Today’s Cool Case is one that I will never forget. Emergency work is never boring. And when you pair emergency work at the clinic with the stresses of everyday life as a human, things get interesting. Let’s set the stage for this particular Saturday in February in the northern Midwest. As a solo practitioner, I was on call every evening, and also every weekend, and most holidays for my clients. I knew how important my availability was to animals in need. However, this February day was honestly one where I hoped the phone didn’t ring…..
Saturday morning dawned bright and early and COLD. This day in February was supposed to be 10 below zero - 20 below zero if you factored in the wind chill. My young daughter had been sick for days, but that day she had spiked a 104 degree fever. And, my husband, the practice manager, who helped me in an assistant role for many emergencies, was not going to be around that evening. He was volunteering in town for a cross country ski/snowshoe event on our local trails. This was a day where I secretly hoped all the pets in my area stayed healthy.
But, that was not the case. Mid-afternoon I received a phone call from a very nice young client of mine. He had a very sweet female Chesapeake Bay Retriever, named Charli, that had just eaten a razor blade. What! Yes, a RAZOR BLADE. Now, this was not a large razor blade from a box cutter or an exacto knife, it was from a women’s shaver, but nonetheless, a razor blade. It had happened within the last 10 minutes, and he was panicking. Sometimes when a pet has eaten something it shouldn’t have, I can talk the owner through how to induce vomiting at home. Not this time. If that razor blade got lodged in the esophagus on the way up, it could cause huge problems.
What do you do in this case? You load up your sick child, call another assistant to come meet you at the Animal Hospital, and do your best to manage multiple crises at once. Charli came into the clinic bright and alert. This was not her first time eating something that she shouldn’t have. However, this was the first time she ate something that could cause a penetrating wound in her abdomen if it migrated. As always I began with a complete physical examination to make sure nothing else was amiss that day. She was determined to be healthy in every other way, so our next step was to take an abdominal x-ray.
Do you see her razor blade? Pretty easy to spot on her film. 
Now, what do we do about it? As always, I give owners all of their options as well as the pros and cons of each. If we elected to NOT go to surgery, we could feed her extra food at each feeding for the next week in the hopes of really bulking up the intestines and colon full of ingesta/stool, so that the razor blade would hopefully be well coated and move through without causing injury. This option would save her from having to undergo a major abdominal surgery, but the risk of puncture/rupture was a big possibility. Our other option was to take her to surgery that afternoon to remove the razor blade. While this method would immediately remove the dangerous razor blade, there are always risks of complications with abdominal surgery, especially when opening the stomach or small intestines.
Charli’s owner chose the surgical option that afternoon. I agreed that it was the best option for her. After clipping her fur and doing a sterile prep of her abdomen, I began her abdominal exploratory. The razor blade appeared to be located in her stomach right before surgery, but in case it had moved, I very gently palpated her entire intestinal tract. No foreign body was felt, so I turned my attention back to her stomach. Once her stomach was partially elevated and isolated with sterile gauze, I made an incision into it. The inner surface of the stomach has many many folds in it, making small objects tough to find, but I was successful after a short while. Happy with my treasure, I did a little more exploring of the stomach prior to closure of both it and the abdomen.
Now, with any exploratory that involves metal, bone, or urinary stones, I always take a post-op x-ray to make sure everything was removed. We took Charli to x-ray while she was still anesthetized and took our picture. I have never had to re-open a pet, and assumed this would be the same case today. When the x-ray came up on the screen I was shocked at what I saw…….a razor blade in her stomach. WHAT! I had a razor blade on my instrument table that I had just removed from this dog! It even matched the size and shape of the pre-op x-ray. As I stood there open-mouth staring at this film, only one thing made sense - this dog had eaten not only one, but TWO razor blades. When the earlier x-ray was taken, this razor blade must not have made it to the stomach yet; it must have been stuck in the esophagus, and our positioning and movements during or after surgery must have dislodged it.
What do you do? You do the thing you need to do - you re-open the dog and try to find the second razor blade. To be honest, my second attempt was not successful. As mentioned, the inner lining of the stomach contains many many folds. This small razor blade hid itself very well in these folds and try and I might, I was not able to find it.
Not only am I a very careful surgeon, but I am a very SAFE surgeon. This dog had been under anesthesia for long enough and it was time to wake her up.
She had done very well under anesthesia throughout the entire surgery and I wanted to keep it that way. So, dejectedly, I closed her up a second time, monitored her closely during her recovery, and then called her owner. He was understandably concerned about the second razor blade that was still in her stomach, but also very thankful and understanding on the phone as I explained both of my attempts to recover her swallowed treasure. Our plan was to feed her a canned diet of intestinally friendly food for the next week and monitor every single stool she had outside. I sent the first razor blade home in a bag with him so that he knew what to watch for in her stool.
I’m very happy to report that she recovered very well from surgery, ate well over the next week, and within a couple days the owner found the second razor blade in her stool. At her two week recheck and suture removal appointment her owner not only reported that she was back to normal, but that her new trick outside was eating ROCKS. I secretly crossed my fingers thinking that if this was her new hobby, hopefully she chose only the small rocks!
What do you do in this case? You load up your sick child, call another assistant to come meet you at the Animal Hospital, and do your best to manage multiple crises at once. Charli came into the clinic bright and alert. This was not her first time eating something that she shouldn’t have. However, this was the first time she ate something that could cause a penetrating wound in her abdomen if it migrated. As always I began with a complete physical examination to make sure nothing else was amiss that day. She was determined to be healthy in every other way, so our next step was to take an abdominal x-ray.
Do you see her razor blade? Pretty easy to spot on her film.
Now, what do we do about it? As always, I give owners all of their options as well as the pros and cons of each. If we elected to NOT go to surgery, we could feed her extra food at each feeding for the next week in the hopes of really bulking up the intestines and colon full of ingesta/stool, so that the razor blade would hopefully be well coated and move through without causing injury. This option would save her from having to undergo a major abdominal surgery, but the risk of puncture/rupture was a big possibility. Our other option was to take her to surgery that afternoon to remove the razor blade. While this method would immediately remove the dangerous razor blade, there are always risks of complications with abdominal surgery, especially when opening the stomach or small intestines.
Charli’s owner chose the surgical option that afternoon. I agreed that it was the best option for her. After clipping her fur and doing a sterile prep of her abdomen, I began her abdominal exploratory. The razor blade appeared to be located in her stomach right before surgery, but in case it had moved, I very gently palpated her entire intestinal tract. No foreign body was felt, so I turned my attention back to her stomach. Once her stomach was partially elevated and isolated with sterile gauze, I made an incision into it. The inner surface of the stomach has many many folds in it, making small objects tough to find, but I was successful after a short while. Happy with my treasure, I did a little more exploring of the stomach prior to closure of both it and the abdomen.
What do you do? You do the thing you need to do - you re-open the dog and try to find the second razor blade. To be honest, my second attempt was not successful. As mentioned, the inner lining of the stomach contains many many folds. This small razor blade hid itself very well in these folds and try and I might, I was not able to find it.
Not only am I a very careful surgeon, but I am a very SAFE surgeon. This dog had been under anesthesia for long enough and it was time to wake her up.
Comments
Post a Comment