Gastric perforation following endoscopic removal of a Bravo pH capsule in a cat.

A 7-year-old domestic shorthair cat was evaluated for hyporexia and weight loss following endoscopic placement of an intragastric pH monitoring device. Physical examination of the cat was unremarkable, and its blood work was notable for a mild hypoalbuminemia. The cat's acute hyporexia and weight loss was attributed to discomfort associated with the intragastric pH monitoring device, as has been reported in humans. Endoscopic removal of the intragastric pH monitoring device resulted in gastric perforation. The cat underwent exploratory laparotomy for surgical resection and repair of the perforated area. To our knowledge, this is the first report of gastric perforation secondary to removal of a Bravo pH capsule. Caution may be advised when considering intragastric pH capsule removal in cats.

Spontaneous gastrointestinal perforation in cats: a retrospective study of 13 cases.

OBJECTIVES: The aim of this study was to describe the clinical characteristics and the frequency of malignant vs non-malignant causes for spontaneous gastrointestinal perforation in cats. METHODS: The medical records of cats diagnosed as having gastrointestinal perforation between August 2010 and July 2013 were reviewed. Diagnosis was confirmed by exploratory surgery. Patients with incomplete records, perforation due to external trauma, leakage at previous enterotomy or anastomotic sites, or foreign bodies were excluded. Each record was examined for different information pertaining to signalment, medical history, clinical and clinicopathological data, imaging findings, abdominal fluid examination, surgical findings, histopathological examination, treatment received after surgery and outcome. RESULTS: Thirteen cats were included. Five of these cats had concurrent illnesses, including viral upper respiratory tract disease, pancreatitis and chronic kidney disease. Two cats had previously received non-steroidal anti-inflammatory drugs and four had received corticosteroids. Clinical signs and clinicopathological abnormalities were not specific. Six of 13 patients were diagnosed during surgery with gastric perforations, four patients with duodenal perforations and three patients with jejunal perforations. Histopathological examination of the ulcerated wall was performed in 11/13 cats. Alimentary lymphoma was diagnosed in six cats. Non-neoplastic lesions (lymphocytic- plasmacytic inflammatory bowel disease, necrotic suppurative enteritis) were observed in the other five cats. The major limitation of the study was the small sample size. CONCLUSIONS AND RELEVANCE: Lymphoma may be a frequent cause of spontaneous perforation in cats. Therefore, histological examination of ulceration is essential in all cases. The direct and sole implication of anti-inflammatory administration in a gastrointestinal perforation is not clearly established in this study.

Spontaneous gastroduodenal perforations in dogs: a retrospective study of 15 cases.

The clinical findings and outcomes following surgical management of spontaneous gastroduodenal perforations in 15 dogs were reviewed in a retrospective study to identify related risk factors. Clinical and clinicopathological findings were diverse. Use of multiple diagnostic procedures yielded a strong index of suspicion for gastrointestinal perforation. There was a trend towards improved survival for animals with perforation of the gastric fundus/body compared to pyloric or duodenal perforation, although the difference was not statistically significant. Five dogs were euthanased at surgery; two dogs died within two days after surgery. Seven of the eight surviving dogs had a favourable long-term outcome. Previous administration of NSAIDs was the only identified predisposing factor in ten of 10 of the dogs.

Challenging diagnosis--icterus associated with a single perforating duodenal ulcer after long-term nonsteroidal antiinflammatory drug administration in a dog.

A dog developed icterus, vomiting, and anorexia 2 wk after orthopedic surgery and treatment with meloxicam for approximately 1 y. Exploratory laparotomy revealed a single perforated duodenal ulcer. The most likely cause of the hyperbilirubinemia was intrahepatic cholestasis resulting from peritonitis associated with the perforation.

Pneumoperitoneum secondary to a perforated gastric ulcer in a cat.

A 7-year-old domestic cat was examined because of a history of weight loss, intermittent diarrhea, and anorexia of 6 months' duration. Results of physical examination were normal except for marked abdominal tension. Results of a CBC and serum biochemistry profile were unremarkable. Severe pneumoperitoneum was noted radiographically, and abdominocentesis yielded 640 mL of air. Abdominal distension recurred 1 day after abdominocentesis. Exploratory laparotomy was performed 3 days after recurrence of abdominal distension and revealed a gastric perforation along the greater curvature of the stomach with omental and pancreatic adhesions at the site of perforation. Mild local peritoneal inflammation was also noted. A partial gastrectomy was performed to resect the lesion, and histologic examination confirmed a severe perforating ulcer. The gastric wall adjacent to the ulcer was histologically normal. Aerobic and anaerobic bacteriologic cultures of abdominal swab specimens were negative for bacterial growth. The cat was discharged 4 days after surgery and clinically normal at suture removal.

Dilated cardiomyopathy and amebic gastritis in a giant anteater (Myrmecophaga tridactyla).

