Hi Everyone! It’s Friday! And, that’s right, it’s time for a cool clinical case I saw.
**Some forewarning…..not only does this case have an x-ray image in it, but also contains pictures during surgery. Some might find these images difficult to look at, and possibly not appropriate for young children to view.**
Alright! Let’s dive in! This case involves a young lab with a voracious appetite. Wait, don’t all labs have a voracious appetite? Possibly true, but this one had an appetite for the wrong thing. Why don’t we call him “Cooper” to protect his privacy :)
Cooper came in to see me one morning after having not eaten for a couple days. For any young lab, this is an instant red flag. He was also vomiting fluid, and was very “dumpy.” His dad reported that he was just laying around and not his usual playful self.
Time to start with a good physical exam. I had this image to the left posted in my exam room so that owners knew everything I was checking with each physical examination I did on their dogs. He was alert, but quiet. Cooper wagged his tail when I walked in the room, but then immediately retreated to the corner and layed down while his dad and I talked. Not normal Lab behavior. His eyes and ears looked good. Mucus membranes in his mouth were nice and pink, but a bit dry; evidence that he either wasn’t drinking much, or was vomiting a fair amount, resulting in moderate dehydration. No foreign bodies were located in his mouth. His heart sounded normal, with no murmurs heard, and a normal rate and rhythm were heard as well. No skin infection was found. When doing a standing palpation (gentle pressing and squeezing) of his belly, he seemed a bit painful, and would tense when touched in certain areas. Lastly, he moved all of his joints well in his four limbs. In addition, the owners did not report any seizure activity during his life, and more importantly, during the last few days.
Ok, let’s step back for a minute. Why do the intestines fill with gas or fluid if there is a foreign body stuck in them? Well, with normal digestion, pets usually chew their food into smaller pieces. In the stomach, the addition of digestive juices reduces these food chunks to small squishy pieces or even liquifies them. The food is then moved through the intestines in its liquified state by rhythmic pushing movements while the small intestines absorb the nutrients in the food, and the colon (last part of the intestines) turns it into more solid waste to leave the body. If then, you introduce a foreign object that is large and can’t be reduced in size or liquified, it will become stuck…..somewhere. Where……that is the question. Some dogs are extremely lucky, and will pass socks, underwear, toys, etc, through the entire intestinal track with only mild symptoms of pain or nausea before they poop them out. Many are not so lucky. Keep in mind that the small intestine that leaves the stomach and travels many, many, many feet through the abdomen is only the width of your pointer finger. It will expand a little, but NOT MUCH. Imagine the discomfort of trying to pass a pair of underwear or a sock or a corn cob through that! OUCH. Sadly, many do not learn, and I see plenty of repeat offenders.
Okay, back to Cooper. I showed Dad the x-ray and discussed my concerns. As with any foreign body situation, I gave Dad his options. My top recommendation was exploratory surgery. It’s a big decision to take a dog to surgery, one that I don’t take lightly. I always stress that we may not find a foreign body and that something else may be going on, but in about 95% of cases with an x-ray like this, I have found a foreign body.
Other options included waiting a day or two to see if the gas pattern changed and if the suspected foreign body would move. Again, where is it? Is it in the duodenum, right out of the stomach, or is it near the end of the jejunum, near the colon? Who knows. If it makes it to the colon, likely it will make it out of the body without assistance on our part because the colon can stretch way more than the small intestine. I also discussed the risks of surgery versus the risks of monitoring with the owner. If we go in surgically, there is risk of infection due to stomach/intestinal contents leaking into the abdominal space, or there is risk of the intestinal incision breaking down. These are things the owner needs to know. But, if we wait and monitor, there is risk of the intestine rupturing over the foreign body due to prolonged stretch and stress of the area, leading to abdominal infection. Also, there is risk of that portion of the intestines literally “dying,” with the need for surgery to remove an entire section (sometimes a foot or more) of the intestines and re-attaching them in healthier sections. YIKES!
The owner elected to proceed with surgery. Hooray for the dog! During this type of surgery, after entering the abdomen, I examine the entire length of the intestines. I start at the stomach, feeling it if that is my only option, but gently lifting and examining it visually if able. Then, we start with the intestines leaving the stomach and traveling all the way to the colon. Did you know that the dog can have 12-20 feet, yes FEET of small intestine! It’s important to check all of it, to make sure there aren’t multiple areas of obstruction (I have had to open the intestines in up to five different places in dogs that have eaten rags). Cooper had an area not far down the intestinal tract that was firm, expanded, red and angry looking.
We found it! Notice in the picture above how loooonnnngggg this foreign body was. It was at least 16 inches long….the entire portion of intestines you see laying on the sterile drape covering his body. So, time to see what it was. Cutting into the intestines over a healthy part, we can start removing the foreign object as you’ll see in the next picture. Any guesses????? Cooper’s “treasure” was a foot long tube sock…..one of those that goes all the way up to your knee. Yikes. We often wonder why these guys find this tasty, and how on earth they swallowed it in the first place.
No other areas of concern were noted through his intestines or on inspection of his other abdominal organs. Cooper recovered from surgery well. Now was the real test. Though I am a very thorough and careful surgeon, I always remind owners of the risks with surgery, and what to watch for, just as your own human doctor would do if you or a family member had surgery. In Cooper’s case, and with other foreign body surgeries, I hospitalize them overnight to continue re-hydrating them through an IV, and begin them on antibiotics. They are kept off of food for 18-24 hours to allow the intestinal incision(s) to begin to heal before offering them food again.
