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."