Time to talk about surgery again! Yay!
A fairly ‘common’ non-elective surgery is an Exploratory. Which is a nice general umbrella term for opening up the abdomen and having a look around. Sometimes we do this to just see what we see – check for tumours or abnormalities, take some biopsies of different parts of the intestinal tract, to try to find out why an animal is not doing well or having chronic gastrointestinal issues. Many times the reason we do this surgery is because of indiscriminate appetite. In other words, the animal has eaten something they shouldn’t have and we have to take it out. Probably because it’s stuck. Occasionally because there’s risk involved in letting them try to pass it, and the owner has chosen the risk of surgery over the risk of that sharp object puncturing the intestines.
I’ve done a couple of exploratories with the intention of investigation and biopsy, but by far most often I do an exploratory because of a foreign body obstruction in the intestines (something is stuck and in the way of food getting through). This is because with a foreign body obstruction, either we go in and take it out, or the animal dies. So that’ll be the focus of the rest of this discussion.
Foreign body ingestion can have several different outcomes. Ideally for the pet, and for your bank account, the item works its way through the GI tract and comes out with some poop. Almost as ideal, the animal vomits it back up before it can do any damage. Anything other than those two options is bad news bears for your pet, and for your wallet. There’s the option that whatever they ate is toxic (say, your medication… and entire bottle of Tylenol… a cat eating a Lily…) and while we may not have to remove the item surgically, we will have to deal with treating the toxic effects, sometimes with fingers crossed there’s no long term damage. Then there’s the option that the non-food item they ate (or food-like item, in the case of garbage items like ham bones or food wrappers…) will get stuck in the GI tract. FUN TIMES!
An object that gets stuck has a few options for where to get stuck. I’d say worst case scenario is actually in the esophagus, because that’s super tricky to get out if you can’t get them to hack it up. Then there’s the stomach, which is probably the best place to get stuck, as long as no perforating ulcers occur. Then you have oodles of small intestines to get stuck in. Finally there’s the colon, but if the object made it there, it should be good to be pooped out – as the colon is larger than the small intestine, it stands to reason that if you made it through the long and loopy smaller tube, you can make it through the less loopy, shorter, wider tube!
If the item is in the stomach, we do a gastrotomy – cut open the stomach and remove said item. Always, always, ALWAYS, when we do an exploratory we do actually EXPLORE. The entire intestinal tract should be examined. If something is stuck in the stomach, that doesn’t mean nothing made it down into the intestines and there could be something stuck there as well. If everything is normal and happy and healthy, except the stomach, then once the item is removed and stomach is stitched back shut, you’re good to go.
If the item is stuck in the intestinal tract, there are a couple of options: enterotomy or resection and anastomosis. I much much much MUCH prefer enterotomy. This is when you make an incision in the intestine near the stuck object to pull the stuck object out of, then you sew it shut and away you go. Resection and anasatomosis is when you have to actual remove the section of intestine where the object is stuck because the tissue is far too damaged to leave behind, and then you have two healthy ends of intestines to sew back together. It’s a bit tricksier, and a bit riskier for the animal. And, frankly, more awkward for me as a surgeon, the whole making tiny stitches all around the circumference of a tube. I like working in flat lines much better.
One option we all hate to be faced with is what is referred to as a “linear foreign body”. This is when something is long and stuck. Like string. Or a half unravelled sock. So it’s stuck high up in the tract, maybe even in the stomach, but parts of it trail along down the tract and sometimes you have to make several incisions to safely remove it all. And if it’s been stuck for awhile, while the intestine contracts over it trying to push it along the string or whathaveyou will have actually cut into the tissue. Not cool.
No matter what happens on the inside, after surgery there will be some pretty strict post-op care instructions. Many dogs and cats do quite well, but there are definitely some pretty serious post-op complications that could arise. If you cut open the intestines and sewed them shut, there’s the very scary risk of those sutures not holding and the intestines leaking into the abdomen. In other words, a bacteria ridden liquid getting into what should be a sterile space. NOT COOL. As surgeons, we hold our breath for several days after surgery. As owners, you should definitely follow your post-op care instructions, and call your vet if you have ANY concerns.
So what are some items I’ve gone in after?
-Rocks. Seriously, just straight up rocks.
-Dog toys, or remnants of. (this is why you’re told not to leave toys in the crate with the dog, or out in the house with the dog when you’re not around)
-Grass and a toothpick .(long story, this one, but short version is he’d had previous surgeries that made his intestines particularly susceptible to things getting stuck)
-Hair elastics. (a cat had eaten an entire bag of them. Interesting radiographs. Very long surgery fetching all the ones that were stuck.)
-Mysterious items of unknown origin. (We’ll save items to show owners, and sometimes they can’t even figure out what was chewed upon. . . )
Basically, if they can swallow it, some vet somewhere has probably removed that item, or part of that item, from the GI tract of some animal. If you’re puppy is a big chewer and gets into all sorts of things, besides learning to pick up after yourself…. GET PET INSURANCE. (This issue seems to be far more common in dogs versus cats. Though cats tend to get linear foreign bodies more… from swallowing thread/string/yarn… so be aware!!)
In closing, I’d like to share with you this somewhat topical PSA: