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lukeLuke's Intestinal Foreign Body

Luke is a 7 year old Shepard mix who presented to us last month with a history of vomiting and reduced appetite for a period of 4 days. During the history taking, the owners thought that Luke might have eaten a rag a few days before the symptoms began. Nothing else had changed in the house and Luke was not exposed to any new foods or toxins.

On presentation, Luke was subdued (he's usually very rambunctious) and appeared a bit dehydrated. His abdomen was tense but I was unable to feel any discrete mass. Based on the history, we did a diagnostic workup consisting of radiographs (x-rays) of the belly, and bloodwork. On the radiographs, the intestines appeared bunched together, but we were
unable to definitively see any foreign body. (The reason for this is that cloth, strings and non metallic or stone foreign bodies don’t often show up
on normal radiographs). The bloodwork was normal for a dog of his age with evidence of mild dehydration.

Based on the history and the suspicious radiographs, we decided with the owners to perform an abdominal exploratory surgery. After rehydrating Luke with intravenous fluids, we took him to surgery. Upon opening the belly, the
intestines were clumped into a tight ball in the center of the abdomen. This is a typical presentation for a linear foreign body in the intestine because the intestine "climbs up" the foreign body as a result of the normal peristaltic motion of the intestine.

bunched_intestines
linear_foreign_body
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Bunched intestines  

Foreign Body 

  

Close up of Foreign body

            (double click on pictures to enlarge.)

We opened the stomach and intestines and found a rubbererized toy of some ort. The intestine was close to rupturing and so we were forced to remove 4.5 feet of it in order to save Luke's life. We reconnected (anastamosed) the fresh ends together and closed Luke up. His recovery from anesthesia was uneventful and over the following days he improved dramatically. We sent Luke home on antibiotics, pain medication and special diets.


He was doing well at home when about 3 days later he started to get depressed and appeared painful. The owners returned to the hospital and we ran more tests only to find that Luke was having trouble passing urine. We attempted to obtain a urine sample by passing a catheter up the urethra and felt granular material hitting the catheter indicating urinary stones. We reviewed the pre operative abdominal radiographs and no stones were visible. Knowing that stones take weeks to months to form, we assumed that these stones were not visible with x-rays or radiolucent. Because of the danger involved in urinary obstruction, we took Luke to surgery again and performed a cystotomy (opening of the bladder ) to remove the stones and a pre-scrotal urethrostomy (opening in the urethra to the outside of the body) to make sure that Luke will be able to pass any residual stones. Male dogs have a bone in their penis which has a small, non-elastic opening. Stones that may be able to pass through the flexible urethra invariably get stuck at the opening of this bone. Therefore the urethrostomy site is placed in the area of the urethra before the bone.

urethrostomy
Urethrostomy site post operatively

Luke recovered beautifully from both surgeries and is doing well at home. He is still on antibiotics to clear up the urinary infection which caused the stone formation. He has a very bright future ahead of him.