An approximately 11-mo-old female giant anteater (Myrmecophaga tridactyla) exhibited anorexia, lethargy, hypothermia, depression, and minimal response to external stimuli. Radiography and ultrasonography revealed an enlarged heart, with free gas and fluid in the abdomen. Abdominocentesis produced a clear brown fluid with an acute to subacute septic suppurative exudate. Cardiac ultrasonography revealed a dilated, thin-walled left ventricle with a comparatively low fractional shortening. Despite intensive supportive care, the anteater died. Postmortem findings included gastric ulceration with perforation near the pylorus. Entameba spp. and Acanthamoeba spp. were both identified in large numbers at the site of the gastric ulceration and perforation.

Spontaneous gastroduodenal perforation in 16 dogs and seven cats (1982-1999).

The records of 23 dogs and cats diagnosed with spontaneous gastroduodenal perforation (GDP) were retrospectively reviewed. Survival was 63% in dogs and 14% in cats. Rottweilers <5 years of age were overrepresented. Clinical evidence of gastrointestinal bleeding was common in dogs but not in cats. Shock was an uncommon presenting condition in dogs and was not closely linked to outcome. In fact, progression of an ulcerating lesion to GDP was not associated with marked changes in symptoms exhibited by many patients in this study. Most GDPs were associated with histopathological evidence of subacute or chronic peritoneal reaction at the time of diagnosis. This suggests that diagnostic methods employed lacked sensitivity in identifying early perforating lesions, and that dramatic signs of acute abdomen following gastroduodenal perforation may not be as common as was previously thought.

Nonsteroidal anti-inflammatory drug-induced duodenal ulceration and perforation in a mature rottweiler.

A mature male rottweiler was evaluated for acute collapse and abdominal pain. The history consisted of concurrent administration of meloxicam and aspirin. On exploratory laparotomy, a large perforated ulcer was discovered in the proximal duodenum, with secondary peritonitis. The pathogenesis of NSAID-induced gastrointestinal ulceration and the supposed safety of COX-2 selective agents are discussed.

Concurrent abomasal displacement and perforating ulceration in cattle: 21 cases (1985-1996).

OBJECTIVE: To evaluate the association of physical examination and clinicopathologic findings with surgical findings in cattle with concurrent abomasal displacement and perforating ulceration, to determine short- and long-term survival rates in these cattle, and to determine whether degree of peritonitis (focal vs diffuse) influences survival rates. DESIGN: Retrospective study. ANIMALS: 21 cattle with concurrent abomasal displacement and perforating ulceration and 42 cattle with uncomplicated abomasal displacement. PROCEDURE: Information on signalment, stage of lactation, physical examination findings, clinicopathologic data, surgical diagnosis, procedure(s) performed, and necropsy findings were retrieved from medical records of all cattle included in this study. Differences between physical examination findings of cattle with concurrent disease and those of cattle with uncomplicated displacements were evaluated, as were differences between survival rates in cattle with focal versus diffuse peritonitis. RESULTS: Cattle with concurrent disease had a greater probability of having pneumoperitoneum and signs of abdominal pain identified on physical examination than did cattle with uncomplicated diseases. There was no relationship between clinicopathologic data and survival time. Short-term survival rate was 38%, and degree of peritonitis significantly influenced survival time in cattle with concurrent abomasal displacement and perforating ulceration. Long-term survival rate in these cattle was 14%. CLINICAL IMPLICATIONS: Cattle with concurrent displaced abomasum and perforating ulceration have a poor chance for survival. In addition to detection of displaced abomasum, physical examination findings that can help lead to a presurgical diagnosis of this syndrome are pneumoperitoneum and signs of abdominal pain.

Gastric ulcer associated with a Helicobacter-like organism in a cougar (Felis concolor).

A 12-year-old captive female cougar (Felis concolor) died following perforation of a gastric ulcer. Histologically, erosions and ulcers were present in the antral area of the stomach. Fibroplasia and infiltrates of neutrophils bordered the ulcers. Modified Steiner silver stain revealed numerous tightly coiled helical bacteria. The bacteria stained positively with a rabbit polyclonal anti-Helicobacter pylori antibody. Morphology, location, and positive immunohistochemical staining suggests that the organism is a Helicobacter.

Duodenal perforation in a cheetah (Acinonyx jubilatus).

An 11-yr-old female cheetah (Acinonyx jubilatus) from a privately owned breeding center for endangered species was referred for evaluation with a history of vomiting and depression of 10 days' duration. After anesthetic induction with tiletamine and zolazepam and anesthetic maintenance with isoflurane, a complete diagnostic workup was performed, including hematology, serum chemistry, and radiography. The clinical diagnosis was septic suppurative inflammation and hemorrhage in the abdomen, consistent with perforation or rupture of the gastrointestinal tract. An exploratory laparotomy showed a perforated duodenal ulcer, which was resected. Subsequent endoscopy revealed no further evidence of ulceration in the upper gastrointestinal tract. Biopsy of the ulcerated tissue collected from the duodenum revealed Gastrospirillum-like organisms. Histologic examination revealed widespread infiltration of lymphocytes and plasma cells into the lamina propria and submucosa. Intraepithelial leukocytes were present along with attenuation, erosion, and ulceration of the superficial epithelium. Fourteen days after surgery, this cheetah was returned to its breeding compound, and no subsequent vomiting has been observed for 4 yr.

