By: Dr. Amy Plankenhorn
For most families with new puppies, the biggest things to worry about are common – housetraining, feeding a good diet, keeping vaccinations current, and socialization (actually, that's as easy as signing up for AHNA's Puppy Preschool!). But two of our recent puppy patients faced even bigger problems that required emergency abdominal surgeries.
Theodore Roosevelt (TR for short) had been in his new home with his dad for just two weeks when he became ill one day. He was lethargic, wasn't eating or playing, and was having diarrhea. His dad called for an appointment and when TR arrived for his physical examination, I was very concerned. This beautiful English Cocker Spaniel puppy wasn't acting like a normal puppy. My biggest concern was that I could feel a firm object in his abdomen which was uncomfortable when I put any pressure on it. We had also noted some blood on the thermometer when we took his temperature. While his Dad didn't think he had eaten any toys or other objects, we were still concerned about an intestinal blockage. Abdominal X-rays showed increased gas in the intestines, and repeat x-rays an hour later showed that the gas was increasing, typical of an intestinal blockage. Although the diagnostic workup could not identify the exact cause of the blockage, I knew he needed surgery right away. Once he was under general anesthesia and prepped for surgery, we began his emergency exploratory surgery. Any time there is a suspicion of a blockage, the entire gastrointestinal tract is examined during surgery from the stomach to the colon so nothing is missed. In TR's case everything looked normal in the stomach and most of the small intestines. But when I got to the last segment of small intestine, the ileum, I found the problem.
TR had an intussusception, which is a telescoping of one segment of the intestinal tract into another. About six inches of the ileum had telescoped into the colon, causing pressure and damage to the tissue of the small intestinal tissue. Although they rarely occur, intussusceptions are very serious when they do occur because the blood supply to the small intestine in the area is disrupted by the pressure caused by one portion telescoping into the next portion (which was the colon in this case). I was able to remove the small intestine from the colon, but due to the degree of damage, I had to remove that six inches of intestine completely. Reattaching the intestines required painstaking suturing and then required suturing a layer of omentum over the intestinal incision sites to prevent any leaks, followed by a thorough flush of the abdomen to remove any bacterial contamination that may have leaked out of the intestine. After over an hour and a half of surgery, TR went to recovery where he received close monitoring and a fluid drip that contained a narcotic for continuous pain management overnight. He was still pretty quiet the next day, but his vitals were normal and he was not in any pain. The next day was a different story! He was hungry, barking, and demanding attention like a normal puppy is supposed to do. He went home with antibiotics and pain medications, and has recovered wonderfully.
About two weeks later, Dr. Amylisa Parker examined Coal, a cute Black Lab mix who had gone to REACH the night before. His family knew that he had eaten a flip-flop, and he had vomited portions of it up during the night. But he still wasn't better, and he continued to retch without bringing up anything but fluid. His morning x-ray also showed increased gas typical of an intestinal blockage. Unfortunately, items like cloth, rubber, and soft plastics don't show up well in x-rays, so we're often faced with a dilemma when we suspect an intestinal blockage. Sometimes we give a liquid that provides contrast in the intestines and take more x-rays to confirm if there is a blockage. In Coal's case, his history of eating the flip-flop, his ongoing vomiting, and the x-ray findings all pointed us toward our diagnosis of an intestinal blockage. I was scheduled as the surgeon that day, so Dr. Parker referred Coal's exploratory surgery to me. Once again, after he was anesthetized and surgery was begun, I started the process of examining entire gastrointestinal tract, but this time the answer came more quickly.
Coal had eaten a flip-flop with fabric straps that were beginning to unravel. Small pieces of thread had shown up in his vomit, but there were longer strings attached to clumps of the fabric strap material. There was a large clump in his stomach, too big for him to pass. This was attached to another clump by about six inches of string...which was attached to a third clump by another length of string. A foreign body with string attached (actually even string by itself) is particularly dangerous. Cats sometimes get a long piece of thread or string caught under their tongue that extends down into the intestinal tract, and dogs like Coal can eat a long piece of fabric that acts as a linear foreign body or has strings attached. In either case, the intestines keep working to pass the string, creating a pleating effect of the small intestines around the string. In advanced cases, the string can actually cut through the intestinal wall, leading to infection in the abdomen. Fortunately, we got to Coal's strap obstruction before there was significant damage to the intestines. I was able to make two small incisions in the intestines to remove the clumps of strap and carefully feed the string back toward the stomach. A third incision into the stomach allowed me to remove the big wad of strap material.
Coal's surgery was not as complex as TR's, but any time a patient has surgery on the intestines, there is a risk of the repair not healing well due to damage in the intestinal tissue that cannot be detected by the surgeon. Fortunately, Coal recovered quickly, and was ready and eager for food by the next morning. He was able to go home the evening after his surgery and has also recovered beautifully. His family is now very careful to keep their shoes well out of Coal's reach!
TR and Coal are examples of puppies that needed surgery to fix their problems. Puppies tend to chew on toys and other objects around the house as part of their learning process. It is important to be vigilant about the types of toys you provide and about putting away tempting items like shoes, dishcloths, underwear, and kids' toys. Adult dogs are often tempted by the same types of objects. If you see your pet eat anything that cannot be digested, including bones, call Animal Hospital of North Asheville during hospital hours, or REACH after hours. We will help you determine how likely the object is to cause problems and advise you on whether to closely observe your pet or whether immediate care is necessary. Often, by acting early while the foreign body is still in the stomach, we can spare your dog abdominal surgery by inducing vomiting or removing the object with our video endoscope. If you didn't see your pet actually eat an item but you're suspicious that it could be in the stomach, we can use x-rays to try to identify if there is still something in the stomach that could be retrieved with our video endoscope. Once an object gets past the stomach and into the narrower small intestines, we will either monitor to see if it can pass all the way through, or make the decision to do surgery.
TR and Coal's families recognized that their precious new puppies were very sick and got them to the hospital quickly. Thanks to their attentiveness and our quick action, both puppies are happy, healthy and beloved members of their families!