Gastrojejunostomy without partial gastrectomy to manage duodenal stenosis in a dog

Abstract

A nine-year-old female Rottweiler with a history of repeated gastrointestinal ulcerations and three previous surgical interventions related to gastrointestinal ulceration presented with symptoms of anorexia and intermittent vomiting. Benign gastric outflow obstruction was diagnosed in the proximal duodenal area. The initial surgical plan was to perform a pylorectomy with gastroduodenostomy (Billroth I procedure), but owing to substantial scar tissue and adhesions in the area a palliative gastrojejunostomy was performed. This procedure provided a bypass for the gastric contents into the proximal jejunum via the new stoma, yet still allowed bile and pancreatic secretions to flow normally via the patent duodenum. The gastrojejunostomy technique was successful in the surgical management of this case, which involved proximal duodenal stricture in the absence of neoplasia. Regular telephonic follow-up over the next 12 months confirmed that the patient was doing well.

Application of Billroth II gastrojejunostomy and a biliary stent in a dog with gastric adenocarcinoma and the associated extrahepatic biliary obstruction

“…as stomal ulceration and rapid passage of food [3,4,8]. Although the Billroth II procedure immediately alleviates gastric outflow obstruction and results in clinical improvement during the initial postoperative period, it requires extensive surgery with difficult and delicate surgical techniques [8]. In the present case, neoplasia was extensively involved in the gastric pylorus region and the proximal duodenal region adjacent to major duodenal papilla.…”

“…as stomal ulceration and rapid passage of food [3,4,8]. Although the Billroth II procedure immediately alleviates gastric outflow obstruction and results in clinical improvement during the initial postoperative period, it requires extensive surgery with difficult and delicate surgical techniques [8].…”

“…The presence of residual gastric antrum after Billroth II gastrojejunostomy, stomal diameter, and the length of the afferent intestine loop are important indicators of the likely success of this surgery [4]. Complete resection of the gastric antrum prevents excessive gastric acid secretions from causing stomal ulceration in the gastrojejunostomy junction [4,8,9]. Moreover, the size of the stab incision for stoma formation is an important prognostic factor: a stomal diameter of 2.1 to 2.3 cm is ideal, but if exceeds 3 cm then persistent vomiting is likely [4].…”

Primary repair of nonsteroidal anti‐inflammatory drug‐associated full thickness gastrointestinal ulcers in 11 dogs

“…4,6,32 Adequate blood supply is one of the most important factors to successful anastomosis healing and in cases of either shock or hypotension this is significantly decreased and therefore a higher risk for failure and mortality exists. 4,15,25,33 Results of this study identified a trend between hyperlactatemia at presentation and postoperative mortality. Previous reports have also shown a correlation between hyperlactatemia and dog mortality in cases of gastric dilation and volvulus.…”

“…Septic shock associated with a gastroduodenal perforation can further compound hypotension and decrease tissue oxygen delivery through the redistribution of the circulatory system to critical organs 4,6,32 . Adequate blood supply is one of the most important factors to successful anastomosis healing and in cases of either shock or hypotension this is significantly decreased and therefore a higher risk for failure and mortality exists 4,15,25,33 …”