That next day they are fed a small amount of a bland soft food (Purina EN or similar). If they eat, typically they will do great. Cooper ate as if he had never seen food before in his life. I hold my breath every time (and I’ve done TONS of these surgeries), and celebrate with the dog each time! After watching him for another few hours to make sure he did not vomit, he was ready to go home!
So, after removing the foreign object, I always ask the owners during my post-surgery phone call to them, if they know where the dog may have found it. In this case, the owner’s daughter was dusting the house with one of Dad’s tube socks. The dog found it, and it must have smelled pretty tasty. You just never know with those young labs……some eat rocks, some eat razor blades (yes there will be a post on that one!), some eat corn cobs, rags, cat toys, remotes, CDs, you name it.
I saw Cooper back for his two week recheck and suture removal and I’m happy to say that he was doing great, had gained some weight and his incision had healed very well. Way to go Cooper!
**Some forewarning…..not only does this case have an x-ray image in it, but also contains pictures during surgery. Some might find these images difficult to look at, and possibly not appropriate for young children to view.**
Alright! Let’s dive in! This case involves a young lab with a voracious appetite. Wait, don’t all labs have a voracious appetite? Possibly true, but this one had an appetite for the wrong thing. Why don’t we call him “Cooper” to protect his privacy :)
Cooper came in to see me one morning after having not eaten for a couple days. For any young lab, this is an instant red flag. He was also vomiting fluid, and was very “dumpy.” His dad reported that he was just laying around and not his usual playful self.
So, back to that abdomen. The first thing I recommend for a young lab that is not eating, is vomiting, and has a painful abdomen is an x-ray. I always ask the owner if the dog has a history of eating things he shouldn’t, or if they noticed anything missing as far as toys, etc. Cooper did not have a history of eating foreign objects. Still, with approval for an x-ray, off we went. 
He was a very good boy for his film, and to the right you will find his abdominal x-ray. In x-rays, tissue will be shades of white, and fluid or air will be black. His head is positioned to the left and tail to the right in the film. What we notice in his x-ray is the long black tube going down the length of his abdomen. These are his intestines, and this is not normal. Usually, we will see a little gas/fluid in a couple areas of the intestines, but not a long dilated tube. My immediate thought was for a foreign body……toy, sock, corn cob, underwear, a rock, who knows!
Ok, let’s step back for a minute. Why do the intestines fill with gas or fluid if there is a foreign body stuck in them? Well, with normal digestion, pets usually chew their food into smaller pieces. In the stomach, the addition of digestive juices reduces these food chunks to small squishy pieces or even liquifies them. The food is then moved through the intestines in its liquified state by rhythmic pushing movements while the small intestines absorb the nutrients in the food, and the colon (last part of the intestines) turns it into more solid waste to leave the body. If then, you introduce a foreign object that is large and can’t be reduced in size or liquified, it will become stuck…..somewhere. Where……that is the question. Some dogs are extremely lucky, and will pass socks, underwear, toys, etc, through the entire intestinal track with only mild symptoms of pain or nausea before they poop them out. Many are not so lucky. Keep in mind that the small intestine that leaves the stomach and travels many, many, many feet through the abdomen is only the width of your pointer finger. It will expand a little, but NOT MUCH. Imagine the discomfort of trying to pass a pair of underwear or a sock or a corn cob through that! OUCH. Sadly, many do not learn, and I see plenty of repeat offenders.
Okay, back to Cooper. I showed Dad the x-ray and discussed my concerns. As with any foreign body situation, I gave Dad his options. My top recommendation was exploratory surgery. It’s a big decision to take a dog to surgery, one that I don’t take lightly. I always stress that we may not find a foreign body and that something else may be going on, but in about 95% of cases with an x-ray like this, I have found a foreign body.
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| Courtesy DVM360 |
The owner elected to proceed with surgery. Hooray for the dog! During this type of surgery, after entering the abdomen, I examine the entire length of the intestines. I start at the stomach, feeling it if that is my only option, but gently lifting and examining it visually if able. Then, we start with the intestines leaving the stomach and traveling all the way to the colon. Did you know that the dog can have 12-20 feet, yes FEET of small intestine! It’s important to check all of it, to make sure there aren’t multiple areas of obstruction (I have had to open the intestines in up to five different places in dogs that have eaten rags). Cooper had an area not far down the intestinal tract that was firm, expanded, red and angry looking.
No other areas of concern were noted through his intestines or on inspection of his other abdominal organs. Cooper recovered from surgery well. Now was the real test. Though I am a very thorough and careful surgeon, I always remind owners of the risks with surgery, and what to watch for, just as your own human doctor would do if you or a family member had surgery. In Cooper’s case, and with other foreign body surgeries, I hospitalize them overnight to continue re-hydrating them through an IV, and begin them on antibiotics. They are kept off of food for 18-24 hours to allow the intestinal incision(s) to begin to heal before offering them food again.
So, after removing the foreign object, I always ask the owners during my post-surgery phone call to them, if they know where the dog may have found it. In this case, the owner’s daughter was dusting the house with one of Dad’s tube socks. The dog found it, and it must have smelled pretty tasty. You just never know with those young labs……some eat rocks, some eat razor blades (yes there will be a post on that one!), some eat corn cobs, rags, cat toys, remotes, CDs, you name it.
I saw Cooper back for his two week recheck and suture removal and I’m happy to say that he was doing great, had gained some weight and his incision had healed very well. Way to go Cooper!
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