Gastrointestinal Intramural Pancreatic Pseudocysts in a Dog: A Case Report and Human Literature Review.

A 9.5 yr old Yorkshire terrier presented with chronic intermittent vomiting and lethargy of 1.5 yr duration that progressed to generalized weakness. Insulin:glucose ratio was consistent with an insulinoma. Triple-phase computed tomography revealed a mid-body pancreatic nodule. The mid-body pancreatic nodule was enucleated; histopathology was consistent with an insulinoma. Two weeks after the operation, the dog presented for anorexia and diarrhea. Abdominal ultrasound revealed a thick-walled cystic lesion along the dorsal stomach wall. An intramural gastric pseudocyst was diagnosed via exploratory laparotomy and intraoperative gastroscopy. Comparison of amylase and lipase levels of the cystic fluid with that of concurrent blood serum samples confirmed the lesion was of pancreatic pseudocyst origin. The gastric pseudocyst was omentalized. Two weeks after the operation, the dog re-presented for anorexia, regurgitation, and diarrhea. An intramural duodenal pseudocyst was identified and treated with a duodenal resection and anastomosis. The dog has remained asymptomatic and recurrence free based on serial abdominal ultrasounds 22 mo following insulinoma removal. To our knowledge, this phenomenon of pancreatic pseudocysts forming in organs other than the pancreas has not been reported in dogs. This case report and comprehensive human literature review purpose is to raise awareness of this disease process in dogs.

Attempted ultrasound-guided ethanol ablation of a suspected pancreatic pseudocyst in a dog.

A 9-year-old, spayed female toy poodle dog developed refractory anorexia after pancreatitis. Abdominal imaging showed a cystic structure compressing the stomach. Appetite improved after percutaneous drainage of the structure, but the structure refilled within 48 h. Percutaneous ethanol ablation of the structure was attempted. Afterwards, the patient developed fatal hypotensive shock.

Tentative d'ablation à l'éthanol par échographie guidée pour un pseudokyste pancréatique suspecté chez un chien. Une chienne caniche stérilisée âgée de 9 ans a développé une anorexie réfractaire après une pancréatite. L'imagerie abdominale a montré une structure kystique comprimant l'estomac. L'appétit s'est amélioré après un drainage percutané de la structure, mais la structure s'est remplie de nouveau dans un délai de 48 heures. On a réalisé une tentative d'ablation à l'éthanol percutanée de la structure. Après l'intervention, le patient a développé un choc hypotensif mortel.(Traduit par Isabelle Vallières).

Pancreatic pseudocyst causing extrahepatic biliary obstruction in a dog.

A 3-year-old Rhodesian Ridgeback was examined because of recurrent pancreatitis of 2 months duration. The dog had signs of abdominal pain and jaundice. Blood biochemical findings were consistent with extrahepatic bile duct obstruction, but on abdominal ultrasonography no cause of obstruction was identified. At surgery a pancreatic pseudocyst was found in the body of the pancreas. Cystoduodenostomy, cystic omentalization and biliary diversion resulted in excellent long-term recovery.

Pancreatic pseudocysts in 4 dogs and 2 cats: ultrasonographic and clinicopathologic findings.

Pancreatic pseudocysts were diagnosed in 4 dogs and 2 cats based on ultrasonographic and clinicopathologic findings. All 6 animals had a clinical diagnosis of pancreatitis. Five of 6 pseudocysts were in the left pancreatic limb, and in 1 cat the pseudocyst was in the pancreatic body region. Cyst size ranged from 2 x 2 cm to 7 x 6 cm. All pseudocysts had anechoic regions that were aspirated using ultrasound guidance for diagnostic and therapeutic purposes. No morbidity was associated with the aspiration procedures. Cytologically the pseudocyst fluid was aseptic in all patients and had low numbers of inflammatory cells in 5 of 6 patients. All animals had high lipase activity in the pseudocyst fluid and in 2 dogs and 1 cat the lipase activity in the fluid was greater than in serum. Three of the 4 dogs were managed medically. In the 1 dog that had long-term follow-up ultrasound examination, the pseudocyst persisted for several days following aspiration and had disappeared 8 months after diagnosis. All 3 of these dogs were clinically normal 1.5-4 years after presentation. The 4th dog underwent surgical exploration and was euthanized shortly thereafter because of bronchopneumonia and chronic pancreatitis. The 2 cats died 10 days and 2 months, respectively, following initial diagnosis of the pseudocyst, but necropsies were not performed in either case. Ultrasound-guided fine-needle aspiration of pancreatic pseudocysts and clinicopathologic evaluation of cystic fluid are useful for diagnosis of pancreatic pseudocysts.

Resolution of a pancreatic pseudocyst in a dog following percutaneous ultrasonographic-guided drainage.

A six-year-old, spayed female Shetland sheepdog was presented with acute onset of anorexia and vomiting. An inflammatory leukogram and elevated serum amylase, lipase, alkaline phosphatase, alanine transferase, and triglycerides supported a diagnosis of severe acute pancreatitis. An enlarged, hypoechoic pancreas was visualized on abdominal ultrasonography. The patient clinically responded to medical therapy consisting of nothing per os, total parenteral nutrition, and supportive care. She presented again three weeks later with anorexia and vomiting. A large, anechoic mass was seen in the left limb of the pancreas on ultrasonographic examination of the abdomen. Differentials for this mass included abscess, focal peritonitis, and pancreatic pseudocyst. Clinical signs resolved with supportive care. The mass failed to resolve. Sterile fluid (35 ml) was removed via ultrasonographic-guided centesis 42 days after initial presentation. Ultrasonographic appearance, biochemical analyses, and fluid examination with negative cultures suggested pancreatic pseudocyst. The pseudocyst gradually resolved over the next seven months postcentesis.

Cystogastrostomy in the treatment of pancreatic pseudocyst/abscess in two dogs.

Two dogs with pancreatic pseudocyst or pancreatic abscess formation were treated by transgastric cystogastrostomy. In each case drainage of the cyst/abscess cavity into the stomach was followed by resolution of the primary lesion. One dog succumbed to an E coli bronchopneumonia after infection of the deep venous line used for total parenteral nutrition. The second dog recovered despite requiring additional surgery for biliary obstruction. Both dogs required intensive care during and after the operation.