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Gastrotomy to remove a foreign body, Gainesville FL

Foreign Body Removal
Gastrointestinal Obstruction/Intestinal Blockage

Foreign body obstruction occurs when the stomach or intestines become blocked from your pet eating a non-food item. We call these items “foreign bodies” to apply to the many different things dogs and cats eat that they aren’t supposed to.

How is this diagnosis made?

  • Physical exam - evaluation for dehydration, abdominal pain, sometimes the foreign body can be felt on abdominal palpation

  • Abdominal X-rays - foreign material or intestinal obstruction may be seen, though not always clear. Some foreign bodies may be obvious, while others blend in with the appearance of the intestine.

  • Chest X-rays - may be performed to check for pneumonia secondary to aspirating vomitus, or foreign material in the esophagus.

  • Abdominal Ultrasound - this test is more sensitive for diagnosing abdominal obstruction and is often used in cases with consistent clinical signs but unclear x-ray results.

  • Blood work - this provides information on the degree of dehydration, and electrolyte abnormalities from loss through vomiting and diarrhea.

What is the treatment protocol for a foreign body obstruction?

Determining which patients will respond to medical management and which will require surgery is a difficult clinical challenge. Veterinarians use all of the available information from the history, physical exam, x-rays, ultrasound, and blood work to make the best decision. However, without a crystal ball, it is impossible to know for sure which patients will require surgery. Typically, if the patient is stable and the obstruction was caught early, medical management is attempted and if the patient does not improve, surgical exploration is recommended.

Overview

My dog eats everything.  Won't this just 'pass' through?

 

Toys, rope, carpet, plastic, sticks, string, bones, trash and clothing are common foreign bodies found in patients with gastrointestinal foreign body obstruction. While some smaller foreign bodies may pass in the stool, the intestine can become obstructed when the material is too large to pass. Sometimes material will expand with digestive fluids or clump together  with other material to become large enough to block the intestine. Foreign bodies with a linear (strings, ropes, carpet, shredded fabrics) component are especially dangerous because they can create perforations (holes) in the intestine if the string becomes tight with digestive motion. Some foreign bodies may also cause chemical damage to the intestinal tract (eg. batteries, cleaning rags, adhesives) or systemic toxicity (eg. lead metals, pennies minted after 1982, poison blocks).

How can I tell if my dog has an 'obstruction'?

 

Animals with foreign body obstruction present with a variety of clinical signs depending on what the foreign body is made of, complete or partial obstruction and duration of obstruction. Common clinical signs in an early obstruction include:

  • Loss of appetite

  • Nausea (salivation, lip-licking behavior)

  • Vomiting

  • Abdominal pain, hunched posture

  • Diarrhea

Excessive vomiting leads to severe dehydration and abnormal blood electrolyte values. If the intestinal obstruction is present for an extended time (>12hr - days), it can cause the intestine to rupture or perforate and spill fecal material into the abdomen. This is a life-threatening condition called a “septic abdomen” because the entire abdomen is contaminated with fecal bacteria and can spread to the rest of the body through the bloodstream (sepsis).  Animals with intestinal perforations are usually much more sick and unstable.

 

In addition to the signs listed above, pets may become weak, lethargic, and more painful. This is a medical and surgical emergency best avoided by early diagnosis and treatment in pets with clinical signs of obstruction.

Medical Management of a Gastrointestinal Obstruction

Some gastrointestinal foreign bodies can be successfully managed without surgery. This decision should be made under the care and guidance of a veterinarian. This always includes fluid therapy to maintain hydration. Normal hydration is important for normal gastrointestinal function. When the patient becomes dehydrated, fluids lubricating the intestinal tract also dry up and can slow the intestinal tract and increase the chance of obstruction. If no intestinal obstruction is present at the time of diagnosis, anti nausea medications may also be used to help decrease vomiting. Examination and X-rays are typically repeated within 12-24 hours of starting medical management to evaluate for signs of improvement or worsening. Sometimes, an abdominal ultrasound is recommended to further evaluate progress. If improvement is appreciated, medical management is continued until clinical signs improve completely, or begin to return. Patients that don’t respond adequately to medical management, or worsen in the face of medical management require surgery.

Endoscopic Treatment of a Gastrointestinal Obstruction

Foreign bodies stuck in the stomach can be removed without surgery using a flexible endoscope camera that is placed through the mouth, down into the stomach. Depending on the size and material of the ingested foreign body, it may or may not be successfully removed using endoscopy. If endoscopic removal fails, surgical removal is recommended. Endoscopic removal is only an option with foreign bodies of the stomach. Once the material moves to the small intestine, the endoscope cannot reach the material. If you know your pet ate foreign material and are concerned for possible obstruction, the sooner they can be seen by a veterinarian, the more likely endoscopic removal will be successful.

