Case Outcome: Shih Tzu with chronic vomiting

A cranial abdominal mass or enlarged pylorus was seen on  the lateral abdominal plain film. (arrows)
Radio-opaque calculi were present in the urinary bladder.

A filling defect (arrows) in the pyloric antrum was seen on the upper GI barium series.

The filling defect was also seen in this VD projection of the upper GI series. (arrows)

Gastric endoscopy revealed hypertrophied mucosa in the pyloric antrum and pylorus. (arrow)

Abdominal exploratory was performed and the pylorus and antrum incised.
Severe hypertrophy of the mucosa was seen. (arrows)

Full thickness biopsies of the pylorus were obtained and a Y-U pyloroplasty was performed.

A cystotomy to remove the calculi was performed. The dog also had a portosystemic shunt and a gall bladder mucocele. An ameroid constrictor was placed around the shunt and a cholecystectomy was done. (How's that for a abdominal surgery combo?) Histopathology of the pylorus revealed changes consistent with chronic hypertrophic pyloric gastropathy. Gall bladder histopathology was consistent with a mucocele. Calculi analysis was urate and struvite in composition. The Shih Tzu did well postoperatively, lived an additional 1 and 1/2 years, and then died of unknown causes.

For more information on this disease and the surgical treatment see:
Johnson SE, Sherding RG, and Bright RM. Diseases of the Stomach, in Saunders Manual of Small Animal Practice, 3rd edition, eds Birchard SJ and Sherding RG, Elsevier, St. Louis, pg. 664.

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