Re: Dog with pyloric tumour/stenosis

Rajat — Fri, 03 Aug 2012 13:53:59 GMT

I think there would need to be a larger mass to cause a functional obstructio than 1 cm..and prokinetics may help to prevent accumulation of ingesta and gas. Sounds like the dog is bloating now that it has had a pexy and management may be better focused at that cf at an obstruction..also sounds like you've removed the mass now so should no longer obstruct? Just my guess..

Re: Dog with pyloric tumour/stenosis

Martin Atkinson — Fri, 03 Aug 2012 11:05:46 GMT

[quote user="Rajat"]If it continues bloating then prokinetics, simethicone, and splitting meals using moist food etc may be the way to go.[/quote] Is a prokinetic a good idea in a patient with a functional obstruction and extreme peristaltic waves or should we be using a relaxant?

Re: Dog with pyloric tumour/stenosis

Rajat — Thu, 02 Aug 2012 21:00:33 GMT

[quote user="Martin Atkinson"]

Hoping not to start a row like my bunny eye thread did: I have a old GSD with too many problems to shake a stick at: but on top of many woes the bottom line is that it bloated a couple of months ago and we assumed it had a partial GDV even though it was vomiting productively. I couldn't pass a stomach tube under GA in lateral recumbancy but as we rolled it onto its back the tube passed into the stomach and it belched forth much gas and a bucket full of fluid. The stomach was in an anatomically normal position (spleen already removed due to one of its other problems) and I considerd that it had righted itself with rolling (a la cow with displaced abomasum) but I performed a belt-loop gastropexy anyway. Dog recovered for 2 months then presented the same with the same response to tubing. On ex. lap this time I examined every last inch of its gut and found a small mass at the pylorus. Dissecting into this revealed a 1cm diameter fibrous mass which I debulked in an excison biopsy and left the muscularis unsutured as you would (at least in my day) for a standard pyloric stenosis op. Histology (sent to Axion therefore Finn) was equivocal might be leiomyoma or just fibrous tissue. Dog has recovered the same as before. It would appear in hindsight this this was the original problem not a GDV. Another thing I noted on ex lap was the strength of the peristaltic waves even with pre-op buscopan were much stronger than anything I've observed previously.

So questions now are: if this was a pyloric tumour/stenosis, why did it recover the first time with no specific surgery and if there seems no option how successful is surgery to remove the whole pyloric sphincter and would anyone attempt it in the first place.

[/quote]

Funny, I have a case on the go with a pyloric mass am waiting for histology at the moment. 8 y.o Shih tzu with generalised ileus not bloating tho!

I think this is prob the wrong breed for pyloric hypertrophy also wrong age, the mass is prob incidental, and a Bilroth procedure (removal of part of the stomach - pyloric region, and hooking it upto Duodenum) is not warranted. Pretty major surgery which the old GSD may not recover from...

If it continues bloating then prokinetics, simethicone, and splitting meals using moist food etc may be the way to go.

Re: Dog with pyloric tumour/stenosis

Hannah Wynne Richards — Thu, 02 Aug 2012 13:33:09 GMT

You've more courage than I have My options to the owner would be refer or liquid diet and euthanasia if that doesn't work Cross ref to Malcolm's thread on bungled 1st opinion ops

Wynne