- 5 years old, French Bulldog, presented for profuse vomiting nonresponsive to symptomatic medication.
- Occasional vomiting in the past, becoming regularly recently. Aggressive vomiting recently.
- Unremarkable blood results.
See the still ultrasound images above in the carousel (four images total) and the two videos below.
- Transverse and longitudinal images of the pyloric region, with a protruding, concentric layered mass suggestive of retrograde gastroduodenal intussusception and folded pyloric mucosa with an alternating hyperechoic and hypoechoic layers.
- Moderate distension with anechoic fluid of the gastric body, with mild amount of echogenic material.
- Concentric thickening of the mucosal and muscularis layer with a folding portion protruding into the pyloric-duodenal portion.
- A mildly pedunculated mass at the level of the mucosal layer is protruding within the pylorus portion of the stomach with ante- and retrograde movement causing gastric obstruction. Normal wall layers but hypertrophied pyloric mucosal and muscular layers were present.
- Due to the intestinal peristalsis, part of the duodenum is protruding into the gastric lumen
- Concentric thickening of the pylorus.
- Mass-like folding of the pyloric mucosal layer.
- Gastric obstruction.Conclusions: Most likely in the presented case, the presentation and finding are suggestive of a congenital pyloric hyperplasia, with protruding gastric folds
- Inflamed rugal folds, multiple ulcerations, pyloric region stenotic, with no gastric foreign body noted.
- Moderate amount of fluid removed by suction.
- Biopsy taken from the pyloric area – this sample consist of markedly hyperplastic superficial epithelium. The epithelium is tall columnar and contains abundant mucous. The epithelium is supported by small amount of stroma/lamina propria. There are rare plasma cells, lymphocytes and eosinophils. Helicobacter like organisms are not observed.Diagnosis: Pyloric hyperplasia with no Helicobacter like organisms. Mild gastric ulceration noted on gastroscopy.
The presentation and finding are suggestive of a congenital pyloric hyperplasia, with protruding gastric folds and secondary intussusception due to profuse vomiting. Pyloric hyperplasia is described as a condition of unknown origin but has been associated with Helicobacter pylori in 90% of patients in human medicine. In veterinary medicine, small breeds are more representative for this condition. Common clinical signs are represented by profuse or chronic vomiting, weight loss, polydipsia, lethargy, anorexia, and abdominal pain. Diagnostic imaging can help in describing the pathology, this including abdominal ultrasound and CT, but a definitive diagnostic can will require biopsy. Treatment options are represented by supportive and symptomatic treatment and adjusting the diet, but in aggressive cases, surgery is indicated. In the presented case, medical management had good results, surgery being declined by the owners.
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