Pylorectomy and Gastroduodenostomy (Billroth I Procedure) for Obstructive Antrum Pyloric Leiomyoma in a Bitch
Background: Gastric neoplasms are uncommon in dogs, especially those affecting smooth muscle layers. Leiomyoma is a smooth muscle benign neoplasm, which requires surgical resection. Pylorectomy and gastroduodenostomy (Billroth I procedure) is the most indicated technique in cases not affecting the biliary and pancreatic tracts. Thus, the purpose of this study was to report a successful case of Billroth I procedure in a bitch presenting antrum pyloric obstructive leiomyoma.
Case: A 12-year-old, non-spayed, Cocker Spaniel bitch was admitted presenting depression, hyporexia, postprandial vomiting and sparse episodes of hematemesis, for 30 days. Clinical suspicion on obstructive gastric outflow disease was established. Bloodwork (complete blood count, BUN, albumin, ALP and ALT), abdominal ultrasound and thoracic radiographs were assessed. The patient undergone upper gastrointestinal endoscopy. On endoscopic evaluation, small hemorrhagic mucosa ulcers were visualized on the gastric body, antrum and pylorus. Moreover, a sessile, ulcerated, round-shape and infiltrated antral-pyloric mass was seen. The mass was 1.5-2.0 cm in diameter and apparently involved the smooth muscle layer, causing severe pyloric obstruction. However, endoscopic evaluation of the duodenum was possible. Several biopsy samples were taken from the neoplasm and sent for histopathologic assessment. The result was not conclusive due to low quality samples. The patient had progressive worsening of obstruction episodes and required surgery. A wide-margin pylorectomy and gastroduodenostomy (Billroth I procedure) was carried out. The retrieved specimen was sent to histopathological and immunohistochemistry (IHC) assessment. Positive staining for actin and desmin confirmed smooth muscle origin of the mass and histopathological assessment confirmed leiomyoma. The patient underwent regular periodic postoperative assessments, revealing progressive clinical improvement and normal weight gain. Control upper gastrointestinal endoscopy was performed. Gastric ulcers were completely healed and gastroduodenal anastomosis was functional. The anastomotic scar tissue was sampled and revealed chronic and normal healing process. Complete healing was confirmed and the patient was discharged.
Discussion: Gastric neoplasms are not common in dogs. However, severe obstruction of gastric outflow is a potential risk for complications in those cases. Upper gastrointestinal endoscopic assessment is important not only for diagnosis, but also for surgery decision making. In the current study, gastroscopy provided accurate preoperative evaluation of severity of pyloric obstruction and diagnosis of secondary gastric ulcers. Direct visualization of lesions and multiple biopsy sampling were performed. The presence of neoplasms over 2-cm in diameter indicates need for complete laparoscopic or conventional surgical resection. In this case report, open resection was carried out due to prohibitive cost of laparoscopic approach, mass dimensions and probable involvement of deeper tissue layers. In conclusion, pylorectomy and gastroduodenostomy (Billroth I procedure) was curative and provided good prognosis following resection of an antrum pyloric obstructive leiomyoma. Endoscopy was critical for both diagnosis and decision-making towards surgery for gastric outflow obstruction due to an antrum pyloric neoplasm. Histopathological and immunohistochemistry assessment confirmed neoplasm type and assured oncological safety of resection with wide margins.
Keywords: gastric neoplasms, smooth muscle tumor, endoscopy, dog.
Acker S., Dishop M., Kobak G., Vue P. & Somme S. 2014. Laparoscopic-assisted endoscopic resection of a gastric leiomyoma. European Journal of Pediatric Surgery Reports. 2(1): 3-6.
Barra M.B. 2006. O uso da imunohistoquímica no diagnóstico: indicações e limitações. Revista da AMRIGS. 50(2): 173-184.
Cooper B.J. & Valentine B.A. 2002. Tumors of muscle. In: Meuten D.J. (Ed). Tumors in domestic animals. 4th edn. Ames: Iowa State Press, pp.319-364.
Cornell K. 2012. Stomach. In: Tobias K.M. & Johnston S.A. (Eds). Veterinary surgery - small animal. Saint Louis: Elsevier, pp.1484-1512.
Day M.J. & Bilzer T. 2008. Histopathological standards for the diagnosis of gastrointestinal inflammation in endoscopic biopsy samples from the dog and cat: a report from the World Small Animal Veterinary Association Gastrointestinal Standardization Group. Journal of Comparative Pathology. 138: 1-43.
