Surgery STAT: Surgical management of gastrointestinal foreign bodies - DVM
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Surgery STAT: Surgical management of gastrointestinal foreign bodies
How to diagnose and effectively treat GI obstructions


DVM360 MAGAZINE


Surgical strategies


Photo 4: An intraoperative photo of the patient in Photos 2 and 3. Note the obvious foreign body in the jejunum.
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.
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.
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
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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Source: DVM360 MAGAZINE,
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