Hemoperitoneum Secondary to Liver Lobe Torsion in a Cat.

A 5 yr old male British blue shorthair cat was presented collapsed with hypotension, hypothermia, and cranial abdominal pain. Abdominal ultrasound and abdominocentesis revealed hemoperitoneum and a suspected hepatic mass. Cytology of fine-needle aspirates of the mass was inconclusive, so exploratory celiotomy was performed for diagnostic and therapeutic purposes. An enlarged, hemorrhagic papillary process of the caudate lobe was identified, with twisting of the vasculature at the hilus, so a complete lobectomy was performed using a thoracoabdominal stapler. Histopathology was consistent with liver lobe torsion with no evidence of hepatocellular neoplasia identified. This report describes the first case of hemoperitoneum secondary to liver lobe torsion without evidence of hepatocellular neoplasia in a cat and demonstrates a successful outcome following surgical management with liver lobectomy.

Comparison of laparoscopic-assisted technique and open laparotomy for gastrointestinal biopsy in cats.

OBJECTIVE: To evaluate and compare the complications, postoperative pain, surgical time, hospitalization time, and adequacy of biopsy specimens between laparoscopic assisted (LAP) versus open laparotomy (OPEN) gastrointestinal biopsies in cats. STUDY DESIGN: Prospective randomized clinical study. SAMPLE POPULATION: Twenty-eight cats with clinical and ultrasonographic evidence of gastrointestinal disease. Fifteen cats in the LAP group and 13 in the OPEN group. METHODS: Signalment, presenting clinical signs, total duration of surgery, operative time, ease of procedure, incision length, postoperative pain scores, complications, and duration of hospitalization were recorded. Quality of gastrointestinal biopsies was compared between techniques. RESULTS: There was no difference in frequency of intraoperative complications (P = .778), surgical duration (P = .333), postoperative complications (P = .722), or duration of hospitalization (P = .728). Pain scores assigned before (P = .198) or 1 hour after surgery (P = .073) did not differ between groups; however, pain scores were lower at 6 hours (P = .003), 12 hours (P = .001), and 24 hours (P = .005) postoperatively in the LAP group. All cases survived surgery, with one case requiring conversion, and diagnostic biopsies were obtained in all cases. CONCLUSION: Laparoscopic-assisted gastrointestinal biopsy technique provided diagnostic specimens and decreased postoperative pain compared to open surgical techniques. No difference was detected in surgical duration, complications, or duration of hospitalization.

Perioperative Mortality and Long-Term Survival in 80 Dogs and 32 Cats Undergoing Excision of Thymic Epithelial Tumors.

OBJECTIVE: To examine perioperative mortality, long-term survival, causes of death, and prognostic factors for dogs and cats undergoing surgical excision of thymic epithelial tumors (TETs). STUDY DESIGN: Multi-institutional case series. ANIMALS: Eighty dogs and 32 cats. METHODS: Follow-up information was obtained for dogs and cats that underwent surgical excision of a TET between 2001 and 2012. RESULTS: Perioperative mortality was 20% in dogs and 22% in cats. No independent risk factors for perioperative mortality were identified. The estimated median survival time for all dogs was 1.69 years (95% CI 0.56-4.32) and the 1- and 4-year survival rates were 55% (95% CI 44-67) and 44% (95% CI 32-56). The estimated median survival time for all cats was 3.71 years (95% CI 0.56-unestimatable) and the 1- and 4-year survival rates were 70% (95% CI 53-87) and 47% (95% CI 0-100). Of animals that survived to discharge, 42% of dogs and 20% of cats eventually died of TET-related causes. The presence of paraneoplastic syndromes (hazard ratio [HR] 5.78, 95% CI 1.64-20.45, P = .007) or incomplete histologic margins (HR 6.09, 95% CI 1.50-24.72, P = .01) were independently associated with decreased survival in dogs. No significant predictors of survival were identified in cats. Conclusions regarding the effect of chemotherapy or radiation therapy could not be made. CONCLUSIONS: While there is substantial risk of perioperative death in dogs and cats undergoing surgery for TETs, many animals that survive to discharge have prolonged survival. Survival is significantly decreased in dogs with paraneoplastic syndromes or incomplete histologic margins.

Evaluation of risk factors for morbidity and mortality after pylorectomy and gastroduodenostomy in dogs.

OBJECTIVES: To (1) identify and describe the type and frequency of postoperative complications after pylorectomy and gastroduodenostomy in dogs and (2) identify preoperative and intraoperative risk factors, including the presence of neoplasia, prognostic for patient mortality after surgery. STUDY DESIGN: Case series. ANIMALS: Dogs (n=24) treated by pylorectomy and gastroduodenostomy. METHODS: Medical records (2000-2007) for 2 teaching hospitals of dogs treated that had pylorectomy and gastroduodenostomy were reviewed. Pre-, intra-, and postoperative data were obtained from the medical record. RESULTS: Of the 24 dogs, 75% survived 14 days, but 10 (41%) died by 3 months. Overall median survival time (MST) was 578 days. On log-rank univariate analysis, preoperative weight loss (P=.001) and malignant neoplasia (P=.01) were associated with decreased survival time. Dogs with malignant neoplasia had a MST of 33 days. Common postoperative morbidity included hypoalbuminemia (62.5%) and anemia (58.3%). CONCLUSIONS: Pylorectomy with gastroduodenostomy has a good short-term outcome but long-term survival time is poor in dogs with malignant neoplasia. CLINICAL RELEVANCE: Overall, most dogs treated with pylorectomy and gastroduodenostomy survived the postoperative period; however, preoperative weight loss and malignant neoplasia were associated with decreased survival time. Because dogs with malignant neoplasia have markedly shortened survival times, pertinent preoperative, diagnostics steps should be exhausted to identify underlying neoplasia.

