Friday, November 30, 2007

Foreign Body Friday

Here we begin a new feature on KatDoc's World, "Foreign Body Friday." {Note to those with delicate systems: This post might be too gross for you.}

A foreign body is vet-speak for "something in the gastrointestinal tract that doesn't belong there." Since most patients with a GI foreign body require surgery, we really don't want to see a case every week
. This series will appear at random, just as in real life.

Jack presented on a Friday morning, with a history of vomiting all night long. In the first episode, he threw up a cardboard paper towel roll, and by morning, he had passed a large wad of paper towels, so when I felt a thickened loop of small intestine, I figured he had more paper towels inside him. Toilet paper and most paper towels will break down and be passed out in the bowels, so I wasn't too worried at first. Jack was alert, well hydrated, not painful, not vomiting, and had stable vital signs, so we gave him IV fluids and monitored him. By Saturday morning, he had not eaten or passed any stool. I could still feel a mass in his intestines, and he was acting a little lethargic.

Abdominal X-rays were taken Friday and Saturday. Before I show you the films, here's a review on how to read X-rays.

In X-rays, air is black, bones are white and the soft tissues (organs, muscle, etc.) are various shades of gray. Metal and mineral densities (bullets, lead sinkers, coins, rocks, etc.) are even whiter than bones. My standard positioning for lateral (side) view X-rays is to put the dog's head on our left, his tail on our right, with his back at the top and his belly at the bottom of the viewer. Are you with me?

Here is Jack, laying on his side. You can see his backbone running across the top of the X-ray. At the upper left corner, you can see a triangular wedge of black, which is the air in his lungs. You should also see his rib cage. Superimposed over that you can see some large, black, gas-filled "sausages," which are dilated bowel loops.

If you look closely, and if you have a good imagination, you can see two roughly circular areas, one over the lung and one over the backbone. This is the end-on view as you look down the tubes of the dilated bowels. This is what we call "an obstructive pattern." Something is blocking the flow, and gas and fluids are backing up behind that obstruction.

Move to the bottom right hand corner of the X-ray. Do you see a wide, gray, hazy, semi-circular tube shape? Here is a close-up of that area:

See it now? (It helps if you sit back from your monitor as you view the X-ray.) That is our foreign object. We describe it as "soft tissue density." (Not metal, rock, bone or air, but something in between.)

For those still having trouble, I added some indicators:

This is our patient, recovering after surgery to remove his GI foreign body.

"It seemed like a good idea at the time."

It was NOT more paper towels. It was, in fact, a sock. In retrospect, given Jack's love of sock-eating, I might have been more aggressive with this case and taken him to surgery Friday afternoon instead of waiting till Saturday morning, but he fooled me with the paper towel history.

Cloth objects are potentially life-threatening. The sock or hair scrunchy or pot holder or beach towel (all things I have taken out of dogs) gets stuck to the mucosal lining of the intestine, and begins absorbing the fluids. Now, it refuses to move along, and if it stays in one spot too long, the tissues begin to die. I worry more about socks than I do about TV remotes and popsicle sticks when it comes to GI foreign bodies.

I also have a photo of the sock. Before you scroll down to see it, I should remind you that it spent 36 hours in a dog's intestine, and it is not pretty. Be sure you really want to see it before proceeding.

. . .

I'm not kidding. This thing is gross. Are you absolutely certain you want to see it?

. . .

This is your last warning. Don't blame me if you lose your lunch after viewing this photo.

. . .

OK, here you go. One GI foreign body, specifically a sock, removed from the small intestine of a young Standard Poodle:

I told you it was nasty.
You should be glad you don't have
"smell-o-vision" on your monitor.
It smells worse than it looks!

The take-home lesson here is "Socks are not toys."


Lisa at Greenbow said...

This makes me thankful for one more thing...I have never had a dog that ate cloth, clothing or TP.
I can't imagine having to deal with that. The poor creatures.

Liza Lee Miller said...

When I used to show labs, we'd get them x-rayed regularly for their hips. Their GI tract usually showed up nicely on the xrays as they almost all had gravel in their guts.

