Pneumoperitoneum and gastric perforation in a minimally clinically affected dog

Accuracy of radiographic diagnosis of pneumoperitoneum secondary to gastrointestinal perforation in dogs and cats

BACKGROUND

Radiography is commonly included in the diagnostic investigation of animals with suspected gastrointestinal perforation and resultant pneumoperitoneum. This study aimed to (1) identify the accuracy of radiographic diagnosis of pneumoperitoneum and (2) determine if observer experience affected accuracy.

METHODS

This was a retrospective case-controlled study evaluating abdominal radiographs of dogs and cats with surgical confirmation of gastrointestinal perforation or peritonitis without pneumoperitoneum. Radiographs were reviewed by a radiologist, an imaging resident, a general practitioner and a veterinary student.

RESULTS

Radiographs from 60 dogs and eight cats were evaluated; 34 animals had confirmed perforation. Accuracy was fair to excellent for all observers: student 61.8%, general practitioner 70.6%, resident 85.3% and radiologist 83.8%. There was no significant difference in sensitivity between observers (all 70.6%-85.3%); however, there was a significant difference in specificity between both the resident (91.2%) and radiologist (91.2%) compared to the student (52.9%) (p < 0.001) and the general practitioner (55.9%) (p = 0.002). Overall, there was slight to substantial agreement between observers (κ = 0.28-0.73), with the highest being between the radiologist and resident.

CONCLUSION

Abdominal radiography, when interpreted by veterinarians with differing experience, has variable accuracy for diagnosis of pneumoperitoneum for animals in this study. Further studies are needed to determine if these results are applicable for other populations of animals with pneumoperitoneum.

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.

Primary Omental Abscessation or Omental Infarction in Four Dogs

Primary omental abscessation was diagnosed in three dogs after laparotomy. Laparotomy was performed to explore an abdominal mass of unknown origin and chronic fat necrosis diagnosed in one dog as an incidental finding during ovariohysterectomy. Primarily hypoechoic masses not connected to any abdominal structures were visualized with abdominal ultrasound in three dogs. Suppurative inflammation was diagnosed from fine-needle aspirate evaluation in two dogs. Bacteria were cultured from two abscesses despite the absence of organisms on Gram stain, cytology, and histopathology. Foreign material was found in one abscess. All four dogs experienced weight loss and/or an episode of gastrointestinal signs. Primary omental abscessation may be preceded by omental vascular compromise and/or interaction of the omentum with foreign material.

Tension Pneumoperitoneum Due to Gastric Perforation in a Cat

A 14-year-old spayed female cat weighing 2.3 kg developed tension pneumoperitoneum that progressed for 6 hr. Abdominocentesis was performed and 1.3 L of gas was aspirated after which the cat's respiratory condition improved. The next day, the cat's abdomen redistended, and laparotomy was performed. A gastric perforation was noted and sutured after the margin was resection. The cat showed a good physical condition without any gastrointestinal signs at 6 months after surgery.

Outcome of and prognostic indicators for dogs and cats with pneumoperitoneum and no history of penetrating trauma: 54 cases (1988–2002)

OBJECTIVE

To determine the outcome of and prognostic indicators for dogs and cats with pneumoperitoneum and no history of penetrating trauma.

DESIGN

Retrospective study.

ANIMALS

43 dogs and 11 cats.

PROCEDURE

Medical records of dogs and cats with radiographic evidence of pneumoperitoneum and no history of penetrating trauma were reviewed. Information collected included signalment, previous medical problems, initial complaint, duration of illness, physical examination findings, radiographic findings, laboratory abnormalities, abdominocentesis results, bacterial culture results, concurrent diseases, hospitalization time, and outcome. Abdominal radiographs were reviewed, and radiographic severity of pneumoperitoneum was classified. For those animals that underwent exploratory laparotomy, time from admission to surgery and results of histologic examination of biopsy specimens were recorded.

