Case Report
Journal of Veterinary Emergency and Critical Care 24(6) 2014, pp 745–750 doi: 10.1111/vec.12249
Heterotopic gastric mucosa associated with abdominal abscess formation, hypotension, and acute abdominal pain in a puppy Bridget N. Tobleman, DVM and Virginia B. Sinnott, DVM, DACVECC
Abstract
Objective – To describe the presence of heterotopic gastric mucosa forming an abscess associated with acute abdominal pain and shock in a puppy. Case Summary – A 7-month-old male intact Shih-Tzu was presented to the emergency service for evaluation of a 12-hour history of vomiting and lethargy progressing to weakness. On presentation, the puppy was obtunded and hypotensive. Radiographs revealed an ill-defined mid-ventral abdominal mass. Ultrasound revealed an echogenic, fluid-filled mass associated with the jejunum. The puppy had an exploratory celiotomy and a 2 × 4 cm oval fluid-filled soft tissue mass was found to be intimately associated, but not communicating with, a section of the mid-jejunum. The mass and associated jejunum were removed via enterectomy. Histopathology of the resected mass revealed heterotopic gastric mucosa; bacterial culture of the fluid contained in the mass revealed heavy growth of Escherichia coli. The puppy recovered from surgery, was discharged from the hospital, and has had no further complications from this episode. Unique Information Provided – Heterotopic gastric mucosa is commonly found incidentally on necropsy. When it has been associated with acute gastrointestinal signs, mechanical intestinal obstruction with or without perforation was noted. To the authors’ knowledge, this is the first reported case of heterotopic gastric mucosa leading to abscess formation and acute abdominal pain in the dog. (J Vet Emerg Crit Care 2014; 24(6): 745–750) doi: 10.1111/vec.12249 Keywords: acute abdomen, congenital, heterotopic
Introduction Acute abdominal pain (acute abdomen) is a common presenting complaint in veterinary emergency practice, and determining whether the underlying cause is best managed medically or surgically concomitant with the resuscitation of an oftentimes hemodynamically unstable animal can be challenging. Common medically managed etiologies of acute abdomen include pancreatitis, dietary indiscretion, and viral enteritis. Surgically managed causes of acute abdomen commonly encountered include gastrointestinal foreign body obstruction, rupture of the gastrointestinal tract, and torsion or volvulus of abdominal organs. Of the numerous possible differentials for acute abdomen, congenital causes are rare.
From Cape Cod Veterinary Specialists, Bourne, MA 02532. The authors declare no conflict of interests. Address correspondence and reprint requests to Dr. Bridget Tobleman, Cape Cod Veterinary Specialists, 11 Old Bourne Bridge Approach, Bourne, MA 02532, USA. Email: [email protected] Submitted November 06, 2012; Accepted September 29, 2014.
C Veterinary Emergency and Critical Care Society 2014
Abbreviations
aPTT activated partial thromboplastin time CRI constant rate infusion CVP central venous pressure
Heterotopic gastric mucosa is defined as the presence of tissue histologically identical to gastric mucosa in areas of the gastrointestinal tract other than the stomach. It has been previously reported as an incidental finding in 4.1% of 365 research Beagles necropsied as part of a toxicology study.1 Although it is not believed to frequently be associated with pathology, it has previously been found associated with cases of intestinal neoplasia, obstruction, and septic peritonitis secondary to diverticular rupture.2,3 This report documents a case of surgically managed acute abdomen in a young dog secondary to abscess formation within a closed diverticulum of heterotopic gastric mucosa.
