Pneumatosis in Canine Gastric Dilatation-Volvulus Syndrome

Radiographic findings in dogs with 360 degrees gastric dilatation and volvulus

Gastric dilatation and volvulus (GDV) is a life-threatening emergency that requires urgent intervention. Radiographic features associated with 360-GDV in dogs have not been investigated. The aim of this retrospective observational study is to describe radiographic features and clinical variables in dogs affected with 360-GDV and to report agreement rates between different radiologists. We also report the sensitivity and specificity of radiographs to diagnose 360-GDV in dogs. Confirmed 360-GDV cases were retrieved, and the radiographic findings were compared with dogs presenting with gastric dilatation (GD) and 180-GDV. Images were reviewed and graded by three blinded board-certified radiologists. A total of 16 dogs with confirmed 360-GDV were identified. The median age was 10 years old (2-13 years). The sensitivity for detection of 360-GDV ranged between 43.7% and 50%, and the specificity between 84.6% and 92.1%. Interobserver agreement on final diagnosis was substantial (Kappa = 0.623; 0.487-0.760, 95% CI). The highest agreement rate was in cases of 180-GDV (87%), followed by the GD cases (72%) and 360-GDV (46%). Severe esophageal distension and absence of small intestinal dilation were the only radiographic features specifically associated with 360-GDV. A similar pyloric position was found between GD and 360-GDV. Additional radiographic variables that could help differentiate GD from 360-GDV include the degree of gastric distension and the peritoneal serosal contrast. Two cases with 360-GDV were misdiagnosed by the three radiologists as GD. In conclusion, radiographically, 360-GDV cases can reassemble GD and vice versa. Radiologists and clinicians should be aware of the low sensitivity of radiographs for the detection of 360-GDV.

Clinical features and outcome of dogs and cats with gastrointestinal pneumatosis: 30 cases (2010-2021)

OBJECTIVES

To describe the presentation, etiology, and outcome of dogs and cats diagnosed with gastrointestinal pneumatosis (GP).

DESIGN

Retrospective study.

SETTING

Three referral institutions.

ANIMALS

Twenty-six dogs and 4 cats.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

The most common sites of GP were the stomach (n = 19), followed by the colon (n = 8) and small intestine (n = 2). One case had pneumatosis of both the stomach and the colon. GP was most commonly associated with gastrointestinal disease in dogs (18/26 [69%]) and cats (3/4 [75%]), with common diagnoses including gastric dilatation and volvulus (n = 5), acute hemorrhagic diarrhea syndrome (n = 4), and gastrointestinal ulceration (n = 4). Of the 4 cases of gastrointestinal ulceration, 3 were dogs with a history of glucocorticosteroid or nonsteroidal anti-inflammatory drug administration and vomiting and diarrhea. Six of 30 cases (20%), all of which were dogs, were determined to have a surgical indication for exploratory celiotomy, although not solely on the basis of diagnosis of GP. Five cases underwent exploratory celiotomy, of which 1 (20%) survived to hospital discharge. Of the medically managed cases, 13 of 24 (54%) survived to hospital discharge. Overall, 14 of 30 cases (47%) survived to hospital discharge.

CONCLUSIONS

GP is an uncommon diagnostic imaging finding that is associated with a variety of disease processes. Its development is often related to primary gastrointestinal diseases. In the absence of other surgical disease, exploratory celiotomy based solely on the diagnosis of GP is unlikely to be indicated.

Feline Emphysematous Gastritis in a Cat with Pancreatitis and Secondary Hepatic Lipidosis

A 7 yr old female neutered domestic shorthair was presented with a 2 mo history of lethargy and hyporexia progressing to anorexia. Initial diagnostics indicated pancreatitis with secondary hepatic lipidosis. Supportive care, including the placement of an esophageal feeding tube, was initiated. The feeding tube was removed traumatically by the cat and thus replaced. The cat acutely deteriorated while hospitalized, developing marked hypersalivation and an obtunded mentation. Radiographs were taken to confirm placement of the feeding tube in case tube dislodgement was contributing to the hypersalivation; results confirmed appropriate positioning and gastric pneumatosis. Despite intensified medical management, the patient suffered cardiopulmonary arrest 7 days after hospital admission. Post-mortem examination confirmed necrotizing gastritis with emphysema alongside segmental mucosal necrosis in the jejunum, focal pancreatic necrosis, and diffuse hepatic lipidosis. Gas in the gastric wall is a rare finding in veterinary medicine and can arise due to gastric pneumatosis or emphysematous gastritis; there are scant reports of either in feline medicine. This report documents a case of emphysematous gastritis in a cat with concurrent pancreatitis and hepatic lipidosis. The cat developed emphysematous gastritis without undergoing gastrointestinal surgery which is currently the only reported feline predis-posing factor for development.

