Small animal veterinary case study - canine duodenal foreign body

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Case study

History
The patient was a 4-year old, 22.5kg, female, Labrador Retriever that presented with a four-day history of vomiting, inappetance and lethargy. The patient last had a season approximately 4 months previously. There was no history of pica.

Clinical signs
The patient was quiet and responsive on presentation, however she collapsed in the consulting room. Rectal temperature was 38.9°C. Oral mucous membranes were pink and dry with a capillary refill time of approximately 4 seconds and decreased skin turgor above the orbit.

Her heart rate was 144 beats per minute with no cardiac murmurs or adventitious lung sounds apparent on thoracic auscultation. There were no pulse deficits however femoral pulses were weak bilaterally.

Respiratory rate was 40 breaths per minute with no evidence of dyspnoea. Abdominal distension was noted and significant discomfort was elicited on palpation of the cranial to mid-abdomen.
A large, firm structure in the region of the stomach was noted on palpation with evidence of gaseous distension on percussion.

Investigation
Haematology, biochemistry and urinalysis indicated a prerenal azotaemia with dehydration estimated at 10% and electrolyte abnormalities consistent with persistent vomiting. Abdominal radiographs were obtained to further evaluate the patient for suspected gastrointestinal disease.

Radiography was performed without sedation in the conscious patient. Orthogonal views (Radiograph 1 - right lateral; and Radiograph 2 - dorsoventral) of the abdomen were obtained.


The radiographs are of diagnostic quality with good patient positioning, collimation to the areas of interest and adequate exposure. There is no right/left marker present on the radiographs.

The primary radiographic abnormality observed on both views is significant gastric dilatation in the cranial abdomen with mixed soft tissue and gas opacity. Loops of small intestine are caudally displaced and there is faecal material is present in the colon.

There is gas present within a loop of intestine observed in the caudodorsal abdomen on the lateral radiograph, however the remainder of the small intestine is non-distended. On the ventrodorsal view, there is a large gas opacity in the fundic region of the stomach and there are smaller, focal, spherical gas opacities in the right cranial abdomen which may be present within the proximal duodenum.

Radiography was performed in this case to rule out the presence of possible differential diagnoses such as gastric dilatation and volvulus (GDV) and pyometra.


Diagnosis
The radiographic findings are consistent with gastrointestinal disease and a possible foreign body.


Treatment/procedure
Treatment options were discussed with the owner and exploratory laparotomy to investigate for a suspected gastrointestinal foreign body was advised. The owner consented to surgical exploration following initial stabilisation of the patient.

Intravenous fluid therapy was initiated to correct for dehydration and electrolyte abnormalities. Gastric decompression was performed through introduction of an orogastric tube enabling approximately 300ml of fluid to be recovered from the gastric lumen.

Twenty-four hours after presentation and following initial stabilisation, the patient was placed under general anaesthesia and an exploratory laparotomy was performed. A foreign body was identified in the proximal duodenum causing complete obstruction of the intestinal lumen. The foreign body (a piece of towel) was removed via enterotomy. No further abnormalities were noted and the surgical site was closed routinely.

The patient was monitored closely following surgery and was discharged with analgesia, antibiotics, gastric protectant medications and anti-emetics. The owner was instructed to feed small meals, monitor the surgical site and restrict patient exercise. At the recheck visit 5 days after discharge, the patient was eating well with no further vomiting episodes and the surgical site was clean and dry. At the 10 day recheck, the abdominal incision was well healed.

Outcome
The patient recovered without further complications or recurrence of the presenting clinical signs.

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