Successful treatment of a pancreatic pseudocyst by omentalisation in a dog

The Omentum-A Forgotten Structure in Veterinary Surgery in Small Animals' Surgery

The greater and lesser omentum are derived from embryonic mesogastrium. The expansive greater omentum in dogs covers intestinal coils, while in cats, it is smaller. Comprising distinct portions, the greater omentum is rich in lymphatics and blood vessels. Conversely, the lesser omentum spans the liver, stomach, and duodenum. Studies on canine omentum reveal unique immune cell composition and regenerative potential attributed to adipose tissue-derived stromal cells (ADSCs). These cells hold promise in regenerative medicine, showing enhanced abilities compared with ADSCs from other sources. The omentum is critical in tissue repair and pathology, making it invaluable in veterinary surgery across various medical fields. The aim of this article was to research current knowledge about the applications of the omentum in veterinary surgery and the possibilities of using this structure in the future.

Left pancreaticoduodenostomy after removal of the right lobe and the head of the pancreas in a cat

OBJECTIVE

To report a surgical technique for pancreaticoduodenostomy and its outcomes in a cat.

ANIMALS

A 14-year-old domestic cat.

STUDY DESIGN

Case report.

METHODS

A cat was referred to our hospital with a large abdominal mass. On ultrasonographic examination, this mass was identified as a large fluid-filled cavity in place of the right pancreatic duct and involved the pancreatic and accessory pancreatic ducts. A small echoic cavity was observed in the left pancreatic lobe. Serous fluid was collected from the large cavity. On cytology, the small cavity was consistent with an abscess. A partial left pancreatectomy was performed to remove the abscess. The large cavity was excised with the remnant of the right pancreatic lobe and body. After ligation of the pancreatic ducts, the left pancreatic duct was isolated and an end-to-side pancreaticoduodenostomy was performed.

RESULTS

The cat recovered without complications. Histological examination was consistent with chronic pancreatitis and peripheral inflammation. No evidence of postoperative pancreatic insufficiency was detected on clinical examination or laboratory findings. A focal ampulla-like dilation of the pancreatic duct was noted on ultrasonography, with no other complications at the anastomosis. The cat presented 225 days postoperatively with respiratory distress. Multiple nodules were identified throughout the lung parenchyma on radiographs. Abnormalities on ultrasonographic examination included an enlarged liver infiltrated with nodules. Due to poor prognosis, the cat was euthanized. Final histopathological diagnosis was diffuse carcinoma.

CONCLUSION

Pancreaticoduodenostomy restored pancreaticointestinal continuity after extensive pancreatectomy involving the pancreatic ducts and resulted in long-term survival in the cat reported here.

Gastrointestinal Intramural Pancreatic Pseudocysts in a Dog: A Case Report and Human Literature Review

A 9.5 yr old Yorkshire terrier presented with chronic intermittent vomiting and lethargy of 1.5 yr duration that progressed to generalized weakness. Insulin:glucose ratio was consistent with an insulinoma. Triple-phase computed tomography revealed a mid-body pancreatic nodule. The mid-body pancreatic nodule was enucleated; histopathology was consistent with an insulinoma. Two weeks after the operation, the dog presented for anorexia and diarrhea. Abdominal ultrasound revealed a thick-walled cystic lesion along the dorsal stomach wall. An intramural gastric pseudocyst was diagnosed via exploratory laparotomy and intraoperative gastroscopy. Comparison of amylase and lipase levels of the cystic fluid with that of concurrent blood serum samples confirmed the lesion was of pancreatic pseudocyst origin. The gastric pseudocyst was omentalized. Two weeks after the operation, the dog re-presented for anorexia, regurgitation, and diarrhea. An intramural duodenal pseudocyst was identified and treated with a duodenal resection and anastomosis. The dog has remained asymptomatic and recurrence free based on serial abdominal ultrasounds 22 mo following insulinoma removal. To our knowledge, this phenomenon of pancreatic pseudocysts forming in organs other than the pancreas has not been reported in dogs. This case report and comprehensive human literature review purpose is to raise awareness of this disease process in dogs.

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.

Treatment for pancreatic abscesses via omentalization with abdominal closure versus open peritoneal drainage in dogs: 15 cases (1994–2004)

OBJECTIVE

To compare survival rate, duration of hospitalization, and complications in dogs with pancreatic abscesses treated with omentalization with abdominal closure versus open peritoneal drainage and evaluate a pancreatitis severity score for potential prognostic value.

DESIGN

Retrospective case series.

ANIMALS

15 dogs with pancreatic abscesses.

PROCEDURE

Data regarding species, breed, age, initial clinical signs, CBC, serum biochemical abnormalities, pancreatitis severity score, anatomic location of the abscess, intraoperative bacteriologic culture results, treatment modality, postoperative complications, outcome (dismissed alive from the hospital, died in the postoperative period, or euthanized at surgery), and duration of hospitalization were evaluated.

RESULTS

6 dogs survived, 6 dogs died or were euthanized after surgery, and 3 were euthanized during surgery. Five of 8 dogs treated with omentalization and abdominal closure survived, and 1 of 4 dogs treated with open peritoneal drainage survived. In several dogs, treatment required additional surgical procedures, which did not appear to affect outcome. Postoperative complications were similar among survivors and nonsurvivors. Mean duration of hospitalization for dogs treated with omentalization and abdominal closure was less than that of dogs treated with open peritoneal drainage. Neither pancreatitis severity score nor any individual components of the score were associated with outcome.

CONCLUSIONS AND CLINICAL RELEVANCE

Omentalization is a viable treatment option for pancreatic abscess in dogs. Furthermore, shorter hospitalization and better survival outcomes may make omentalization preferred over open peritoneal drainage.