Case Of the Month

Gastric Ulcer

Post Holiday Indigestion? That’s Not So “Raven.” Hopefully the holiday festivities didn’t cause your stomach to look like this sonographic presentation. See what Andi Parkinson RDMS & Rachel Brilhart RDMS of Intrapet Imaging, Baltimore MD, USA and their friends @ Eastern AH found in this 7-year-old Dachshund with a major belly-ache.

History (Parkinson/ Brilhart RDMS): A 5-year-old NM Dachshund with a history of chronic lameness that had been treated with naproxen by the owner. The patient presented for vomiting and anorexia for 2 weeks. Abnormalities on CBC and serum biochemistry were severe anemia (PCV 14%), leukocytosis, hypoproteinemia, and low BUN. Blood transfusion was given.

Image 1: The gastrointestinal tract revealed significantly thickened wall with hyperechoic ill-defined mesentery associated with the serosal layer of the stomach, particularly that if the pyloric outflow. A dilated, fluid filled fundic lumen was also noted owing to ileus or pyloric outflow delay.

Image 2: Closer examination of the gastric wall revealed a focal loss of mural detail and a hyperechoic penetrating lesion that is contiguous with the lumen but extends into the muscularis layer. Peripheral luminal air artifact from the gastric lumen obscures the image to some extent.

DX

Recommend surgical excision and repair of suspected ulcerative lesion. Leakage into the abdomen that has been walled off by reactive fat may be an issue. Regional lymphadenopathy and gastric wall biopsies are essential. Aggressive gastrointestinal protectant therapy with plasma expanders, plasma transfusion, aggressive antibiotics and pain management are all recommended.

Outcome

Gastric ulcer was found. No neoplasia was present and the patient recovered uneventfully.

Comments

Special thanks to Andi Parkinson RDMS and Rachel Brilhart RDMS of Intrapet Imaging, Baltimore, MD, USA and Drs. Estelle Ward & Jonathan Kaufman & Staff of Eastern Animal Hospital, Baltimore MD, USA for their excellent management of this case.

Clinical Differential Diagnosis

Clinical Differential Diagnosis (Lobetti):

GI tract ulceration – drug induced, neoplasia, foreign body
GI tract perforation with peritonitis
Sonographic Interpretation (Lindquist) :

Sampling

Surgical excision of a gastric ulcer was performed (Image 7).

Sonographic Differential Diagnosis

Sonographic Differential Diagnosis (Lindquist): Aggressive gastritis, likely ulcer. Reactive mesentery & surrounding lymphadenopathy. Concurrent regional pancreatitis & potential for emerging gastric neoplasia.