrasound-guided cyst drainage and the more invasive laparotomy approach for pancreatic cystectomy with or without omentalization.

Akkermansia and Microbial Degradation of Mucus in Cats and Dogs: Implications to the Growing Worldwide Epidemic of Pet Obesity

Akkermansia muciniphila is a mucin-degrading bacterium that has shown the potential to provide anti-inflammatory and anti-obesity effects in mouse and man. We here focus on companion animals, specifically cats and dogs, and evaluate the microbial degradation of mucus and its health impact in the context of the worldwide epidemic of pet obesity. A literature survey revealed that the two presently known Akkermansia spp., A. muciniphila and A. glycaniphila, as well as other members of the phylum of Verrucomicrobia seem to be neither very prevalent nor abundant in the digestive tract of cats and dog. While this may be due to methodological aspects, it suggests that bacteria related to Akkermansia are not the major mucus degraders in these pets and hence other mucus-utilizing taxa may deserve attention. Hence, we will discuss the potential of these endogenous mucus utilizers and dietary interventions to boost these as well as the use of Akkermansia spp. related bacteria or their components as strategies to target feline and canine obesity.

Pancreatic Abscess in a cat due to Staphylococcus aureus infection

A 16-year-old spayed female American Shorthair cat was presented with lethargy, anorexia, and wamble. Physical and blood examination did not reveal any remarkable findings. Abdominal ultrasonography identified the presence of a localized anechoic structure with a thick wall in contact with the small intestine and adjacent to the liver. Ultrasound-guided fine-needle aspiration of the structure revealed fluid containing numerous cocci and neutrophils. Two days after antibiotic treatment, exploratory laparotomy was performed and the content of the structure was removed before multiple lavages. The pathological and bacteriological examination results supported a confirmatory diagnosis of pancreatic abscess due to Staphylococcus aureus infection, making this the first such report in a cat. The cat remained healthy thereafter with no disease recurrence.

Retrospective characterisation and outcome of canine idiopathic mesenteric purulent lymphadenitis and lymph node abscesses at a teaching hospital from 2005 to 2015

BACKGROUND

Idiopathic purulent mesenteric lymphadenitis or lymph node abscessation, even though rare in dogs, are important diseases in which rapid diagnosis and treatment is critical. This study aimed to characterise the typical features of these conditions in dogs.

MATERIAL AND METHODS

Archived records from 2005 to 2015 were retrospectively evaluated for the occurrence of idiopathic purulent mesenteric lymphadenitis or lymph node abscesses in dogs. History, physical and clinicopathological abnormalities, diagnostic tests performed, treatment and outcome were reviewed.

RESULTS

A total of 14 cases with histopathologic and/or cytologic confirmation were identified. Typically, there were gastrointestinal signs including abdominal pain and elevated body temperature. Blood analysis revealed non-specific inflammatory changes including elevated C-reactive protein. Half of the bacterial cultures from lymph nodes showed growth of various bacteria. A primary cause was not identified in any case. Out of 14 cases, 10 cases underwent surgery and all dogs were discharged from the hospital. Three suffered from a relapse between 1 and 5 months after discharge but were successfully managed with antibiotics.

CONCLUSION AND CLINICAL RELEVANCE

Idiopathic purulent mesenteric lymphadenitis or lymph node abscessation are infrequent but clinically important diseases. Surgical, symptomatic and antibiotic treatment led to resolution of clinical signs in the evaluated cases. Thorough and standardised diagnostic workup and treatment of future cases are necessary to investigate possible pathogeneses and optimal therapeutic options. Outcome was favourable overall.

CONTRAST-ENHANCED ULTRASONOGRAPHY OF THE PANCREAS IN HEALTHY DOGS AND IN DOGS WITH ACUTE PANCREATITIS

Pancreatitis is the most frequent disease affecting the exocrine pancreas in dogs and reliable diagnostic techniques for predicting fatal complications are lacking. Contrast-enhanced ultrasound (CEUS) improves detection of tissue perfusion as well as organ lesion vascular pattern. Objectives of this prospective case control study were to compare perfusion characteristics and enhancement patterns of the pancreas in healthy dogs and dogs with pancreatitis using CEUS. Ten healthy dogs and eight dogs with pancreatitis were selected based on physical examination, abdominal ultrasound, and blood analysis findings. A CEUS study of the pancreas was performed for each dog and two observers who were aware of clinical status used advanced ultrasound quantification software to analyze time-intensity curves. Perfusion patterns were compared between healthy and affected dogs. In dogs with acute pancreatitis, mean pixel and peak intensity of the pancreatic parenchyma was significantly higher than that of normal dogs (P = 0.05) in between 6 and 60 s (P = <0.0001-0.046). This corresponds to a 311% increase in mean pixel intensity in dogs with acute pancreatitis compared to healthy dogs. Wash-in rates were greater and had a consistently steeper slope to peak in dogs with pancreatitis as opposed to healthy dogs. All dogs with pancreatitis showed a decrease in pixel intensity 10-15 days after the initial examination (P = 0.011) and their times to peak values were prolonged compared to the initial exam. Findings from the current study supported the use of CEUS for diagnosing pancreatitis, pancreatic necrosis, and disease monitoring following therapy in dogs.

Pancreatic Abscess in a Cat with Diabetes Mellitus

An 11 yr old spayed female Maine coon cat was referred with uncontrolled diabetes mellitus. The cat had a 2 mo history of weight loss and intermittent vomiting. An abdominal ultrasound identified the presence of a large cavity measuring a maximum of 4.6 cm in the pancreas that was filled with a homogeneous echogenic fluid. Cytological analysis and culture of the fluid obtained from the pancreatic mass indicated the presence of a bacterial abscess. The application of nonsurgical drainage and the administration of glargine insulin and antibiotics resolved the clinical signs. The size of the pancreatic abscess was reduced after 5 mo, and the cat achieved diabetic remission and remained healthy at the time this report was prepared. This case report describes the successful treatment of a pancreatic bacterial abscess concurrent with diabetes mellitus in a Maine coon cat.