D. E. Larsen, DVM
“Doc, I am worried sick about Lily,” Dyann said as I listened on the phone. “She has been vomiting since last night. It is so bad now that everything that goes in comes right back up.”
“Has she gotten into anything that you know about?” I asked.
“No, that is what has me so worried,” Dyann said. “She hasn’t been out of the house, and there is nothing in here that she could have gotten.”
“It sounds like we better get a look at her,” I said. “We are a little busy, but if you bring her in, we will hang onto her and get things checked out over a couple of hours. We are going to need to get some x-rays and do some blood work.”
Lily was a Pug. Actually, for a Pug, she was a pretty good specimen. At least Lily didn’t have any significant upper airway problems, so common to the breed. Dyann was really attached to Lily, and she telegraphed her concern with the stress in her voice on the phone.
When Dyann came through the clinic door, we had just had a cancellation, and we ushered her into the exam room.
“I think she is worse now than from when I called,” Dyann said, obviously holding back tears.
Lily was definitely dehydrated, and she was depressed. Otherwise, her exam was not alarming. On rectal exam, her colon was utterly empty. That raised a red flag when coupled with the constant vomiting.
“I can’t feel anything on abdominal palpation,” I said. “An intestinal foreign body has to be high on the list with Lily vomiting coupled with a completely empty colon,” I said. “Like I mentioned on the phone, we need to do some blood work and get some abdominal x-rays.”
“Will that give you all the answers?” Dyann asked.
“One would hope so,” I said. “But, unfortunately, sometimes all the answers are not always obvious. We had more time than I expected when we talked on the phone. We will have time to get the blood work started and get the x-rays. I should be able to give you a call within the hour. If things are obvious, that will be good. If not, we might have to make a couple decisions.”
“What kind of decisions are you talking about?” Dyann asked.
“I can’t feel anything in her abdomen on palpation,” I said. “Pugs are a little compact, and their abdomen is difficult to palpate. Sometimes, if there is a foreign body, it will not always show up on an x-ray. If it is not obvious, we will have to decide between using some barium or just going to exploratory surgery. Using barium allows us to see the gut a little better and define an obstruction. The problem is if we have to open the gut, the barium remaining in the gut greatly increases the chances of complications if there is a little leakage of it into the abdomen.”
“What about the exploratory?” Dyann said.
“An exploratory is just that,” I said. “We have an idea about what is going on, but we have to go in and look. If we find something that is fixable, we can generally fix it at the time. If we find something unexpected, like a soft tissue tumor that is causing the obstruction, we might have to close up and make other plans.”
“Now I am apprehensive,” Dyann said. “Do you think this could be a tumor?”
“No, those things usually cause other problems before they reach a point of an obstruction,” I said. “But Dyann, I have seen a lot of things in an abdomen that was completely unexpected. I favor an exploratory over the use of barium in a case like this. Hopefully, we can see what we need to see on the plain films.”
“Okay, I will go home and wait for your call,” Dyann said. “If you have to do surgery, when will that happen?”
“We will move appointments around and get Lily on the surgery table as soon as we have a firm decision,” I said. “If you want to come back and see her before surgery, that would be okay. We are going to have to get some fluids into her before we start and surgery.”
“That makes me feel better,” Dyann said. “I will be waiting for your call.”
Blood results showed pretty normal liver and kidney function, along with some significant dehydration. The electrolyte values supported a probable intestinal obstruction.
Unfortunately, the x-rays failed to provide a definitive diagnosis. So now, Dyann would have to make a choice between exploratory surgery or barium x-rays.
I gave Dyann a phone call.
“I don’t know, Doctor Larsen,” Dyann said. “I know you said that you favor an exploratory, but I would hate to put her through surgery if it wasn’t necessary.”
“The possibility of leaking some barium when we open the gut is very real,” I said. “That causes a lot of inflammation in the abdomen. I can’t be positive about a foreign body, but I am confident that this is an intestinal obstruction. I have seen exploratory surgeries that failed to find anything, but I would be surprised if that were to be the case here.”
“Okay, let’s go ahead and do the surgery,” Dyann said. “I don’t need to come down to see her before surgery. I am so worried. I would probably embarrass myself.”
“We will be doing the surgery shortly,” I said. “I think I have a few things to do before we have a block of time set aside of Lily. I will give you a call as soon as I am out of surgery.”
As soon as Lily had enough fluid from her IV to make surgery safe, we got her under anesthesia and prepped for surgery.
I started with a relatively short incision on the ventral midline. I was hoping that I could find a foreign body and elevate it out of this incision without opening the abdomen with a long incision.
Once I had the abdomen open with a three-inch incision, I inserted a couple of fingers with my left hand and swept them through the small intestines. I almost instantly bumped into a hard mass.
I trapped the mass against the abdominal wall with my fingers and pulled it to the midline incision. When I had the mass through the incision, the small intestine upstream from the mass was dilated with fluid. Beyond the mass, the intestine was empty and shriveled in size.
Before opening the gut, I pulled the intestines distal to the mass out of the incision, just to make myself feel confident that there was not another foreign body.
After replacing all the intestines to their normal position, I packed the incision and the exposed loop of gut with the mass with large lap sponges moistened with saline.
I placed a doyen forceps across the dilated intestine to reduce the chance of leakage and contamination of the incision and the abdomen. Then I carefully incised over the mass in the loop of bowel, making an incision just long enough to allow me to express the foreign body out of the gut.
A single ball from the end of a Nylabone dropped onto the waiting surgical sponge. I wondered how that had happened.
I wiped what little intestinal content there was from the edges of the incision. I close this incision with interrupted sutures of Dexon using the crush technique. This allowed for secure closure with no reduction in the lumen size of the gut.
After flushing the area and the abdomen with a saline solution containing gentamicin, I did a routine closure of the abdomen. Then we unhooked Lily from the anesthetic gas and started waking her up.
I headed to the phone to call Dyann.
“Dyann, the surgery went very well, and Lily is waking up now,” I said. “We were able to work through a short incision in the abdomen, and I found a foreign body right away. I removed that mass, and we closed things up. I would expect her to be good as new in a few days.”
“Oh, I am so relieved,” Dyann said. “I have been out of my mind with worry, waiting for this phone to ring. What was it that was causing the problem?”
“It looks like one of the knobs off the end of a Nylabone,” I said. “I am surprised that she could chew one of those off.”
“It wasn’t her,” Dyann said. “Ozie, our large dog, just destroys those bones. Lily probably got in on the end of one of those destruction derbies.”
“Okay, if we can get enough fluid into her by five o’clock, she can go home,” I said. “We will go nothing by mouth until tomorrow afternoon and then only liquids and soft stuff like ice cream for three days. We have a soft canned food that you can use. Then canned food until we get the sutures out in two weeks. If anything concerns you, I should look at it. Otherwise, we will see Lily in two weeks for suture removal.”
“I’ll be there at five,” Dyann said. “And don’t worry, Doctor Larsen, I anything at all looks odd, you will be looking at it.”
Lily healed well, and by the time we removed the sutures, you couldn’t tell that there had ever been a problem with her.
“It looks like Lily gets to be an old dog someday,” I said. “Not all dogs are that lucky.”
“Doctor Larsen, I don’t think luck had a thing to do with it,” Dyann said.
Photo by Nikita Telenkov from Pexels.