Diagnostic utility of abdominal ultrasound for detecting non-perforated gastroduodenal ulcers in dogs

BACKGROUND

Abdominal ultrasound is frequently used to detect non-perforated gastroduodenal ulcers in dogs. Studies assessing the diagnostic utility of abdominal ultrasound for the detection of non-perforated gastroduodenal ulcers have yielded mixed results. No studies to date have investigated the effects of patient bodyweight, breed, sex, age, ulcer aetiology (neoplastic or inflammatory) or location on the diagnostic accuracy of abdominal ultrasound.

METHODS

Retrospective, multicentre study to evaluate the diagnostic utility of abdominal ultrasonography for the diagnosis of non-perforated gastroduodenal ulceration in dogs.

RESULTS

Sixty-one dogs met the inclusion criteria. Ulcers were detected during ultrasound examination in 18 of 61 dogs, yielding a sensitivity of 29.5% (95% confidence interval 18.8%-42.7%). Ulcers in the pyloric region were detected more frequently than those in the duodenum; however, location was not significantly associated with the ability of ultrasound to detect lesions (p = 0.41). No associations were identified between the ability of ultrasound to detect an ulcer and patient bodyweight (p = 0.45), breed (p = 0.98), sex (p = 0.90), age (p = 0.94), and neoplastic versus inflammatory nature of ulcerative lesions (p = 0.93).

CONCLUSION

The diagnostic utility of ultrasound as the sole modality for the detection of non-perforated gastroduodenal mucosal ulceration is poor. The authors therefore recommend the use of additional modalities when ulcerative lesions are suspected.

CT findings in five dogs with surgically confirmed colonic torsion

Colonic torsion is a life-threatening condition that results in colonic ischemia, necrosis, perforation, sepsis, and eventual death. The aim of this multicenter, retrospective case series study was to describe the CT findings in dogs with surgically confirmed colonic torsion. Medical records were searched for dogs with surgically confirmed colonic torsion following abdominal CT. Five dogs met the inclusion criteria. Three had a history of chronic intermittent diarrhea prior to presentation. Two dogs presented with acute vomiting, diarrhea, and abdominal pain and one dog presented with acute vomiting and lethargy. Computed tomographic findings in all dogs with surgically confirmed colonic torsion include: "whirl sign," displacement and distension of the cecum and colon, focal narrowing of the colon, and distension of the mesenteric vasculature in all dogs (5/5); streaky peritoneal fat and peritoneal effusion (4/5), pneumatosis coli (2/5), small intestinal distension (2/5), portal vein thrombosis (1/5), and reduced colonic wall contrast enhancement (1/5). In all dogs (5/5), the torsion site was the descending colon and demonstrated an anticlockwise rotation. At surgery, three of the five dogs had a partial colonic torsion with hyperemia at the site of obstruction and two of the five dogs had a complete torsion with marked necrosis of the colonic wall. Displacement of the colon and cecum, segmental distension and focal narrowing of the colon, the presence of a "whirl sign" and distension of the mesenteric vasculature are CT findings highly suggestive of colonic torsion.

Assessment of the Prevalence of Gastric “Gravel Sign” in Dogs with Acute Gastric Dilatation-Volvulus

Radiological examination of gastric “gravel sign” was retrospectively conducted in 60 dogs presented with acute gastric dilatation-volvulus (GDV) syndrome. Other radiographic findings including loss of peritoneal serosal detail, presence of radiopaque foreign bodies, gastric pneumatosis, splenomegaly, and megaesophagus, were also examined in these patients. “Gravel sign” was detected on the pre-operative radiographs of 17 dogs with acute GDV (28.3%), suggesting that these patients could be suffering from chronic partial gastric obstruction before examination. German Shepherd dogs were significantly over-represented in this group (10/17, 58.8%). Dogs with acute GDV showing “gravel sign” should be carefully investigated for the presence of underlying gastrointestinal processes that might be associated with chronic partial obstruction.

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.

