Submucosal Resection of a Gastroesophageal Leiomyoma in a Dog

Signalment: 12-year-old, MN, Chihuahua

History:

This dog was previously diagnosed with inflammatory bowel disease (IBD). Five months before presentation, he presented with mild hyporexia and more frequent vomiting (from once every 6 weeks to one to two times per week).

Physical exam findings:

• No abnormal findings

Diagnostic and clinical staging tests:

• CBC: no abnormalities

• Serum biochemistry: no abnormalities

• Abdominal ultrasound: 1 cm mass in the gastric wall of the gastric body

Treatment:

Submucosal resection of a gastroesophageal mass via a gastrotomy

Outcome:

• Leiomyoma, complete excision

• Complications:

  • Vomiting and hyporexia, responsive to management with appetite stimulants, gastric protectants, and prokinetic drugs

Notes: Less aggressive resections can often result in good clinical outcomes. The mass in this dog was well circumscribed and located in the submucosal space of the gastroesophageal junction with no serosal or mucosal involvement. Considering its gross presentation and the likelihood that this was going to be either a benign or low-grade smooth muscle tumor (leiomyoma/leiomyosarcoma or gastrointestinal stromal tumor), a less aggressive surgical resection was chosen because of the high likelihood of a good oncologic outcome, and a much less risk of postoperative complications, especially in this region of the stomach. This surgery should be curative for this benign gastroesophageal leiomyoma.

Video link: https://www.youtube.com/watch?v=2NCiyakeG2k&t=37s

Tags: #leiomyoma

Preoperative ultrasound showing a mass in the gastric wall.

Intraoperative image of the mucosal-covered mass visible in the gastroesophageal junction. The mass has been exposed through a gastrotomy. The mucosa could be freely moved over the mass, but I resected the overlying mucosa en bloc with the mass.

The submucosal mass evident (arrow) after incising the mucosa around the mass. The mass was then bluntly dissected from the space with Metzenbaum scissors.

The gastric mucosal defect was closed with a single layer of 3-0 PDS in a simple continuous suture pattern. Note that a Poole suction tip was inserted into the gastric cardia and esophagus to avoid inadvertent narrowing of the lumen while closing the mucosal defect.

Once resected and the mucosal incision was closed, the gastrotomy was closed in two layers. This image shows closure of the mucosal-submucosal layer with 3-0 PDS in a simple continuous suture pattern.

Once resected and the mucosal incision was closed, the gastrotomy was closed in two layers. This image shows closure of the muscular-serosal layer with 3-0 PDS in a simple continuous suture pattern.

Postoperative specimen image of the gastroesphageal mass. This was diagnosed as a completely excised, benign leiomyoma. Surgery should be curative for this dog.