Eisele J., Mcclaran J.K., Runge J.J., Holt D.E., Culp W.T., Liu S., Long F. & Bergman P.J. 2010. Evaluation of risk factors for morbidity and mortality after pylorectomy and gastroduodenostomy in dogs. Veterinary Surgery. 39(2): 261-267.
Foale R.D. & Demetriou J. 2011. Oncologia em pequenos animais. Rio de Janeiro: Mosby Elsevier, 224p.
Frost D., Lasota J. & Miettinen M. 2003. Gastrointestinal stromal tumors and leiomyomas in the dog: a histopahologic, immunohistochemical, and molelur genect study of 50 cases. Veterinary Pathology. 40: 42-54.
Hall J.A. 2004. Doenças do estômago. In: Ettinger S.J. & Feldman E.C. (Eds). Tratado de medicina interna veterinária: doenças do cão e do gato. 5.ed. São Paulo: Guanabara Koogan, pp.1218-1242.
Hu X., Tian D., Cao L. & Yi Y. 2009. Progression and prognosis of gastric stump cancer. Journal of surgical oncology. 100(6): 472-476.
Huang L., Cui J., Wu C., Zhang B., Jiang L., Xian X., Lin S., Xu N., Cao X. & Wang Z. 2014. Endoscopic fullthickness resection and laparoscopic surgery for treatment of gastric stromal tumors. World Journal of Gastroenterology. 20(25): 8253-8259.
Jones T.C., Hunt R.D. & King N.W. 2000. Sistema digestivo. In: Jones T.C., Hunt R.D. & King N.W. (Eds). Patologia veterinária. 6.ed. Barueri: Manole, pp.1087-1088.
Kosmidis C., Efthimiadis C., Anthimidis G., Vasileiadou K., Stavrakis T., Ioannidou G. & Basdanis G. 2013. Endoscopically assisted laparoscopic local resection of gastric tumor. BMC Research notes. 6: 410-414.
Matthiesen D.T. 1998. Obstrução crônica e esvaziamento gástrico. In: Slatter D. (Ed). Manual de cirurgia de pequenos animais. 2.ed. São Paulo: Manole, pp.682-690.
Radlinsky M.G. 2014. Cirurgia do sistema digestório. In: Fossum T.W. (Ed). Cirurgia de pequenos animais. 4.ed. Rio de Janeiro: Elsevier, pp.461-497.
Rasmussen L. 2007. Estômago. In: Slatter D. (Ed). Manual de cirurgia de pequenos animais. 3.ed. Barueri: Manole, pp.592-641.
Stanton M.L.E. 1996. Ulceração e neoplasia gástrica. In: Bojrab M.J. (Ed). Mecanismos da moléstia na cirurgia dos pequenos animais. 2ed. São Paulo: Manole, pp.275- 277.
Sturgess C.P. 2001. Doenças do trato alimentar. In: Dunn J.K. (Ed). Tratado de medicina de pequenos animais. São Paulo: Roca, pp.367-409.
Swann H.M. & Holt D.E. 2002. Canine gastric adenocarcinoma and leyomyosarcoma: a retrospective study of 21 cases (1986-1999) and literature review. Journal of the American Animal Hospital Association. 38(2): 157-164.
Walter M.C., Matthiesen D.T. & Stone E.A. 1985. Pylorectomy and gastroduodenostomy in the dog: technique and clinical results in 28 cases. Journal of the American Veterinary Medical Association. 187: 909-914.
Willard M.D. 2010. Distúrbios do sistema digestório. In: Nelson R.W. & Couto C.G. (Eds). Medicina Interna de Pequenos Animais. 4.ed. Rio de Janeiro: Mosby Elsevier, pp.351-484.
Zhang B., Huang L., Wu C., Cui J., Jiang L. & Zheng H. 2013. Endoscopic full-thickness resection of gastric stromal arising from the muscularis propria. Chinese Medical Journal. 126(13): 2435-2439.
How to Cite
This journal provides open access to all of its content on the principle that making research freely available to the public supports a greater global exchange of knowledge. Such access is associated with increased readership and increased citation of an author's work. For more information on this approach, see the Public Knowledge Project and Directory of Open Access Journals.
We define open access journals as journals that use a funding model that does not charge readers or their institutions for access. From the BOAI definition of "open access" we take the right of users to "read, download, copy, distribute, print, search, or link to the full texts of these articles" as mandatory for a journal to be included in the directory.
La Red y Portal Iberoamericano de Revistas Científicas de Veterinaria de Libre Acceso reúne a las principales publicaciones científicas editadas en España, Portugal, Latino América y otros países del ámbito latino