Pneumatosis of the intestines, colon and liver in a young cat

To describe a case of naturally occurring pneumatosis intestinalis, pneumatosis coli and emphysematous hepatitis in a cat. A 9-month-old, indoors-only, female spayed, domestic medium hair cat presented for vomiting, open-mouth breathing and acute collapse. The initial physical examination identified moderate to severe hypothermia [35°C (95°F)], obtunded mentation, weak femoral pulses, tachycardia (heart rate 240 beats per min), pale pink mucous membranes and significant splenomegaly on abdominal palpation. Immediate diagnostics performed [packed cell volume and total solids (PCV, TS), venous blood gas and electrolytes] revealed severe anaemia (PCV 12%), hypoproteinaemia (TS = 2.2 g/dl), and severe metabolic acidosis (pH 6.956). Additional diagnostics performed included Feline Leukaemia Virus and Feline Immunodeficiency Virus testing (FeLV/FIV), complete blood count (CBC) with pathology review, serum biochemistry profile, prothrombin time (PT) and partial thromboplastin time (PTT), urinalysis, and abdominal radiographs. Abdominal radiographs were consistent with gas within hepatic and splenic veins and parenchyma, small intestinal walls and colonic wall. Due to the guarded prognosis, euthanasia was elected. Necropsy was performed and the most significant gross and histopathological findings included intra-luminal and intra-mural intestinal haemorrhage and vascular congestion with mild neutrophilic hepatitis, and marked hepatic periportal emphysema. Clostridium perfrigens and Escherichia coli were cultured from the bowel wall; no bacterial growth from the liver or spleen was identified. This case report describes idiopathic emphysematous hepatitis, with concurrent emphysema of the spleen and intestinal wall and intestinal haemorrhage. To the authors' knowledge, this type of pathology in a feline patient has not been previously described.

Cardiovascular and systemic effects of gastric dilatation and volvulus in dogs

Gastric dilatation and volvulus (GDV) is a common emergency condition in large and giant breed dogs that is associated with high morbidity and mortality. Dogs with GDV classically fulfill the criteria for the systemic inflammatory response syndrome (SIRS) and can go on to develop multiple organ dysfunction syndrome (MODS). Previously reported organ dysfunctions in dogs with GDV include cardiovascular, respiratory, gastrointestinal, coagulation and renal dysfunction. Cardiovascular manifestations of GDV include shock, cardiac arrhythmias and myocardial dysfunction. Respiratory dysfunction is also multifactorial, with contributory factors including decreased respiratory excursion due to gastric dilatation, decreased pulmonary perfusion and aspiration pneumonia. Gastrointestinal dysfunction includes gastric necrosis and post-operative gastrointestinal upset such as regurgitation, vomiting, and ileus. Coagulation dysfunction is another common feature of MODS in dogs with GDV. Disseminated intravascular coagulation can occur, putting them at risk of complications associated with thrombosis in the early hypercoagulable state and hemorrhage in the subsequent hypocoagulable state. Acute kidney injury, acid-base and electrolyte disturbances are also reported in dogs with GDV. Understanding the potential for systemic effects of GDV allows the clinician to monitor patients astutely and detect such complications early, facilitating early intervention to maximize the chance of successful management.

Gastric Dilatation-Volvulus in a Guinea Pig (Cavia porcellus)

A 3-year-old, intact female guinea pig (Cavia porcellus) was presented for anorexia and abdominal distention of 24 hours’ duration. Radiographs revealed a severely distended stomach, suggestive of severe gastric dilatation or gastric dilatation-volvulus (GDV). Exploratory surgery was recommended, but the owners elected euthanasia. On necropsy, the guinea pig was found to have GDV. No underlying conditions were identified that could have predisposed this guinea pig to the development of GDV.

A Retrospective Study of Factors Influencing Survival Following Surgery for Gastric Dilatation-Volvulus Syndrome in 306 Dogs

Gastric dilatation-volvulus (GDV) is a life-threatening condition in dogs that has been associated with high mortality rates in previous studies. Factors were evaluated in this study for their influence on overall and postoperative mortality in 306 confirmed cases of GDV between 2000 and 2004. The overall mortality rate was 10%, and the postoperative mortality rate was 6.1%. The factor that was associated with a significant increase in overall mortality was the presence of preoperative cardiac arrhythmias. Factors that were associated with a significant increase in postoperative mortality were postoperative cardiac arrhythmias, splenectomy, or splenectomy with partial gastric resection. The factor that was associated with a significant decrease in the overall mortality rate was time from presentation to surgery. This study documents that certain factors continue to affect the overall and postoperative mortality rates associated with GDV, but these mortality rates have decreased compared to previously reported rates.

Pneumatosis coli in a dog

A 17-year-old, castrated male Maltese was presented with chronic polyphagia and a 2-week history of tenesmus, diarrhea, hematochezia, weight loss, and ribbon-like feces. Pneumatosis coli was diagnosed by abdominal radiography. Concurrent hyperadrenocorticism was suspected. The clinical signs of colorectal disease resolved within 2 days of initiating a lowresidue diet and oral metronidazole. Pneumatosis coli should be considered as a differential diagnosis for colorectal disease in dogs.