Safe endoscopic removal of a sharp-edged foreign body from a dog's stomach

Although this gastric foreign body was an incidental finding, it was just a matter of time before if caused gastrointestinal distress. Inserting an endoscope through a protective overtube allowed the sharp object to be retrieved without inflicting further damage.
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Apr 01, 2011

An 11-year-old 16.5-lb (7.5-kg) spayed female dachshund was referred to Mississippi State University's College of Veterinary Medicine for evaluation of an acute onset of rear limb paresis. On physical examination, the dog had no conscious proprioception or voluntary movement in either rear leg; however, deep and superficial pain were present in both rear legs. All other rear limb reflexes were intact and considered to be normal. The front limbs were neurologically normal. The primary differential diagnosis was a Hansen type-I disk extrusion affecting spinal cord segments T3-L3. No other abnormalities were noted on physical examination. Except for a stress leukogram, hematologic and serum chemistry profile abnormalities were not noted.


1. A lateral survey radiograph revealing a surprising incidental finding: a triangular, radiopaque foreign body in the stomach lumen.
Survey spinal radiographs revealed a narrowed disk space at T11-T12, but the myelogram showed extradural compression of the dye column at L2-L3. An incidental finding was a radiopaque triangular foreign body with sharp edges in the stomach lumen (Figure 1). The owners had not observed any clinical signs suggestive of gastrointestinal disease. They also could not recall that the dog had eaten anything abnormal.

INITIAL SURGERY

The dog was taken to surgery on the day of admission, and a hemilaminectomy was performed at L2-L3. Herniated disk material found in the spinal canal was removed, and 0.75 mg of methylprednisolone sodium succinate was given intravenously. A wait-and-monitor approach to the gastric foreign body was initially taken since it was not an emergent problem and the patient was not exhibiting clinical signs that could be attributed to the foreign body.

The dog made an uneventful recovery, and its neurologic condition slowly improved. By three days postoperatively, the dog could support weight in its rear limbs. The dog's appetite was normal, and no vomiting was noted. Loose stools, but no melena or hematochezia, were observed, and the patient remained hospitalized.

Abdominal radiographs were repeated on day 3 postoperatively to evaluate the location of the foreign body. The foreign body was still in the stomach along with a large volume of food. A decision to remove the foreign body was made even though it was not causing clinical signs because the continued presence of the foreign body in the stomach put the dog at risk for developing gastric lacerations, erosions, ulcers, and peritonitis due to gastric perforation.1,2

SECOND SURGERY

Endoscopic removal would be attempted first, and, if not successful, a gastrotomy would be performed. The procedure was delayed over the weekend because the large amount of food in the stomach at that time made successful endoscopic visualization and removal of the foreign body highly unlikely. Treatment with cimetidine (60 mg orally t.i.d.) and sucralfate (500 mg orally t.i.d.) was initiated. The patient remained hospitalized.

On day 6 after surgery, abdominal radiographs were repeated; the foreign body was still in the stomach. Food had been withheld from the dog for about 12 hours. The dog was anesthetized and positioned in left lateral recumbency for gastroscopy. An Olympus GIF-100 videoendoscope with an external diameter of 9.5 mm was used. The oropharynx and esophagus were grossly normal, and there was no evidence of trauma.


2. An endoscopic view of the foreign body lying along the greater curvature of the stomach.
The endoscope was advanced into the stomach. The stomach was then insufflated, which allowed visualization of the greater curvature. A triangular foreign body with sharp edges was seen along the greater curvature; it appeared to be a piece of glass (Figure 2). There were some mucosal erosions around the foreign body, but the rest of the gastric mucosa appeared normal.