Spontaneous gastric perforation

From Felipedia

Intraoperative views of a small perforation within a gastric ulcer. This lesion is being resected with 1 cm margins of normal-looking gastric wall. Courtesy of Cariou et al, 2010)

Spontaneous gastric perforation is relatively rare in cats and usually results from primary gastritis.

Helicobacter spp have been fingered as the leading etiology in many cases, but spontaneous gastric perforation has been reported elsewhere without bacterial involvement, and often can be attributed to gastritis consequent to long-term stress (e.g. post-accident confinement), gastric trauma^[1], neoplasia (lymphosarcoma and gastric adenocarcinoma^[2]) or long-term NSAID use (e.g. Meloxicam)^[3], where hyperacidity of the gastric contents leads to erosive injuries to the gastric mucosa with subsequent secondary perforation. Gastric perforation has also been recorded in cases of irritable bowel disease^[4], systemic mastocytosis^[5], gastrinoma^[6], hypereosinophilic syndrome^[7] and toxicity following ingestion of Diffenbachia spp plants^[8].

The majority of cases appear to involve the lesser curvature of the stomach and clinical signs are referable to slow leakage of stomach contents into the peritoneum. Cats often present with acute onset of vomiting, anorexia, lethargy, fever, bloated abdomen and shock. Radiographic findings are often suggestive of pneumoperitoneum.

A differential diagnosis of pneumoperitoneum includes more rare diseases such as gastrointestinal or urogenital viscus^[9], transmural migration of gas across bowel with vascular compromise^[10], or peritonitis associated with Clostridium spp infection^[11].

Surgical intervention is usually successful, although secondary complications, including peritonitis, are common and require judicious and expedient attention.

References

1. ↑ Hinton, LE et al (2002) Spontaneous gastroduodenal perforation in 16 dogs and 7 cats (1982-1999). J Am Anim Hosp Assoc 38:176-187
2. ↑ Weller, RE & Hornof, WJ (1979) Gastric malignant lymphoma in two cats. Mod Vet Pract 60:701-704
3. ↑ Cariou, M et al (2010) Successful surgical management of spontaneous gastric perforations in three cats. JFMS 12:36-41
4. ↑ Jergens, AE et al (1992) Idiopathic inflammatory bowel disease associated with gastroduodenal ulceration-erosion: a report of nine cases in the dog and cat. J Am Anim Hosp Assoc 28:21-26
5. ↑ Liptak, JM et al (2002) Gastroduodenal ulceration in cats: eight cases and a review of the literature. JFMS 4:27-42
6. ↑ van der Gaag, I et al (1988) Zollinger-Ellison syndrome in a cat. Vet Q 10:151-155
7. ↑ McEwen, SA Valli, VE & Hulland, TJ (1985) Hypereosinophilic syndrome in cats: a report of three cases. J Am Anim Hosp Assoc 49:248-253
8. ↑ Muller, N, Glaus, T & Gardelle, O (1998) Ausgedehnte magenulzera durch Diffenbachia-intoxikation bei einer katze. Tierarztl Prax 26:404-407
9. ↑ Lykken, JD Brisson, BA & Etue, SM (2003) Pneumoperitoneum secondary to a perforated gastric ulcer in a cat. J m Vet Med Assoc 222:1713-1716
10. ↑ Smeltoys, JA et al (2004) Outcome of and prognostic indicators for dogs and cats with pneumoperitoneum and no history of penetrating trauma.: 54 cases (1988-2002). J Am Vet Med Assoc 225:251-255
11. ↑ Wong, PL (1981) Pneumoperitoneum associated with splenic necrosis and clostridial peritonitis in the dog. J Am Anim Hosp Assoc 17:463-467