Endoscopic assessment of presumed acquired pyloric narrowing in cats: A retrospective study of 27 cases.

Acquired pyloric narrowing is a rare and poorly-documented condition in cats, but the endoscopic appearance of pyloric narrowing has never previously been reported. The objectives of this study were to describe the clinical, endoscopic and histological features in cats with gastrointestinal signs where the pylorus could not be passed during endoscopy, and to compare these data with a control group. Medical files of cats that underwent upper GI endoscopy by the same operator between 2006 and 2015 were reviewed. Cats for which the pylorus could not be passed were assigned to the case group, whilst those with an easily-passable pylorus were assigned to the control group. The case group comprised 27 cats and control group comprised 35 cats. Median age and weight were not different between groups, but there were more Siamese cats in the case group (6/27) compared with the control group (1/35; P = 0.04). Chronic vomiting was the main clinical sign in both groups, but the vomitus was more likely to contain food in case group (23/25) than in cats in control group (17/30; P < 0.01). Endoscopic findings confirmed gastric inflammation in both groups, whilst histological findings revealed similar lymphoplasmacytic infiltration of the gastric mucosa and the duodenum in most cases, neoplastic features being infrequent. Acquired pyloric narrowing is probably an underdiagnosed condition in adult cats. A possible association between pyloric narrowing and gastrointestinal inflammatory disease requires further study but, for now, it is recommended that multiple gastric, pyloric, and duodenal biopsies be acquired during the endoscopy.

Distal esophageal sphincter achalasia in a Labrador retriever dog with polypoid gastric mucosal hyperplasia and pyloric stenosis.

An 11-year-old, neutered female, Labrador retriever dog was presented with a history of intractable vomiting, regurgitation, and coughing. Computed tomography (CT) imaging identified marked hypertrophy of the distal esophagus with a suspicion of distal esophageal achalasia, based on the observation of a "bird beak" appearance. This was later confirmed on a fluoroscopic swallow study. Marked hypertrophy of the gastric pylorus was also identified on CT imaging, and polypoid gastric mucosal hyperplasia was diagnosed based on the gross endoscopic appearance combined with gastric histopathology. Secondary aspiration pneumonia was diagnosed based on the results of CT imaging, bronchoscopy and bronchoalveolar lavage fluid analysis. Medical therapy alone failed to elicit any significant improvement, but clinical resolution was achieved following surgical intervention comprising Ventral Heller myotomy, Dor's fundoplication, and pyloroplasty.

Achalasie du sphincter oesophagien distal chez un chien de race Labrador avec hyperplasie polypoïde de la muqueuse gastrique et sténose du pylore. Une femelle Labrador stérilisée âgée de 11 ans fut présentée avec une histoire de vomissements intraitables, de régurgitation et de toux. Un examen par tomodensitométrie (CT) identifia une hypertrophie marquée de l'oesophage distal avec un doute d'achalasie oesophagienne distale, sur la base de l'observation d'une apparence en « bec d'oiseau ¼. Ceci fut ultérieurement confirmé par examen fluoroscopique. Une hypertrophie marquée du pylore gastrique fut également identifiée lors de l'examen par CT, et une hyperplasie polypoïde de la muqueuse gastrique fut diagnostiquée sur la base de l'apparence macroscopique lors de l'endoscopie combinée avec l'examen histopathologique de la muqueuse gastrique. Une pneumonie par aspiration secondaire fut diagnostiquée basée sur les résultats du CT, de la bronchoscopie et de l'analyse du liquide de lavage broncho-alvéolaire. Une thérapie médicale seule ne parvint pas à éliciter une amélioration significative, mais une résolution clinique fut obtenue à la suite d'une intervention chirurgicale comprenant une myotomie ventrale de Heller, une fundoplicature de Dor, et une pyloroplastie.(Traduit par Dr Serge Messier).

Treatment of pyloric stenosis in a cat via pylorectomy and gastroduodenostomy (Billroth I procedure).

CASE DESCRIPTION: A 5-month-old 1.9-kg (4.2-lb) spayed female Siamese cat was evaluated because of a history of decreased appetite, regurgitation, vomiting, and lack of weight gain. CLINICAL FINDINGS: Radiographic findings included a fluid- and gas-distended stomach with a small accumulation of mineral opacities. Ultrasonographic examination confirmed severe fluid distention of the stomach with multiple hyperechoic structures present and revealed protrusion of the thickened pylorus into the gastric lumen, with normal pylorogastric serosal continuity. Endoscopy of the upper gastrointestinal tract revealed an abnormally shortened pyloric antrum and stenotic pyloric outflow orifice. Pyloric stenosis resulting in pyloric outflow obstruction was diagnosed. TREATMENT AND OUTCOME: A pylorectomy with end-to-end gastroduodenostomy (Billroth I procedure) was successfully performed, and a temporary gastrostomy tube was placed. Six days after surgery, the cat was eating and drinking normally, with the tube only used for administration of medications. The gastrostomy tube was removed 12 days after surgery. Results of follow-up examination by the referring veterinarian 3 weeks after surgery were normal. Occasional vomiting approximately 2 months after surgery was managed medically. Fifteen months after surgery, the owners reported that the cat seemed completely normal in appearance and behavior. CLINICAL RELEVANCE: Pyloric stenosis should be considered a differential diagnosis for young cats with pyloric outflow obstruction. The cat of this report was treated successfully with a Billroth I procedure. Histologic examination and immunohistochemical analysis of the excised tissue showed the stenosis to be associated with hypertrophy of the tunica muscularis.

[Generalized metastatic intestinal and cutaneous calcinosis in a Hovawart puppy with leptospirosis]. / Generalisierte metastatische intestinale und kutane Kalzinosis bei einem Hovawart-Welpen mit Leptospirose.

