Gastrointestinal Foreign Bodies
Dr. J. Hunter, 2012-12-29
Ever wake feeling nauseated and having absolutely zero interest in eating or drinking? If you have, and a plausible reason isn’t forthcoming, you’ll likely have taken it easy for a day or two before seeking a physician’s advice. Toddlers showing similar clinical signs would result in a guaranteed trip to the nearest pediatrician’s or e-clinic doctor’s office.
Just like little kids, young cats and dogs have a penchant for exploring their environment with their mouths. Dogs and cats ages one to four, unlike human toddlers, typically receive decreased supervision as they become more trustworthy. Continued vigilance and “child-proofing” is recommended in all dog and cat residing households due to the propensity for these furry family members to put inappropriate things not only into their mouths but also to consume them.
When presented with a dog or cat, especially one with a previous history of ingesting inappropriate items and frequent vomiting, LazyPaw Veterinarians immediately try to rule out both metabolic problems and a potential foreign body. (A gastrointestinal (GI) foreign body is any consumed object unable to leave the body in the manner in which Nature intended. This failure causes subsequent problems, some of which can be life threatening.)
Initially, a nose to tail inspection is performed and any abnormalities noted. If no obvious physical problems are detected, a complete blood profile is run to rule out evidence of infection, organ dysfunction and metabolic imbalance which could account for the patient’s symptoms. Radiographs are employed as non-invasive means of examining internal organs for shape, size, location and overall appearance. Sometimes the inciting cause of a patient’s symptoms is readily apparent, especially when a dense object made up of bone or one containing metal, such as a fishhook or an engagement ring, has been ingested. These substances are readily identifiable on standard radiographs. Sometimes the abnormal location of the internal organs, say if the entire length of bowel is located on only one side of the abdomen, indicates that an as yet undiagnosed abnormality is changing the patient’s normal, internal abdominal anatomy. A segment of the intestines having the appearance of a string of pearls is a common radiographic finding in cases where a string or other filamentous substance has been consumed causing the bowel to plicate, the so-called “drawstring effect,” while attempting to move the foreign material along its length through normal peristalsis.
Sometimes a foreign item can potentially pass normally through the GI tract but should be removed to prevent the development of a serious toxicity. Cases in which a patient has consumed zinc containing money or lead containing shot or fishing weights are at risk of dying if these items are left to pass out of the body in their own time due to the leaching out of these toxic substances into the bloodstream. In other instances, the ingested item or items may cause or be causing localized damage due to bowel compression, obstruction or even perforation. (Bowel rupture and intestinal content spillage into the abdomen immediately sets up a localized inflammatory response called peritonitis which can lead very quickly to bacterial growth outside of the body’s normal means of containment and resultant sepsis (blood borne infection) leading to fast patient deterioration and death.)
If an item is non-toxic and small enough to likely traverse the length of the GI tract successfully, AND the patient is showing no significant physical or biochemical abnormalities, non-chemical means of GI motility stimulation can be attempted to aid in the more rapid transit and passage of the foreign material. Such conservative, medical therapy consists mainly of small frequent feedings of a moist to wet ration and light walking every 2-3 hours. Close monitoring of patient clinical signs and the object’s progress through serial radiographic studies is performed. Should progress cease or patient clinical signs deteriorate, surgical intervention is warranted.
When an abdominal exploratory surgery is performed, the length of the gastrointestinal tract within the abdomen is visually and physically inspected to determine the location of the foreign material and to assess the health of the bowel through which it has already traversed. In many instances, it is a simple matter to simply remove the offending object, sew up the hole made to permit its extraction (enterotomy), cleanse the affected bowel and abdomen with sterile saline and then close the abdominal incision and recover the patient. (To date, the most exotic items LazyPaw veterinarians have surgically removed from their patients have been corn cobs, golf balls, men’s athletic socks, wine corks, rubber garden hose, a Spiro the Dragon, and women’s lingerie!)
After a few weeks’ of a special diet, restricted and controlled exercise, and treatment with antibiotic and pain relieving medications, most patients are as good as new. In some instances the foreign body has been in place for so long or has completely obstructed the bowel causing localized ischemia (loss of life-sustaining blood flow) that the injured segment must be fully removed and the remaining two, normal appearing ends reattached (resection and anastomosis). This intervention too can be recovered from provided the affected length of bowel is not substantial and that proper at-home care therapy is performed.