Monday, June 18, 2012

Gastrointestinal Foreign Bodies

By Beth Guerra, DVM  

In my eleven years as a veterinarian, I have amassed quite a list of objects I have removed from the GI tract of dogs and cats. We veterinarians all have that one item we have pulled from the stomach or intestine that seems unique. I am constantly amazed at the ability of our furry friends to actually swallow these objects. I have seen some spectacular objects pass through with no problem, like straight pins and acorns, but I more frequently deal with patients where the offending object has caused an obstruction. Objects that make it into the stomach have two options; either they will be vomited up or try to leave the stomach through the pylorus. If the object is too big to advance into the intestine, it will remain in the body of the stomach and usually causes intermittent vomiting. Objects that advance into the small bowel will either pass without incident or cause a bowel obstruction.

Patients with GI foreign bodies can have a variety of symptoms, including vomiting, inappetance, or abdominal pain. Some pets will still want to eat but will vomit partially digested stomach contents shortly afterwards. In smaller dogs or cats, the foreign object can often be felt on abdominal palpation. Diagnosis is usually based on x-rays. Some objects, such as rocks or metal, show up easily on an x-ray, but others like cloth can be difficult to visualize, so a diagnosis of obstruction is made based on the appearance of the intestines and gas patterns. Abdominal ultrasound is used in those cases where the x-ray is inconclusive.

A rapid diagnosis and treatment of GI obstructions is ideal, especially when objects are obstructing the small bowel. The longer an object remains in the bowel, the greater the concern for complications such devitalized bowel or intestinal perforation. There can be pressure necrosis, or death of the tissue, over the object. This pressure necrosis can cause the tissue to tear and lead to leakage of intestinal contents into the abdominal cavity. In severe cases, the compromised bowel may need to be resected. If perforation has occurred, the resulting infection in the abdomen, called peritonitis, can be fatal.

Obstructing foreign bodies often need surgery. In some cases where a small, smooth object is in the stomach, the veterinarian may induce vomiting to see if the object can be retrieved. Alternatively, endoscopy can be attempted to pull the object out through the esophagus. If the object is sharp, very large or no longer in the stomach, surgery is indicated. The patient is usually started on aggressive fluid therapy to combat dehydration from vomiting, and in rare cases, this can encourage an object to pass. If the duration of symptoms is more than several days, or if there is concern for bowel perforation, surgery should not be delayed. With prompt treatment, pets often recover uneventfully from these surgeries.

Ingestion of foreign bodies can be prevented by providing your pet with toys that are adequately sized for the breed of dog to prevent accidental swallowing. You should also consider supervising your dog when offering treats such as large rawhides or greenies to make sure the treat is chewed slowly and not gulped down in large chunks. If you suspect that your pet has ingested something inappropriate or is showing clinical symptoms, a veterinary exam is recommended sooner rather than later.

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