Feline gastric pneumatosis.

CASE SUMMARY: A 9-year-old male neutered domestic shorthair cat was presented with a 2 day history of anorexia and vomiting. A minimum database, including a complete blood count, serum biochemistry profile and urinalysis were unremarkable apart from a toxic neutrophilic left shift and borderline proteinuria. Abdominal ultrasound revealed intramural gas entrapment with thinning of the gastric wall, a hypoechoic pancreas, peritoneal fluid and a small volume of peritoneal gas along with a hyperechoic mesentery. CT was performed and demonstrated gas within the gastric submucosa and gas in the peritoneal cavity. Generalised gastric erythema was present at surgery and histopathology of excised abnormal areas reported gastric erosion with no obvious causative agents; however, pretreatment with dexamethasone may have been a contributing factor. Culture from biopsied gastric tissue was sterile. Clinical signs resolved after partial gastrectomy and medical management. RELEVANCE AND NOVEL INFORMATION: Feline gastric pneumatosis is a rare clinical finding. Imaging is essential for diagnosis and to decide on the appropriate treatment; this is often medical but in cases where there is suspicion or evidence of gastric perforation, surgery is indicated. To our knowledge, this is the first case of feline gastric pneumatosis secondary to gastric ulceration, diagnosed via CT and where dexamethasone may have been a contributing factor.

Laparoscopic Resection of a Pancreatic ß Cell Tumor in a Dog.

Laparoscopic partial pancreatectomy has been performed in experimental canine studies and has been evaluated in human medicine but has not been reported in a clinical veterinary case. The authors present a 9 yr old field spaniel with weakness and hypoglycemia with insulin levels and Amended Insulin: Glucose Ratio results equivocal for a pancreatic insulinoma. Multiple abdominal ultrasounds did not detect the tumor, yet dual-phase computed tomographic angiography revealed the presence of a focal hypoattenuating nodule in the left lobe of the pancreas. A 3-port laparoscopic approach to the abdomen confirmed a 1.5-cm mass in the mid-left limb of the pancreas, and resection of the mass was performed with a bipolar vessel-sealing device. The surgery was performed without complication, and the dog became normoglycemic within 4 hr following surgery. Final histopathology results revealed pancreatic neuroendocrine carcinoma of the ß cells. Recurrence of hypoglycemia was noted 18 mo postoperatively; however, repeat computed tomographic angiography did not reveal pancreatic abnormalities and fine needle aspirates of liver nodules did not suggest metastatic disease. Medical management was elected and the patient was euthanized 28 mo after surgery due to refractory hypoglycemic seizures.

Safety and efficacy of laparoscopic hepatic biopsy in dogs: 80 cases (2004-2009).

OBJECTIVE: To evaluate the safety and efficacy of laparoscopic hepatic biopsy in dogs. DESIGN: Retrospective case series. ANIMALS: 80 client-owned dogs. PROCEDURES: Medical records of dogs that underwent laparoscopic hepatic biopsy between 2004 and 2009 because of suspected hepatic disease were reviewed to obtain information on signalment, intraoperative and postoperative complications, and histologic diagnosis. Follow-up information was obtained through medical records and telephone conversations with owners. RESULTS: 76 of the 80 (95%) dogs survived to hospital discharge. Three (4%) dogs required conversion to laparotomy, but in none of the dogs was conversion to laparotomy needed to control hemorrhage associated with the laparoscopic biopsy procedure. Another 3 (4%) dogs required a blood transfusion; all 3 had been anemic prior to surgery. All laparoscopic biopsy samples were considered to be of sufficient size and to contain a sufficient number of portal triads to obtain a histologic diagnosis. However, disagreements in histologic diagnoses were identified for 7 of the 49 (14%) dogs for which multiple slides were available for review. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that laparoscopic hepatic biopsy is a safe procedure in dogs, with low morbidity and mortality rates, that typically yields sufficient samples for histologic examination. However, because of the possibility of disagreement among histologic diagnoses, multiple samples should be obtained.

Complications and need for conversion to laparotomy in small animals.

Laparoscopic procedures provide the advantage of decreased patient morbidity with improved visualization and rapid patient recovery. Complications associated with laparoscopic procedures are discussed. Conversion to open laparotomy may depend on a variety of factors related to the patient, procedure, and surgeon. There are few contraindications for performing laparoscopic procedures, but complications or conversions to an open laparotomy may be expected in a percentage of patients.