A 2-month-old female French Bulldog presented just days after adoption, experiencing persistent vomiting following administration of a liquid wormer. An initial veterinary examination was unremarkable, and metoclopramide was prescribed. However, vomiting persisted, and she was admitted to our hospital the following day dehydrated and in poor body condition.
Diagnostic Findings
- Radiographs: Evidence of a fluid-distended stomach, raising concern for gastric outflow obstruction. A foreign body was initially suspected.
- Blood Tests: Moderate dehydration, severe hypokalemia, mild hypochloremia, and hyponatremia; normal WBC count; mild SDMA elevation.
The puppy was initially started on Hartmann’s solution, but due to significant metabolic alkalosis, the specialist team transitioned to 0.9% saline for its acidifying effects and higher sodium content. Potassium chloride was added for supplementation. She was also given IV maropitant and esomeprazole. Given the radiographic findings, further imaging was recommended. Due to the risk of regurgitation and concern for pyloric outflow obstruction, general anesthesia (GA) was advised for a CT scan, as the stomach contained a significant volume of material.
CT Scan and Gastroscopy
CT imaging revealed abnormalities in the pyloric region, suggestive of a hyperplastic polyp and pyloric wall thickening, raising suspicion for either gastritis or pyloric stenosis. Gastroscopy was performed in left lateral recumbency after manual gastric emptying. Examination revealed a prominent pylorus with a large fold of hyperplastic tissue at the entrance, while the duodenum appeared grossly normal. No foreign body was found.
The procedure was aborted due to significant hypotension and concern for fluid in the endotracheal (ET) tube.
Differential Diagnosis
- Congenital pyloric stenosis
- Gastric polyp formation
- Gastritis
- Gastric neoplasia
Management
A prokinetic was avoided due to concerns about functional outflow obstruction. While anti-emetics were considered less effective, maropitant was continued for patient comfort. The puppy was offered a liquid diet to assess whether it could pass through the digestive tract, but this was unsuccessful. Two days later, the surgical team reviewed the case.
Surgical Intervention
Given the severity, rarity, and small patient size, the prognosis was guarded. However, as the puppy was unable to retain food and continued losing weight, surgery was deemed the best option. Humane euthanasia was discussed as an alternative.
Potential complications included:
- Surgical site leakage (leading to septic peritonitis)
- Aspiration pneumonia
- Ileus
- Persistent gastric motility issues
Procedure
A Y-incision gastrotomy was performed over the pylorus, with a Poole suction sleeve placed to ensure adequate diameter during closure. Marginal excision of the pyloric mucosal mass and a Y-U pyloroplasty were performed. The resected mass was sent for histopathology.
Intraoperative Management: The puppy was hypotensive at the onset of surgery, requiring atropine and dopamine. Both had little effect, necessitating phenylephrine CRI, which was successful in helping with blood pressure control.
Postoperative Care:
- Blood electrolyte levels remained similar to pre-surgery values.
- Supportive care included Cephazolin, Esomeprazole, saline with potassium supplementation, and Buprenorphine for analgesia.
Over the next few days, the puppy showed significant improvement. While some regurgitation continued, it was markedly reduced. Feeding was carefully managed with small, frequent meals, starting with a liquid diet and gradually transitioning to mushed wet food. Daily POCUS assessments were performed to monitor gastric filling and check for free fluid. Initial ileus was managed successfully with metoclopramide, later transitioning to oral cisapride.
After a week in hospital, she was discharged with ongoing cisapride for gastric motility support and esomeprazole for residual regurgitation.
Histopathology
Results suggested pyloric hyperplasia with secondary bacterial infiltration, notably Helicobacter.
Dietary Management
Feeding was gradually increased, beginning with a low-fat diet and transitioning to Royal Canin Puppy food over several weeks to support growth. Occasional regurgitation necessitated adjustments in meal volumes and frequency. Initially fed six small meals per day, she eventually transitioned to three meals daily as symptoms improved.
Outcome
The puppy continues to thrive, growing well and behaving like a normal, healthy dog. She remains on a low dose of cisapride every second day, with the aim of further tapering over time.
Key Takeaways
- Gastric mucosal polyp formation, though rare, should be considered a differential in young French Bulldogs presenting with pyloric outflow obstruction.
- Thorough diagnostic workups, including advanced imaging and gastroscopy, are critical in identifying structural abnormalities.
- Despite the complexity of treatment, a positive outcome is achievable with meticulous perioperative management.
- A rare case that reinforces the importance of comprehensive diagnostics and careful surgical intervention!
24/7 Emergency Care at North Shore Specialist & Emergency Centre
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