Surgical Treatment of a Gastrointestinal Obstruction

Gastrotomy, Enterotomy

The decision to pursue surgery or medical management is made by your veterinarian based on consideration of all information provided by physical examination, x-rays, and blood work. Surgery is indicated in patients presenting with more severe clinical signs, longer duration of obstruction, or that fail to respond to medical management. Pets with evidence of severe obstruction, intestinal perforation, or a linear foreign body on x-rays require emergency surgery.  
 
Surgery to explore the abdominal organs and inspect the gastrointestinal tract is performed. Depending on the location of the foreign body and degree of damage to the intestinal tract, different surgical procedures are performed. Below we outline the best to worst case scenario in foreign body surgery depending on the condition of the affected intestine:
  • Abdominal exploration only - Some foreign bodies do not need an incision into the intestinal tract to relieve the obstruction. The intestine with the foreign body can be massaged in surgery to reshape the material and allow for it to be gently moved all the way to the colon, where the pet can defecate the material out after surgery. This is ideal, as no incision into the intestinal tract is required. Patients can typically return home the same day of surgery.
  • Removal through intestinal incision (Gastrotomy/Enterotomy) - If the obstruction cannot be dislodged and the intestinal tissue is still alive and healthy, then the foreign body is removed through an incision into the intestinal tract to remove the foreign body, and is closed with suture. Depending on how stable the patient is, hospitalization may be recommended.
  • Resection of damaged intestine (Resection & Anastomosis) - If the obstruction cannot be dislodged and the intestinal tissue has been ruptured, or badly damaged, then the whole affected section of intestine is surgically removed along with the foreign body. The remaining healthy ends of the intestinal tract are sutured back together. Depending on how stable the patient is, hospitalization may be recommended
  • Fatal damage to the intestinal tract - In the most severe cases, the intestinal tract may have too much damage to allow for successful surgical repair. In these cases, patients are not able to recover from the intestinal damage and humane euthanasia is indicated. This is fairly uncommon, but more common in patients with more severe signs on presentation, or with longer duration of clinical signs without treatment. 
Early diagnosis and treatment of foreign body obstructions will help prevent the disease process from worsening. For this reason, it is always best to have your pet seen by a veterinarian quickly if they have eaten foreign material or have consistent clinical signs. The best course of action is made under the care and guidance of a veterinarian.

Post-Operative Care/Planning

Depending on severity of clinical signs, and degree of damage to the intestinal tract, some pets will need continued supportive care after surgery for the best chance of full recovery. 

  • Patients who present stable, and are treated early without complication, often can go home the same day as surgery as long as they can be closely observed at home for the next 3-5 days. 

  • Patients with moderate illness secondary to the foreign body ingestion may require a brief hospitalization with supportive care to restore normal hydration and electrolytes.

  • Patients who present with intestinal perforation and sepsis require hospitalization until they are stable enough to return home. They require aggressive supportive care after surgery including IV fluids, antibiotics, blood pressure support, and pain medication to fully recover. Some septic patients unfortunately succumb to the disease despite supportive care. 

Most uncomplicated gastrointestinal surgery has an excellent prognosis. The earlier treatment is provided, the more likely a positive outcome. The most likely time for leakage from the intestinal surgical site is within 3-5 days after surgery. During this time period, your pet should be watched closely for any signs of illness which may indicate this life-threatening complication. In general, your pet should be improving each day after surgery. If they suddenly become worse, less willing to eat, lethargic, or begin vomiting again, they should be seen immediately to rule out dehiscence (leakage at the surgical closure). If leakage occurs, this is a surgical emergency, and requires another abdominal exploration.

Post-Operative Care Once Home

Once the pet is at home, the following post-operative care is to be expected:

  • Close observation at home for 3-5 days after surgery.

  • Bland diet (eg. Hill’s ID) for 1 week after surgery may be recommended.

  • E-collar at all times for 2 weeks, until skin incision check.

  • Exercise restriction for 2 weeks: no off-leash activity allowed, no play, no jumping on/off furniture

  • Pain medication will be prescribed.

  • Antibiotics may be prescribed depending on the patient.

  • Anti-nausea and antacid medications may be prescribed.

What is a Gastronomy or Foreign Body Removal?

For more information about this topic, please visit here. 

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