RESULTS

24 (44%) animals survived and were discharged from the hospital, but none of the variables examined was associated with whether animals survived. Rupture of the gastrointestinal tract was the cause of pneumoperitoneum in 40 animals. However, cause and location of gastrointestinal tract rupture was not associated with whether animals survived. Twenty-three of 40 (58%) animals that underwent exploratory laparotomy survived, compared with only 1 of 14 animals that did not undergo surgery.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggest that pneumoperitoneum in dogs and cats without any history of penetrating trauma is most commonly associated with rupture of the gastrointestinal tract and requires immediate surgical intervention. Even when appropriate treatment is instituted, the shortterm prognosis is only fair.

Ultrasonographic findings in dogs and cats with gastrointestinal perforation

A retrospective study was performed to evaluate the sonographic features of gastrointestinal (GI) perforation in dogs and cats. Sonographic findings in 19 animals (14 dogs and 5 cats) included regional bright mesenteric fat (19), peritoneal effusion (16), fluid-filled stomach or intestines (12), GI wall thickening (11), presence of free air (9), loss of GI wall layering (9), regional lymphadenopathy (8), reduced GI motility (7), pancreatic changes (4), corrugated intestines (4), presence of a mass (3), presence of a foreign body (3), and mineralization of the gastric wall (1). In 14 patients, "perforation" was listed as a differential diagnosis by the sonographer. Abdominal radiographs and radiographic reports were available for 14 patients. Radiographic findings were decreased serosal detail (12), free air (8), peritoneal contrast medium (1), and suspected foreign body (1). GI perforation was listed as radiographic diagnosis in eight patients, seven of which had evidence of pneumoperitoneum, and one had leakage of contrast material on an upper GI study. In 9/14 patients with radiography, "GI perforation" was listed as a sonographic diagnosis. In three patients in which free air was diagnosed sonographically, radiographs were either not available (2) or the presence of free air was not detected at presentation (1). Peritoneal fluid analysis was performed in nine patients, five of which were identified as septic inflammation, and the remaining four were classified as neutrophilic inflammation with no etiologic agent identified. The histologic or surgical diagnoses were as follows: three intestinal surgical dehiscence; one percutaneous endoscopic gastrostomy tube site leakage; one duodenal adenocarcinoma; one ileocolic lymphoma; one trichobezoar; one ascarid impaction; and one bobby pin foreign body. In the remaining 10 patients, a focal area of gastric/intestinal ulceration or transmural necrosis with perforation was identified without evidence of an underlying cause.

Pneumoperitoneum in dogs and cats: 39 cases (1983-2002)

OBJECTIVE

To identify the most common causes of pneumoperitoneum in dogs and cats and determine history, clinical features, and outcome of affected animals.

DESIGN

Retrospective study.

ANIMALS

31 dogs and 8 cats.

PROCEDURES

Medical records were reviewed for signalment; history; abnormal physical, clinicopathologic, and radiographic findings; results of cytologic analysis and bacterial culture of abdominal fluid; gross and histologic findings at surgery or necropsy; and outcome.

RESULTS

Pneumoperitoneum was classified as spontaneous in 25 animals and traumatic in 14. Causes of traumatic pneumoperitoneum included vehicular impact, gunshot wounds, abdominal dog bite wounds, and iatrogenic pneumothorax. Spontaneous pneumoperitoneum was caused by gastrointestinal tract perforation in 23 animals; underlying causes included neoplasia, nonsteroidal anti-inflammatory drug administration, and corticosteroid administration. Two animals developed spontaneous pneumoperitoneum after bladder rupture. Animals with spontaneous pneumoperitoneum were significantly older and had clinical signs of longer duration than those with traumatic pneumoperitoneum. Sixteen animals survived, including 15 of 23 animals that underwent surgery. Animals that survived had significantly higher serum albumin concentrations than did animals that died or were euthanatized.

CONCLUSIONS AND CLINICAL RELEVANCE

Although pneumoperitoneum is most often attributable to perforation of a hollow viscus, other causes do exist. Early exploration is recommended for diagnosis and treatment of the underlying condition.

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.

Spontaneous pneumoperitoneum in two cats

Spontaneous pneumoperitoneum is an infrequently observed presentation in cats. This report details two cases of pneumoperitoneum in the cat. The first case was suspected to have been caused by a gastric perforation secondary to gastric lymphoma. The second case was caused by a perforated gastric ulcer in a cat that had been recently treated with corticosteroids and a non-steroidal anti-inflammatory drug.