Gastritis caused by Aonchotheca putorii in a domestic cat.

Aonchotheca putorii is a parasitic nematode of the stomach and small intestines of many wild mammals. Although A putorii has been found in domestic cats in Iowa, it has not been reported to be pathogenic. The parasite caused severe gastric and was associated with a gastric ulcer and secondary anemia in a 10-year-old domestic shorthair cat from Ohio. The source of infection was not determined. Surgical resection of the affected tissue resolved clinical signs. The importance of postoperative administration of an anthelmintic in the resolution of any remaining A putorii is unknown. Ivermectin was given empirically to this cat. It is not known whether, or at what dosage, ivermectin or any other anthelmintic is effective against A putorii.

Gastroduodenal ulceration associated with flunixin meglumine administration in three dogs .

In 3 clinically ill dogs, signs of gastroduodenal ulceration were first noticed within 7 days of beginning flunixin meglumine administration and included pyrexia, anorexia, weight loss, vomiting, melena, pain on abdominal palpation, and abdominal distention. One dog was euthanatized and 2 dogs recovered after surgical repair of the perforated ulcers and treatment of peritonitis. Prolonged administration of flunixin meglumine should be avoided, especially in debilitated dogs or when concurrently administering other nonsteroidal anti-inflammatory drugs or corticosteroids.

Duodenal perforations and gastric ulcers in foals.

The history, clinical signs, post mortem and histopathological findings from two foals with perforating gastroduodenal ulcers and one foal with a non-perforating gastric ulcer are compared with those of other species with similar lesions. Two of the foals had several erosions in the oesophageal mucosa and the condition had been associated with strictures in the duodenum. The cause of the disease remains obscure but a possible connection with stress has been suggested.

Gastric perforation associated with administration of ibuprofen in a dog.

A 3-year-old Chow Chow was examined because of a 2-week history of vomiting and anorexia after administration of 200 mg of ibuprofen. Peritoneal effusion and free gas within the peritoneal cavity were observed on radiography of the abdomen. A full-thickness perforation of the pyloric antrum and pylorus were detected during exploratory laparotomy, and a Billroth-I gastroduodenostomy was performed successfully.

Naproxen-associated duodenal ulcer complicated by perforation and bacteria- and barium sulfate-induced peritonitis in a dog.

Signs of abdominal pain and frequent vomiting developed in a 4-year-old dog that had been given naproxen sodium for 3 weeks. The examination included an upper gastrointestinal contrast study, using barium sulfate (BaSO4). Nine hours after barium administration, a duodenal ulcer perforated, leaking duodenal contents and BaSO4 into the peritoneal cavity. The ulcer was surgically resected, and the BaSO4 was manually removed, using saline solution-soaked gauze sponges. Treatment included peritoneal drainage and lavage every 6 hours. Recovery was without complications and the dog has not had any detectable long-term effects from peritonitis induced by BaSO4.

Surgical treatment of perforating duodenal ulcer in a dog by use of modified choledochoduodenostomy and gastrojejunostomy.

Modified choledochoduodenostomy and gastrojejunostomy were used successfully to treat extensive duodenal ulceration and perforation in a dog. Concomitant pyometra, simultaneously managed by ovariohysterectomy, may have predisposed the dog to stress ulceration. Choledochoduodenostomy was performed by transplantation of the entire common bile duct and associated major duodenal papilla to a more distal duodenal location. An indwelling choledochostomy tube was used to stent the anastomotic site, externally divert bile flow, and allow postoperative cholangiography. Early postoperative complications included presumed metronidazole-induced neurotoxicosis, choledochostomy tube obstruction, and pancreatitis, all of which resolved within 2 weeks. The dog was clinically normal and medication (ranitidine and sucralfate) was discontinued 35 months later.

Suppurative splenitis and peritonitis in a horse after gastric ulceration caused by larvae of Gasterophilus intestinalis.

A 12-year-old Thoroughbred mare, with a history of anorexia, dramatic weight loss, fluctuating pyrexia and intermittent diarrhoea after an episode of colic, was presented for examination with depression, emaciation and ataxia. Thoracic and abdominal paracenteses yielded copious quantities of inflammatory exudate. Palpation per rectum revealed an enlarged spleen. The primary alterations in haematology included a severe leucocytosis with a left shift, and a hyperproteinaemia characterised by hypoalbuminaemia and hypergammaglobulinaemia. Post-mortem examination revealed a low grade pleurisy and peritonitis with fluid accumulation in both cavities. A suppurative gastritis with full thickness perforations of the stomach wall associated with Gasterophilus intestinalis larvae had extended to the juxtaposed organ initiating an extensive suppurative splenitis. Streptococcus zooepidemicus was cultured.