Surgical strategies
Photo 4: An intraoperative photo of the patient in Photos 2 and 3. Note the obvious foreign body in the jejunum.
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Common procedures performed for GI foreign bodies include gastrotomy, enterotomy (Photos 4 to 6,) or intestinal resection
and anastomosis. Before gastrotomy, pass a gastric tube to remove excess fluid and gas. Isolate the affected sites from the
rest of the abdomen, change instruments and gloves after completion and before closure to minimize contamination and, if indicated,
obtain full-thickness biopsy samples prior to closing the site.
Photo 5: An enterotomy has been done, and a portion of a rubber ball is being removed.
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You may be able to offer prophylactic gastropexy in cases of an uncomplicated foreign body. Gastropexy should be done at a
new site at the pyloric antrum, not at the original gastrotomy site. A linear foreign body may require gastrotomy and one
or more enterotomies. As always, plan your surgery to retrieve as much material as possible through the fewest sites. Perform
intestinal resection and anastomosis when the intestine is compromised, nonviable or perforated. If there are multiple perforations
or segmental regions of compromise, plan your surgery to minimize the number of resections needed. Risk of dehiscence does
not significantly increase with multiple intestinal procedures, but surgery time is prolonged.
Photo 6: The enterotomy has been completed, and the site is being leak-tested with sterile saline solution.
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If you do enough surgery, you will, at some point, have what appears to be a negative exploratory. But note, there should
never be a truly negative exploratory. In a case in which a foreign body is not identified, it's strongly recommended that you obtain biopsy
samples of the stomach and small intestinal tract and evaluate the entire abdomen to rule out other causes of GI upset. Discuss
this possibility with the owner before surgery.
Postoperative care and complications
Table 1: Postoperative recommendations
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Standard postoperative care for GI foreign body patients is shown in Table 1.
The most detrimental complication after gastrointestinal surgery is leakage or dehiscence of the surgical site leading to
life-threatening peritonitis. Note that the chance of leakage from a site is greater in dogs requiring surgery for removal
of a foreign body than those needing intestinal surgery for any other reason. Leakage typically results from either poor surgical
technique or a patient's compromised ability to heal. Poor apposition of tissues, improper suturing or stapling techniques
and failure to recognize ischemic, devitalized tissue are technical errors that lead to leakage. A patient's ability to heal
can be compromised by hypoalbuminemia, malnutrition, concurrent disease, medications (e.g., glucocorticoids, nonsteroidal
anti-inflammatory drugs) or by some therapies (e.g., chemotherapy, radiation therapy).
Other potential complications include nausea, vomiting, ileus, anorexia and incisional problems. Most complications can be
addressed medically and will resolve with appropriate supportive therapy. However, if peritonitis occurs, additional surgical
intervention is warranted.
EDITOR'S NOTE: SurgerySTAT is a collaborative column between the American College of Veterinary Surgeons (ACVS) and DVM Newsmagazine.
Dr. Janice Buback is a surgeon with Lakeshore Veterinary Specialists, Port Washington and Racine, Wis. She is a proud Cheesehead
(Go Packers!) and enjoys camping and other outdoor activities with her family and black Labrador, Angus (who so far has not
needed surgery for a foreign body).
Next month, Dr. Kathleen Ham will address the topic of primary hyperparathyroidism.
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