I did have one dog that ate something fabric. I didn't realize how far in it went . . . it was a pair of panty hose and one leg was in and the rest was out. I pulled. In retrospect, I wouldn't have done that one my own again, but it did work out fine although the horror of pulling that much fabric out of her has stayed with me.

Amazing critters. And thanks for that picture of Jack -- hilarious expression on his face. :)

Anonymous said...

What is it about socks that some dogs find so fascinating? We have a friend whose Golden Retriever goes looking for them. They give her peroxide to make her throw them up. Is that a good practice?

Mary said...

My dogs always passed what they ate...ID tag, tree ornaments, etc. I've had more trouble with cats. My daughter's cat swallowed a sewing needle last winter which required surgery. How on earth can human or animal swallow a needle? I had a cat many years ago who swallowed a sport shoe lace. I didn't know it until I saw her acting strangely...and began to regurgitate a pile of shoe lace and finished the job. Unbelievable!

Poor Jack. I hope he gives up socks.

Lisa said...

What I've noted about cats in particular, but somewhat also with dogs, is that as they chew and lick at any string-y thing it goes further and further down their gullet. Must be some evolutionary thing designed to get food down their throats. If there was a length of thread attached to that needle I could easily see it going down...

Kathy said...

I'm glad the poodle will be fine, thanks to your good care. He looks handsome, even in his fasionable collar. I had no problem looking at the nasty sock, but I'm sure if I smelled it I would not feel well. My dogs tear up cloth items, but so far don't seem to eat them.

KatDoc said...

Liza Lee: When I was in high school, I had a Dachshund that ate everything. One time, she was passing a pair of pantyhose. I took hold of the part that was exposed and pulled the rest out. It wasn't until I was in vet school that I found out how dangerous that practice can be. Luckily, both our dogs survived!

Anon: If a dog has eaten something like a sock within the hour, you can use hydrogen peroxide to try to induce vomiting. I have done it many times, and often, it works. If it has been longer than 2 hours, however, the thing has likely moved into the small intestine, and this kind of first aid won't work.

Mary and Lisa: Needles and thread are a very common cat thing. I think they start with the thread and get the needle by accident.

True story: I was examining a cat once, a routine health exam for vaccinations, and as my hand brushed along the cat's neck, I felt something sharp jag me. Upon further investigation, I found the point of a needle sticking OUT of the cat. I carefully pulled it, and the rest of the needle, plus the thread, came out! The cat had swallowed them, and the needle worked its way out from the esophagus through the subcutaneous tissues and skin. The cat had no symptoms, the owners never suspected a problem, and Kitty was fine!

I will never fail to be amazed at the things pets eat.

Glad you enjoyed Foreign Body Friday. I'll be sure to post the next one. It may be Jack - he was caught eating the turkey neck after Thanksgiving!


Sara said...

This post is so well written, from the title to the last word. You do know how to turn a phrase. I laughed so much at the picture of poor Jack, the expression on his face is priceless ! I hope he is doing well, otherwise I'd feel really guilty for laughing. Fascinating story, thanks !

Mary C said...

Hi Kat Doc - a very informative post - thanks. I didn't realize that cats swallowing needles was "common." I had to deal with this same incident a couple years ago. And yes, it's the thread my cat went after. We rushed him to an emergency vet and they performed surgery on him. He is aptly named Tornado - faster than the average cat! ;o)

Julie Zickefoose said...

I love love love love this post, from the first word to Jack looking sheepish. How you discern that foreign body in the X-ray is beyond me. And I am so excited about your pot habit. Bill took a pottery course and loved it, too. Wish he'd do more of that. We could recreate that famous scene from Ghost, only backerds.

Thanks for the tip about hydrogen peroxide. Just another miraculous use of this most wonderful liquid.

This blog is da bomb.

KatDoc said...

Thanks for the kind comments, all. Glad you liked this one. I actually sat on it for a couple of weeks, as I was not sure how much my readers could take in the "gross-out dept." (Except you, Zick - I know I could never turn your stomach!)

Took out Jack's sutures last week, and he gave me kisses afterwards, so I know he forgives me.