745
B. N. Tobleman & V. B. Sinnott
Case Summary A 6 kg, 7-month-old male intact Shih-Tzu was referred to a private practice emergency and specialty hospital for a 12-hour history of anorexia and vomiting. The puppy had vomited approximately 15–18 times with increasing frequency throughout the day. On physical examination, the puppy was obtunded, laterally recumbent, had tacky mucous membranes, and decreased skin turgor. Rectal temperature was 38.1°C (100.6°F), heart rate was 126/min with no auscultable murmur, and respiratory rate was 24/min with normal lung sounds. Mucous membranes were injected with a normal capillary refill time and dorsal metatarsal pulses were hyperkinetic. The puppy splinted with abdominal palpation and was assessed as painful. No masses or foreign material were suspected on palpation. At initial presentation, a Doppler blood pressure was obtained using the dorsal metatarsal artery and was 55 mm Hg (reference interval 80–120 mm Hg).4 An IV catheter was placed in the cephalic vein and a total of 30 mL/kg of lactated Ringer’s solution was administered as a bolus after which the puppy was alert, able to stand, and interactive. The Doppler blood pressure had also improved to 124 mm Hg. The puppy’s PCV prior to administration of IV fluids was 0.42 L/L (42%) with an associated total plasma protein of 72 g/L (7.2 g/dL). A plasma lactate performed on the same sample was 1.4 mmol/L (reference range
Journal of Veterinary Emergency and Critical Care 24(6) 2014, pp 745–750 doi: 10.1111/vec.12249
Heterotopic gastric mucosa associated with abdominal abscess formation, hypotension, and acute abdominal pain in a puppy Bridget N. Tobleman, DVM and Virginia B. Sinnott, DVM, DACVECC
Abstract
Objective – To describe the presence of heterotopic gastric mucosa forming an abscess associated with acute abdominal pain and shock in a puppy. Case Summary – A 7-month-old male intact Shih-Tzu was presented to the emergency service for evaluation of a 12-hour history of vomiting and lethargy progressing to weakness. On presentation, the puppy was obtunded and hypotensive. Radiographs revealed an ill-defined mid-ventral abdominal mass. Ultrasound revealed an echogenic, fluid-filled mass associated with the jejunum. The puppy had an exploratory celiotomy and a 2 × 4 cm oval fluid-filled soft tissue mass was found to be intimately associated, but not communicating with, a section of the mid-jejunum. The mass and associated jejunum were removed via enterectomy. Histopathology of the resected mass revealed heterotopic gastric mucosa; bacterial culture of the fluid contained in the mass revealed heavy growth of Escherichia coli. The puppy recovered from surgery, was discharged from the hospital, and has had no further complications from this episode. Unique Information Provided – Heterotopic gastric mucosa is commonly found incidentally on necropsy. When it has been associated with acute gastrointestinal signs, mechanical intestinal obstruction with or without perforation was noted. To the authors’ knowledge, this is the first reported case of heterotopic gastric mucosa leading to abscess formation and acute abdominal pain in the dog. (J Vet Emerg Crit Care 2014; 24(6): 745–750) doi: 10.1111/vec.12249 Keywords: acute abdomen, congenital, heterotopic
Introduction Acute abdominal pain (acute abdomen) is a common presenting complaint in veterinary emergency practice, and determining whether the underlying cause is best managed medically or surgically concomitant with the resuscitation of an oftentimes hemodynamically unstable animal can be challenging. Common medically managed etiologies of acute abdomen include pancreatitis, dietary indiscretion, and viral enteritis. Surgically managed causes of acute abdomen commonly encountered include gastrointestinal foreign body obstruction, rupture of the gastrointestinal tract, and torsion or volvulus of abdominal organs. Of the numerous possible differentials for acute abdomen, congenital causes are rare.
From Cape Cod Veterinary Specialists, Bourne, MA 02532. The authors declare no conflict of interests. Address correspondence and reprint requests to Dr. Bridget Tobleman, Cape Cod Veterinary Specialists, 11 Old Bourne Bridge Approach, Bourne, MA 02532, USA. Email: [email protected] Submitted November 06, 2012; Accepted September 29, 2014.
C Veterinary Emergency and Critical Care Society 2014
Abbreviations
aPTT activated partial thromboplastin time CRI constant rate infusion CVP central venous pressure
Heterotopic gastric mucosa is defined as the presence of tissue histologically identical to gastric mucosa in areas of the gastrointestinal tract other than the stomach. It has been previously reported as an incidental finding in 4.1% of 365 research Beagles necropsied as part of a toxicology study.1 Although it is not believed to frequently be associated with pathology, it has previously been found associated with cases of intestinal neoplasia, obstruction, and septic peritonitis secondary to diverticular rupture.2,3 This report documents a case of surgically managed acute abdomen in a young dog secondary to abscess formation within a closed diverticulum of heterotopic gastric mucosa.
745
B. N. Tobleman & V. B. Sinnott
Case Summary A 6 kg, 7-month-old male intact Shih-Tzu was referred to a private practice emergency and specialty hospital for a 12-hour history of anorexia and vomiting. The puppy had vomited approximately 15–18 times with increasing frequency throughout the day. On physical examination, the puppy was obtunded, laterally recumbent, had tacky mucous membranes, and decreased skin turgor. Rectal temperature was 38.1°C (100.6°F), heart rate was 126/min with no auscultable murmur, and respiratory rate was 24/min with normal lung sounds. Mucous membranes were injected with a normal capillary refill time and dorsal metatarsal pulses were hyperkinetic. The puppy splinted with abdominal palpation and was assessed as painful. No masses or foreign material were suspected on palpation. At initial presentation, a Doppler blood pressure was obtained using the dorsal metatarsal artery and was 55 mm Hg (reference interval 80–120 mm Hg).4 An IV catheter was placed in the cephalic vein and a total of 30 mL/kg of lactated Ringer’s solution was administered as a bolus after which the puppy was alert, able to stand, and interactive. The Doppler blood pressure had also improved to 124 mm Hg. The puppy’s PCV prior to administration of IV fluids was 0.42 L/L (42%) with an associated total plasma protein of 72 g/L (7.2 g/dL). A plasma lactate performed on the same sample was 1.4 mmol/L (reference range
