Surgery STAT: Surgical management of gastrointestinal foreign bodies

Surgery STAT: Surgical management of gastrointestinal foreign bodies

How to diagnose and effectively treat GI obstructions

Dr. Janice Buback
Veterinarians often hear clients report that their dogs and cats vomit after indiscriminant eating. Indeed, pets with gastrointestinal foreign bodies frequently present with a history of nausea, vomiting, inappetence, discomfort and lethargy.

Sometimes signs are subtle or even absent in the case of a known recent ingestion and early presentation. Vomiting is a common sign of other maladies as well, which is why getting a complete patient history is imperative.

Diagnose the problem

A gastrointestinal (GI) foreign body is generally diagnosed based on history and physical examination findings, clinical signs and a radiographic examination.

Photo 1: An abdominal radiograph showing an obvious metal density foreign body and mixed populations of small intestine. (Photos courtesy of Dr. Buback)
Radiography is the first-line diagnostic tool for identifying GI foreign bodies (Photo 1); however, a foreign body is not always readily apparent. Obstruction is suggested by small intestinal loops that are dilated to greater than the width of the second lumbar vertebral body or by the presence of two populations of small intestine (i.e., normal sized and enlarged, gas-distended loops).

Photo 2: A ventrodorsal view of a barium study demonstrating an intestinal foreign body.
A barium study can confirm suspicions (Photo 2 and Photo 3). However, if you plan to use endoscopy, do not use barium. Ultrasonography can sometimes identify a GI foreign body or intestinal changes suggestive of a foreign body. Note, however, that gas in the GI tract can impair the ability to evaluate the abdomen.

Photo 3: A lateral view of the patient in Photo 2.
Laboratory studies may support a diagnosis of obstruction (e.g., hypochloremic hypokalemic metabolic alkalosis with high duodenal obstructions), and it's always prudent to evaluate electrolyte concentrations.

Determine the next step

Often the most challenging part of these cases is knowing when to cut and when to wait. An exploratory examination is recommended in any of the following scenarios:

  • The patient continues to vomit
  • Abdominal palpation elicits pain
  • The patient has an obstructive gas pattern or one that has not changed over time with appropriate supportive care
  • A known foreign body that's unlikely to safely pass on its own is present.

Good antiemetics are available, some of which are so effective they can control nausea and vomiting in an obstructed pet, thereby delaying diagnosis. Remember to assess the whole patient and all the information.