D. E. Larsen, DVM
I rolled over and looked at the clock; it was one thirty. Then the phone rang again. Yesterday had been a hectic day. I was tempted to let the phone ring, but Sandy elbowed me in the ribs.
“Hello, this is Dr. Larsen,” I said into the phone.
“I’m so sorry to wake you up, Doc,” the female voice answered. “This is Barbara, and Sierra’s blanket is missing.”
Barbara was a good client and a breeder of registered Malamutes. Most months, she visited the clinic several times, and it was unlike her to call about a simple problem.
“Barbara, you called because you can’t find Sierra’s blanket?” I asked.
“It’s gone, Doctor,” Barbara said, close to tears. “I know you think I am crazy, but the whole thing is gone. She has been in her kennel, and I think she ate it.”
“When do you think this happened?” I asked.
“I woke up just now because Sierra was gagging and making some terrible sounds,” Barbara said. “She is really distressed, and her blanket is missing. There is no way the blanket could get out of the kennel. She had to have eaten it.”
“If that happened, I probably should check her,” I said.
“Oh, thank you, Doc,” Barbara said. “She is so distressed. I don’t think it would wait till morning.”
“It will take me at least a half hour to get to the clinic,” I said. “I was sound asleep.”
“I’m so sorry, Doc,” Barbara said.
“That’s okay, I wasn’t going to come to help you look for a blanket, but if it is a medical emergency, that is just part of this job,” I said.
I got up and pulled on my clothes.
“Are you going be alright with this alone?” Sandy asked as she rolled over.
“I guess it will be Barbara and me,” I said. “We can’t drag the kids to the clinic on a school night at this hour, and Judy and Dixie are in the same boat. Hopefully, it won’t be something that requires surgery.”
Barbara and Sierra were waiting at the clinic when I pulled up.
Sierra was standing at the door and gagging and trying to vomit. The noise she was making was loud, almost a bark.
“That doesn’t sound good,” I said as I unlocked the door.
“She has been doing that constantly since she woke me up,” Barbara said.
I did a quick exam on Sierra. Everything was okay except for some abdominal distress when I palpated her belly.
“Make yourself comfortable, Barbara,” I said. “I am going to get a couple of x-rays of Sierra’s abdomen just to make sure something is in there.”
As soon as the x-rays were developed, I held them up to the viewer. Her stomach was stuffed with what we could assume was her blanket. The thing that was most concerning was a lot of content was making its way down the small intestinal tract. Fabric in the small intestines can result in a string effect where the gut accordions up on the string, which can wear through the gut wall in multiple locations.
“Barbara, it looks like the blanket is in her stomach,” I said. “The most disturbing thing is it has started down the small intestines. We should plan an exploratory surgery and get things out of there.”
“Can you do that tonight, Doctor?”
“It would be better to wait until morning when I have help,” I said. “But the problem is the longer we wait, the greater the potential for major intestinal injury. I have seen string foreign bodies that were fatal events.”
“If you can do it tonight, that would be great,” Barbara said. “I am no medical person, but I could help as much as possible.”
“There is a risk for me to do this surgery alone,” I said. “I am going to be opening the gut, maybe in a couple of places, and there will be a risk of contamination.”
“And you said there is a risk if we wait until morning,” Barbara said. “I elect to assume the risk tonight.”
With that settled, I had Barbara help me get Sierra on the surgery table and under anesthesia. I set up the surgery for the worst-case scenario, laying out several sets of gloves, multiple suture packs, and an extra surgery pack for closure.
I gave Barbara a two-minute lesson on sterile technique, showing her how to open suture packs and gloves. Then I got started with the surgery.
I made a long incision on the ventral midline and opened the abdomen. Sierra’s stomach was stuffed full with the blanket.
After securing the stomach and packing it off with lap pads, I opened it with a small incision. Then I started teasing the blanket out of the incision.
How stupid was this dog to eat the whole thing? The blanket just kept coming. Sometimes in pieces, sometimes in long strips. After removing most of the blanket from the stomach, I could see some blanket was still in the esophagus. Luckily, I could pull it into the stomach and remove it. The bad luck was the blanket pieces were starting into the small intestine. I was able to retrieve some of it, but I would have to open the intestines to get the rest.
After closing the stomach incision, I started exploring down the small intestine. It was stuffed with content for a considerable distance.
I picked a midpoint and hoped I could get all of the blanket out with one incision.
“I am going to have to open the intestines to get the rest of the blanket out,” I said to Barbara, sitting in a chair in the corner of the surgery room. “The problem is every time I open the gut, it increases the chances of contamination of the abdomen and the incision. Those chances are increased with me working alone. But we can’t leave this stuff in there.”
“I am amazed that she ate all of that,” Barbara said.
“It’s probably good that we are doing this surgery tonight,” I said. “By morning, she would have had this blanket most of the way down her gut.”
I isolated the selected loop of the bowel and opened it with a one-inch incision. I started pulling blanket material from the incision. It was easy to pull the fabric down through the incision from the upper portions of the intestine, but I had difficulty removing the material from the lower portions of the gut. When I had pulled all that I could from this incision, there was still blanket content lower in the tract.
From the second incision in the gut, I got the rest of the blanket. I was careful to flush the incisions and ensure everything was out of the gut. I instilled some saline and gentamicin into the abdomen before closing the incision.
After giving Sierra a dose of IV antibiotics, we recovered her in a kennel without a blanket. She was comfortable on recovery and not showing any of the distress that was apparent when she came to the clinic.
“I think she will be fine here for the rest of the night,” I said. “I need to check her over in the morning before sending her home.”
“When should I check with you in the morning?” Barbara asked.
“Not too early,” I said. “I might not be here at opening time, and I need some time to check that incision before sending Sierra home. We are going to have to keep a close eye on her incision. Plus, we need to give her some fluids again in the morning, and we will need to have her on nothing by mouth until the following morning. Then we can give her liquids for a few days before starting a soft diet.”
Sierra was feeling well by the time Barbara came to pick her up. I cautioned Barbara to watch the incision closely and lined out the diet and antibiotics regimen more time.
Only three days later, Barbara was back at the clinic with Sierra.
“I was worried about being a nuisance,” Barbara said. “But the incision is starting to weep some fluid at the upper end this morning.”
“You are not a nuisance, Barbara,” I said. “This is what you are supposed to do. We need to correct this incision now. It would be breaking open tomorrow had you not brought her in today.”
We went back to surgery with Sierra. I opened the incision. The first few sutures of the incision were starting to break down. I removed all the sutures and derided the infected areas. Then I closed the incision with stainless steel sutures.
I kicked myself out of having the forethought to use stainless steel in the initial closure. All the newer suture material will break down in an infected closure, but stainless steel will not allow dehiscence.
Sierra healed well after that, and Barbara was both thankful and apologetic every time she saw me for many weeks following Sierra’s recovery. She also changed to using commercial kennel mats instead of blankets.
Photo by Mark Sc on Pexels.