Gastrointestinal foreign body surgery

Causes

There are many objects a dog can swallow but cannot be passed through the whole intestinal tract. The foreign body may lead to penetration of the intestinal wall, obstruction of the intestinal lumen and resultant luminal dilation, subsequent inflammation and necrosis of the intestinal wall.

Sometimes thin objects (string or hair) which would normally pass through gets lodged on something firm and results in a linear intestinal foreign body and plication of the bowel.

What signs do animals show?

·         Regurgitation

·         Vomiting

·         Lethargy

·         Inappetence/ anorexia

·         Abdominal pain (photo)

·         Fever

How is an obstruction diagnosed?

Once your pet has been admitted, a thorough examination will be initiated. These include physical examination (evaluation of the hydration status, vitals, and abdominal palption), blood tests and tools to identify the problem. Tools used to find the problem include:

·         Radiography (X-rays) – A useful tool to undercover gas dilatation of the intestinal tract and to discover some foreign materials such as metals or bones

·         Ultrasonography – Compared to radiography, it is helpful in the examination of intestinal wall layers (there are 4 layers to the bowel!), bowel motility and other abdominal organs. Foreign material such as fabric or plastic can be found this way. Ultrasound is also useful in identifying other intra-abdominal concerns.

Treatment

Once the foreign body is diagnosed, surgery to remove the obstruction is indicated. This typically involves making an incision through the abdominal wall (on midline). Upon entering the abdomen, the entire gastrointestinal tract will be examined via direct visualization and palpation to localize the foreign body. The material may be removed by one of the following (or combination) of procedures:

·         Enterotomy – The intestinal wall is incised (cut open) and the foreign body will be removed. The incision wound is then closed with sutures.

·         Enterectomy – If a certain section of the intestinal wall is very unhealthy (necrosis), an enterectomy (resect a section of the intestines) will be performed. The resected ends of the intestines will then be apposed where there are healthy tissues.

·         Gastrotomy – An opening in the stomach to faciltate removal of the material. The opposed ends of the linear incision are then closed primarily with suture material.

Post operative care

Hospitalization: During hospitalization, intravenous fluid therapy will be continuous peri-operatively to restore fluid loss before and during the surgery (due to continuous vomiting and anorexia) and to maintain a stable hydration. Pain relief, antibiotics, antacid and prokinetics (help the intestines to resume functional motility) may be given.

Potential complications

Complications post gastrointestinal surgery are uncommon but can occur. These include:

• wound infection or disruption

• ongoing intestinal obstruction due to bowel narrowing

• breakdown of the bowel incision leading to life threatening peritonitis

Take home tips

It is extremely important to keep an eye on your pets at home. Make sure there are no “dangerous “objects around them. The best treatment is prevention!!! Once a suspected clinical sign is presented, call the hospital immediately. The prognosis for an early-diagnosed foreign body without necrosis of the intestinal wall is very good.