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INTESTINAL OBSTRUCTION IN A DOG FROM A FOREIGN BODY

Intestinal obstruction from a foreign body is fairly common in dogs.  Dogs seem to like to chew on and even consume odd things at times; and there isn't a veterinarian anywhere that wasn't amazed on occasion at what ends up in the gastro-intestinal tract of dogs and cats.  Obstruction of the intestines in dogs and cats is always considered an emergency situation.  In the case presented below the dog, a 60 pound mixed breed of six years of age, had been vomiting, had stopped eating for three days and although he was drinking water, at the time he was presented to the doctor he was vomiting any water he drank as well.  

Upon physical examination it was noted that his temperature was slightly elevated at 103 degrees.  His abdomen was slightly tense but the veterinarian was able to palpate (feel with his hands) a firm mass in the central abdomen.  The dog was taken to Radiology and you can see the x-ray image on the right.  Click on it to see a larger image of the x-ray of the intestinal obstruction in this dog.  Some routine laboratory tests were done to make sure the dog was not seriously dehydrated and that organ systems were working well.  

The patient was taken to surgery, an i.v. fluid administration line was inserted, antibiotics were administered and anesthesia given.  The surgery indicated that the rock was part way down the small intestine but due to muscle cramping around the object, it was "captured" by the spastic intestinal segment and was not moving any further.  Severe inflammation and swelling was present but the blood supply seemed intact so the surgeon decided rather than removing an entire section of the obstructed intestine that an incision over the obstruction and removal through the incised intestinal wall would be the ideal method of removal in this case.  On  occasion, if there is severe necrosis (death) of the intestinal tissue over an obstruction, the damaged section needs to be removed entirely and the open ends of the intestine are then sutured back to together at a point where healthy tissue is present.

It is interesting to note that smooth, rounded objects such as golf balls, marbles, coins and beads have a higher chance of obstructing the intestinal tract than irregularly shaped and sharp objects.  If a smooth rounded foreign object gets into the intestinal tract, the intestinal muscles seem to go into a spasm and constrict around the object, thereby creating an obstruction.  Usually when a sharp object enters the intestinal tract the sharp or pointed object will stimulate the intestinal wall to "back off" from constricting around it.  Eventually such items as wire fragments, bone shards, tacks and nails will make their way to the larger and more spacious colon to be passed out in the stool.

INTESTINAL OBSTRUCTION SURGERY IN A DOG

Click on an image to see a larger view.
Under sterile conditions the incision is made in the midline of  the abdomen	The segment of intestine that is obstructed is isolated and carefully examined to see if the blood flow has been compromised.	In this case the incision is made over the obstruction lengthwise along the small intestine.	The foreign body, a small rock, is seen at the intestinal incision.
The surgical area is evaluated for blood flow and  is rinsed with antiseptic solution.	The first row of sutures goes into the deep mucosal layer of the intestine.	The second row of sutures closes the muscular layer of the intestine.	The incision is carefully inspected for leaks and the blood supply evaluated.
A section of the abdominal fatty sheet called the omentum is sutured over the incision to assist with healing.	The omentum is has an active blood supply and helps to seal the incision and improves the rate of healing.  ZOOM for close-up view.	The abdominal wall is closed in layers.	The patient is viewed after surgery.  The skin incision should be healed within ten days.

POST OPERATIVE CARE

All surgeries where the intestinal tract is entered requires vigilance for the possibility of leakage of contaminated intestinal contents.  If this happens, peritonitis (infection of the lining and support tissues of the abdomen) can have dangerous consequences.  The patient is monitored carefully for signs of fever (over 102.5 degrees in a dog) and abdominal pain.  Antibiotics are generally administered for a week to ten days. Liquids are allowed from 12 hours after surgery and for the first three days.  Then yogurt and mushy foods are fed for five days.  If all is well and the patient seems to be healing and feeling well, regular high quality dog food is fed.  Skin sutures are removed ten to twelve days post operatively.  The patient is firmly instructed never to consume rocks again!
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