Table 1.
Information relative to the diagnosis, treatment and follow-up of gastric diverticula in six cats
| Case 1 | Case 2 | Case 3 | Case 4 | Case 5 | Case 6 | |
|---|---|---|---|---|---|---|
| Signalment | Age 15 years; MN; Maine Coon cat | Age 9 years; MN; Himalayan | Age 17 years; MN; DSH | Age 10 years; FS; Maine Coon cat | Age 17 years; MN; DSH | Age 13 years; MN; Maine Coon |
| History | Vomiting (3 years); weight loss (3 years); anorexia (1 week) | Vomiting (daily, 3 years); vomiting (twice daily, 4 days) | Anorexia (10 months); vomiting (2 weeks) | Vomiting hairballs (6 years); vomiting without hairballs (1 month) | Vomiting (2 years); weight loss (2 years); anorexia (2 months); chronic kidney disease (2 years) | Vomiting (3 years); aversion to being picked up (2 months) |
| Clinical findings | Temperature 38.3°C; dehydration; abdominal pain | Temperature 38.6°C | Temperature 37.8°C; palpably thickened intestines; abdominal pain | Temperature 38.2°C; dehydration; gastric distension | Temperature 37.7°C | Temperature 37.6°C; palpably thickened intestines |
| Cobalamin, folate, fPL, TLI* | NP | NP | NP | Cobalamin: 354 ng/l (low–normal); folate: 5.3 µg/l; fPL: 4.2 µg/l |
Cobalamin: 185 ng/l; fPL: 9.4 µg/l |
Cobalamin: 260 ng/l |
| Esophagogastroscopy | NP | Unremarkable | NP | NP | NP | NP |
| Abdominal radiography | Outpouching at gastric fundic region; gastric distension | NP | Abnormal gastric distension; irregular gastric shape | Irregular gastric shape | Irregular gastric shape | Ingesta within the stomach despite fasting for 12 h |
| Ultrasonography | NP | NP | NP | No abnormalities | NP | Duodenal muscularis thickening (0.04 cm); ileal muscularis thickening (0.1 cm) |
| Negative contrast upper GI study | Outpouching at the gastric fundus | Outpouching at the gastric fundus; gastric linear opacity | Outpouching at the gastric fundus | Large outpouching along greater gastric curvature at the gastric fundus; smaller gastric outpouching along lesser gastric curvature | Outpouching at the gastric fundus | Outpouching at the gastric fundus |
| Gastric cytology | Unremarkable | Unremarkable | NP | Extracellular rods; Malassezia yeast; polymorphonuclear leukocytes | NP | NP |
| Gastric diverticula histopathology | Atrophy of the muscularis layer; hypertrophy of the muscularis mucosa; segmental reduplication of the muscularis layer | Atrophy of the muscularis layer; hypertrophy of the muscularis mucosa; invagination and infolding of the muscularis layer | Atrophy of the muscularis layer; fibrosis of the muscularis mucosa | Atrophy of the muscularis layer; hypertrophy of the muscularis mucosa | Atrophy of the muscularis layer; ill-defined bundles and fibrosis within the muscularis layer | Atrophy of the muscularis layer; hypertrophy of the muscularis mucosa; hypertrophy of the tunica media arteries |
| Other histopathology, comorbidities | Intestines: inflammatory bowel disease (eosinophilic) Liver: no abnormalities Spleen: no abnormalities |
Intestines: no abnormalities | Intestines: inflammatory bowel disease (duodenum); alimentary small cell lymphoma (jejunum) Pancreas: nodular hyperplasia |
Intestines: no abnormalities Liver: no abnormalities Mesenteric lymph node: no abnormalities |
Intestines: alimentary small cell lymphoma Pancreas: no abnormalities Liver: no abnormalities Mesenteric lymph node: no abnormalities |
Intestines: inflammatory bowel disease |
| Treatment | Gastrotomy with foreign body (trichobezoar) removal; subsequent partial gastrectomy; prednisolone PO 48 months; cyanocobalamin SC 38 months |
Partial gastrectomy ; gastrotomy with foreign body (stick) removal |
NA | Partial gastrectomies (n = 2); cyanocobalamin SC 26 months |
Partial gastrectomy; prednisolone PO 18 months; cyanocobalamin SC 18 months; chlorambucil 17 months |
Partial gastrectomy; dexamethasone sodium phosphate SC 9 months; cyanocobalamin SC 9 months |
| Survival | 48 months (renal cause) | 15 months then lost to follow-up | Euthanized at time of exploratory laparotomy | 26 months then lost to follow-up | 18 months (renal cause) | 9 months at time of writing |
*
Reference interval (RI) for cobalamin, 290–1499 ng/l; RI for folate, 9.7–21.6 µg/l; RI for fPL, 0–3.5 µg/l (Gastrointestinal Laboratory, Texas A & M College of Veterinary Medicine & Biomedical Sciences).
MN = male neutered; DSH = domestic shorthair; FS = female spayed; fPL = pancreatic lipase immunoreactivity; TLI = serum trypsin-like immunoreactivity; NP = not performed; GI = gastrointestinal; NA = not applicable