Tension pneumoperitoneum in a dog

Front Vet Sci - 2023

Myounghun Kim Jeongyun Jeong Changhyeon Cho Kidong Eom Jaehwan Kim*

Background: Tension pneumoperitoneum (TPP) is a rare but life-threatening condition caused by excessive gas accumulation in the peritoneal cavity, leading to cardiorespiratory distress. It is usually caused by gastrointestinal (GI) perforation, which requires urgent decompression and surgical correction.

Study: The authors report the first case of a dog with TPP secondary to gastric perforation caused by gastric neoplasm. They describe the clinical, radiographic, and computed tomography (CT) findings of the case, as well as the surgical and medical management.

Methods: The dog presented with severe abdominal distension, fever, and panting. Blood tests revealed leukocytosis, increased C-reactive protein, and D-dimer levels. Abdominal radiography showed massive pneumoperitoneum with cranial displacement of the diaphragm and a radiopaque stripe in the mid-abdomen. After emergency needle decompression, peritoneal fluid analysis confirmed septic peritonitis. CT revealed a gastric mass with a low-attenuating cleft suggestive of perforation site, as well as compression and centralization of the abdominal organs by free gas. Exploratory laparotomy confirmed gastric perforation adjacent to the gastric mass, which was resected with a surgical margin. Imprinting cytology indicated gastric carcinoma.

Results: The dog was treated with fluid, analgesic, antithrombotic, and antibacterial therapy. However, the dog’s condition deteriorated, and euthanasia was performed at the owner’s request. The authors concluded that TPP was caused by gastric perforation due to gastric neoplasia, resulting in peritonitis.

Limitations: The authors did not perform biopsy or histopathology of the gastric mass, which could have provided more definitive diagnosis and prognosis. The authors also did not report the follow-up of the dog after surgery, which could have provided more information on the outcome and complications.

Conclusions: The authors suggest that TPP is a potential complication of gastric perforation in dogs, and that imaging modalities such as radiography and CT are valuable tools for the diagnosis and detection of its underlying causes. They also emphasize the need for prompt decompression and surgical intervention in cases of TPP.

Lateral (A,B) and ventrodorsal (C,D) abdominal radiographic projections of the dog. The images on the left (A,C) were obtained before decompression, and those on the right (B,D) were obtained immediately after decompression. Before decompression, massive pneumoperitoneum is characterized by the outlining of the peritoneal cavity with massive amount of gas and outlining of both sides of the small bowel wall with peritoneal gas (open arrow); a decreased overall abdominal serosal detail is also noted. On the ventrodorsal (C) radiograph, a radiopaque stripe (arrow) is identified in the mid-abdomen, which is considered a peritoneal ligament. After decompression, the abdominal distension decreased, but a large amount of free gas is still present. Cranial displacement of the diaphragm indicates increased intraperitoneal pressure.

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