Case Study

Delayed Pyloric Emptying in a 9 year old MN Boxer dog

This 9-year-old MN Boxer was presented for retching, hyporexia, and foul halitosis. The physical exam, CBC, blood chemistry, and urinalyses were all normal. The dog presented 14 hours postprandial of 1 can of i/d diet. The patient had been empirically treated with amoxicillin and metronidazole for presumed Helicobacter gastritis with partial response over a 3 week protocol.

This 9-year-old MN Boxer was presented for retching, hyporexia, and foul halitosis. The physical exam, CBC, blood chemistry, and urinalyses were all normal. The dog presented 14 hours postprandial of 1 can of i/d diet. The patient had been empirically treated with amoxicillin and metronidazole for presumed Helicobacter gastritis with partial response over a 3 week protocol.

Sonographic Differential Diagnosis

Gastric stasis. Potential causes include a primary motility disorder, mild or emerging inflammatory or infiltrative gastric or perigastric (i.e. pancreatitis) disease in a partially or intermittently obstructing, non-visualized gastric foreign body.

Image Interpretation

The stomach is moderately filled with echogenic, faintly shadowing ingesta. Pyloric outflow obstruction was not apparent. Luminal distention is hindering critical assessment of gastric mural thickness; however, the discernible wall appears to be within normal limits.

DX

Multifocal lymphocytic plasmacytic infiltrate with helicobacter infection

Outcome

This patient presented with simple delayed pyloric emptying secondary to the inflammatory pathology. Endoscopy was selected in this case due to the lack of significant mural pathology that would necessitate full thickness biopsies. The patient responded well to a 6 week treatment for Helicobacter as well as a hypoallergenic diet.

Clinical Differential Diagnosis

GI pathology- Gastric foreign body, gastritis, IBD, neoplasia, pancreatitis.

Sampling

Endoscopic exam after an additional 12 hours NPO revealed an empty lumen with gastric and duodenal mucosal biopsies revealing mild multifocal lymphocytic plasmacytic infiltrate with helicobacter infection.