A 10-week old male Hovawart presented with acute renal failure. Based on clinical symptoms, blood analysis results and serology, a diagnosis of leptospirosis was made. Besides being acotemic, the puppy was initially also severely hypercalcemic. The dog was treated successfully, but developed widespread cutaneous and visceral calcifications. Severe pyloric calcification resulted in functional pyloric obstruction, which was successfully treated by pyloromyotomy. All skin lesions were cured with topical therapy within a few weeks. To the authors' knowledge, this is the first report of generalized intestinal and cutaneous calcification associated with acute renal failure due to Leptospirosis.

Pulsus alternans during halothane anesthesia in a dog.

An adult dog with pyloric obstruction was anesthetized with thiamylal and halothane for surgical revision. When an ECG was attached, the QRS-complex rate was noted to differ dramatically from the peripheral pulse rate. A dorsal pedal arterial catheter was introduced, and direct arterial pressure measurements revealed a blood pressure waveform that alternated in amplitude. Blood pressure and ECG traces were recorded, and the condition was diagnosed as pulsus alternans. The inhalation anesthetic was changed to isoflurane, and the condition was resolved.

[Functional pyloric stenosis in sheep]. / Funktionelle Pylorusstenose beim Schaf.

The clinical findings, the autopsy and the histology of functional pyloric stenosis in three sheep between four and eight years old are described. A chronic ulcer with structural alterations of the pyloric protuberance was found in the first animal. In the second sheep there were several polyps in the pylorus, and in the third erosions throughout the whole pylorus, and a few hyperplastic areas of epithelium at the junction between pylorus and duodenum. The abomasum was moderately to extremely congested and the contents weighed between 6.7 and 13 kg. In addition to these findings chronic and unspecific abomaso-duodenitis was found in all three sheep. These three cases can be attributed to the distal functional pyloric stenosis (Hoflund syndrome).

Chronic hypertrophic pyloric gastropathy in 14 dogs.

Ten male and 4 female dogs with chronic hypertrophic pyloric gastropathy were seen at the Sydney Veterinary Teaching Hospital in the period 1982-88. The most commonly affected breeds were the Shihtzu and Maltese. The mean age was 8.2 yr and the mean body weight 6.5 kg. The most common clinical signs were vomiting, weight loss, polydipsia and depression. Hypokalaemia was present in 11 of 12 dogs examined and hypochloraemia in 10 of 11 dogs examined. Five of the six dogs that had blood gases measured were found to have a metabolic alkalosis. Surgery was performed on 13 dogs; pyloromyotomy 7, pyloroplasty 4, gastroduodenostomy 2. There was a recurrence of symptoms in one pyloromyotomy dog, and fatal ulceration and perforation of the cardia occurred in one pyloroplasty case. The remaining 11 dogs had a mean known symptom-free survival time of 20 mo. This study confirms the preponderance of affected males, identifies electrolyte and blood gas disturbances as significant complication of chronic hypertrophic pyloric gastropathy, and suggests that relatively minor surgery (pyloromyotomy) may have a place in the treatment of a selected subgroup of cases.

Paraesophageal hiatal hernia and pyloric obstruction in a dog.

Paraesophageal hiatal herniation and pyloric obstruction were diagnosed in a pup with a history of vomiting. Findings of contrast radiography included esophageal reflux, delayed gastric emptying time, and paraesophageal herniation. Exploratory celiotomy revealed increased firmness of the pylorus and a primary defect in the esophageal hiatus, which allowed gastric herniation. Nissen fundoplication was performed following reconstruction of the esophageal hiatus, and pyloroplasty was performed to relieve the gastric outlet obstruction. Pyloric biopsy findings were consistent with a diagnosis of chronic gastritis. Recovery from surgery was initially unremarkable; however, the dog died suddenly 3 weeks after surgery. Necropsy revealed a large diaphragmatic hernia adjacent to the esophageal hiatus; the hernia had resulted in incarceration of the abdominal organs. The hiatal hernia reconstruction remained intact and was not the cause of the diaphragmatic disruption.

Chronic hypertrophic pyloric gastropathy as a cause of pyloric obstruction in the dog.

Six small-breed, middle-age dogs with a history of chronic intermittent vomiting had benign pyloric lesions causing gastric outlet obstruction. Marked similarities were found in clinical signs, pathologic changes, and treatment results. The condition was classified as a syndrome and was named chronic hypertrophic pyloric gastropathy. The appearance of the obstructive lesions at surgery were various forms of mucosal hypertrophy. Microscopically, the syndrome was characterized by mucosal foveolar and glandular hyperplasia, cystic glandular dilatation, superficial mucosal ulcerations, and various cellular infiltrates. The affected dogs were successfully treated by surgical correction of the gastric outlet obstruction.

Intestinal surgery in the foal.

Intestinal surgery in the foal is seldom necessary but some conditions in which it is essential are well recognized. The foal is a good surgical subject but success depends mainly on operating promptly before irreversible degenerative changes take place. Exploratory laparatomy is recommended whenever mechanical obstruction is suspected. Indications fall broadly into two main categories: 1. Cases arising from congenital defects. These form a miscellaneous group and present considerable difficulties in diagnosis and effective treatment. 2. Cases related to acute onset of obstruction, mainly due to volvulus or torsion. By far the most important condition in this category is volvulus of the ileum close to the ileocaecal valve. Aetiological factors are discussed, and the value of resection of affected small intestine and creation of a new jejuno-caecal opening is indicated. It is suggested that with improvement of such techniques it will be possible to save a higher proportion of foals suffering from mechanical intestinal obstruction.