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| Unhappy intestines. The foreign body is distending this dog's intestine, compromising blood supply. |
Radiographs can tell incredible stories, and often the
best radiographic stories relate to foreign bodies: things that should not be
inside animals that are inadvertently ingested.
Every year, Veterinary Practice News runs their ”They ate
what?!” imaging competition, to highlight the more unusual items dogs, cats and
other species swallow. You can review the impressive results here, and nope, you don't have to work as a vet, nurse or student to interpret most of these x-rays.
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| The foreign body once removed - a piece of rubber from a toy. |
Such as 26 golf balls (all swallowed by one dog). Or a
fishing pole. Gorilla glue, hair ties, a plastic dinosaur, steel wool pads,
teddy bears and rocks also feature. The radiographs presented give an indication of just
how problematic foreign bodies can be, without the full-colour gore we see on the operating table.
They make for great stories, but foreign bodies are
life-threatening. As mentioned in the results of the competition, unfortunately
not all of the patients made it. Why not?
Even in the best hands, intestinal repairs can break down
(the overall rate of intestinal incision breakdown, or dehiscence, is 12-16 per
cent). The risk of such complications is much higher in animals over time, i.e.
the longer the foreign body is present, the higher the risk. The risk is also
higher in animals that are systemically unwell, septic or those who have had a
previous surgery.
There is a fabulous article by Sabrina Barry explaining
all of this in the latest issue of Clinician’s Brief. Following surgery,
intestine undergoes inflammation in the early stages of healing. Inflammation
actually reduces the holding strength of the wound – so there is a real race between
collagen breakdown and collagen synthesis.
Barry recommends supporting tissue oxygen delivery to the
GIT, minimising contamination, being mindful of vascular anatomy, minimising
inflammation and ensuring vascular wound edges, engaging the submucosa during
suturing (even though its softer than the muscular layer, the submucosa is the
layer that maintains its integrity when other tissues at the wound edge have
lost their strength), approximating submucosal edges, minimising the number of
enterotomies, preserving the omentum and offering early nutrition.
This is a lovely article and well worth a read for anyone
who performs intestinal surgery.
However, you can do all of these things and an intestinal
incision can still break down. As Barry points out, intestinal incisions aren’t
like skin incisions – we can’t inspect them regularly, treat them topically or
just throw in a few additional sutures if we think the wound needs reinforcing.
And foreign bodies can wreak total devastation on the gut, especially those
with sharp or abrasive edges.
Prevention is the best bet. Often, foreign body eaters
are repeat offenders. I’ve surgically retrieved foreign objects from the same
patient (almost invariably a dog) up to four times. They don’t associate eating
the thing they ate with gut pain, nausea, hospitalisation or surgery.
If you notice your animal swallowing things they should
not in your presence, it’s reasonable to expect they will do so in your
absence. Toddler-proof your home, lock your laundry basket, put the garbage
bins out of reach, block access to the compost – it’s worth the inconvenience.
And if you see your pet swallow something, seek immediate
veterinary attention. Sometimes these objects can be retrieved by inducing
vomiting or endoscopy, before they hit the intestines.
Reference
Barry, SL (2016) Intedyinal incision dehiscence. Clinician’s Brief April 2016: 71-76.
