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!
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