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  News from the Maryland Veterinary Medical Association                                                   Spring 2012

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Guess What I Saw?

by Elizabeth Daher, DVM, Greater Annapolis Veterinary Hospital

Vincent, a 9 year old male, castrated Labrador retriever, presented to GAVH on 1/3/12 with a 7- day history of vomiting. Initially vomiting was intermittent, but became constant, and the dog was unable to drink or eat without vomiting. On the day of presentation the owner reported Vincent was very lethargic and had lost interest in food and water. Upon exam he was quiet, with pale pink, tacky mucous membranes, and he was very painful upon abdominal palpation, especially cranially. Differential diagnoses included inflammatory, metabolic, or anatomic/obstructive disease.

Abdominal radiographs revealed a spoon foreign body in the cranial abdomen. An in-house CBC and chemistry panel revealed a mild anemia and a leukocytosis. Vincent was then admitted for abdominal exploratory surgery to remove the spoon.

After routine anesthetic induction and preparation, the abdomen was entered via a midline incision. The abdominal cavity contained brown liquid, hair, and grass. A 6 cm granulation/omental ball was seen attached to the greater curvature of the stomach, with 5 cm of a spoon handle protruding from the center. Dissection down the handle revealed the gastric mucosa; the opening in the stomach was enlarged to remove the spoon bowl. The stomach was debrided and closed in multiple layers. The abdomen was flushed with 2 liters of saline and suctioned. The remainder of the abdomen was quickly explored as the patient was becoming hypotensive . The omentum and organs were red, with

fibrin clots throughout the abdominal cavity. The body wall was closed quickly and the skin was stapled. Anesthetic recovery was prolonged, but otherwise uneventful . The prognosis was listed as guarded.

Peritonitis is a common consequence of foreign object penetration of the gastrointestinal tract or body wall, and the bacterial infections are usually mixed. Four quadrant antimicrobial therapy (against Gram positive, Gram negative, aerobic and anaerobic bacteria) is indicated at the time of diagnosis, with attention to support of blood pressure and circulatory perfusion, and pain management, with timely exploration when the patient has been stabilized. The post operative management of septic peritonitis may include placement of closed suction devices or maintaining the abdomen open if abdominal contamination or the resulting exudate is severe.

Vincent has done well since his release from the hospital with a simple treatment regimen of antibiotics and pain management. That’s certainly the last time he ever gets to lick the spoon!

Send Us Your Interesting Case

The Maryland Veterinarian invites you to submit an interesting case for our recurring feature "Guess What I Saw!" Highlight your special interest or your practice’s special services, or just tell the readers about a "Gee whiz" case. Electronic submissions should be 750 to 1500 words in length, and use an eye-catching illustration in jpeg format.

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