History
- A 2-year-old intact male Malamute with a history of consuming foreign objects. Half a ball had been removed from its stomach 4 months earlier.
Presentation
- Patient was presented with vomiting/inappetence/lethargy of 2 days’ duration. Client voiced financial concerns. (8/14)
- Abdominal radiographs revealed distended stomach filled with homogeneous material/no further foreign material identified. Client asserted patient had not had anything by mouth for 2 days.
- Fecal testing from initial presentation 4 months previously: +1 Clostridium, +3 spirochetes/motile bacteria. No fecal test done on this presentation.
- Exploratory laparotomy revealed stomach full of water, which was removed by stomach tube. Client then remembered dog had drunk a bowl of water prior to exam. Palpation of length of GI tract from stomach through exteriorized intestines (pylorus to ileocecal junction) repeated several times. Nothing found.
- In face of financial constraints, a sample for histopathology was not obtained.
Recovery
- Patient recovered from surgery with no appetite. Had soft scant stools/improved spirits.
Postsurgical Treatment
- Fluid therapy before/during/after surgery: lactated Ringer’s solution
- 8/14:
- Penicillin (300,000 U/mL): 5.5 mL SC
- Gentamicin (100 mg/mL): 0.5 mL SC
- Maropitant citrate (10 mg/mL): 3.0 mL SC
- 8/15–8/18:
- Sucralfate: 1 g q12h PO
- Maropitant citrate: 60 mg q24h PO
- Metronidazole: 500 mg q12h PO
- Amoxicillin: 500 mg q12h PO
- 8/16:
- Patient ate on its own (full can i/d and a/d mixed)
- 8/17:
- Stopped eating/lethargic
- Force fed half can a/d
- Mirtazapine: 15 mg PO (one time dose)
- 8/18:
- Still not eating
- Continued oral meds (above)
- Radiograph: distended stomach, food passing through bowel
- Sedated to pass stomach tube: Removed gas/fluid; radiograph afterward showed normal stomach
- SNAP cPL Test (canine pancreas-specific lipase): Negative
- CBC/serum analysis: WNL
- IV fluids: lactated Ringer’s solution @ 50 mL/hr started; decreased to 30 mL/hr ~ 90 min later
- Prednisolone injectable: 100 mg IV slow
- Discontinued amoxicillin
- NPO in evening
Treatment
8/19–8/24:
- Famotidine: 20 mg q12h PO X 2 days; q24h X 2 days; q12h for 2 days
- Metronidazole: 500 mg q12h PO X 3 days; q24h X 1 day; then q12h for 1 day (discontinued evening dose on 8/24)
- Sucralfate: 1 g q12h PO X 3 days; then q24h X 1 day; then q12h X 2 days)
- IV fluids
- Lactated Ringer’s solution with 3.0 mL (100 mg/mL) vitamin B complex at varying rates X 2 days
- Continued lactated Ringer’s solution @ 75 mL/hr X 3 days
- Maropitant citrate reinitiated (8/20): 60 mg q24h PO; none X 1 day; q24h X 2 days; then discontinued
- Penicillin (300,000 U/mL): 5 mL SC (8/19)
- Gentamicin (10 mg/mL): 0.5 mL SC (8/19)
- Vitamin B12 (100 mg/mL): 0.6 mL SC (8/20)
- Metoclopramide (5 mg/mL): 0.8 mL SC initiated 8/23; then q12h X 1 day
- Mirtazapine: 15 mg PO (8/22–8/24)
- Nutrition: Force fed canned a/d (8/21–8/22); offered canned a/d (little interest) 8/23 and a/d dry & canned (8/24)—ate 1 cup dry
- Removed IV catheter 8/23; offered small amount of water
Monitoring
- Bowel Activity: None AM despite posturing, small volume PM on 8/19; scant soft feces 8/20; none 8/21 & 8/22; scant diarrhea 8/23–8/24
- Urinated daily in varying amounts 8/19-8/24; ate ice cubes 8/24
Diagnostics
- Barium radiograph (8/23) after 4 daily doses barium (20 mL PO)
- Serum biochemical analysis (8/18): Normal
- CBC (8/18): Normal
Activity
- Client took dog with her for a few hours to get it out of clinic (8/24). Closely watched during outing.
8/25:
- Urinated only in AM, wanted to eat grass
- Sucralfate: 1 g PO
- Famotidine: 20 mg PO (AM only)
- Offered i/d canned and dry in separate bowls, no immediate interest. Found both bowls empty about an hour later.
- Offered ice cubes; ate readily
- Metoclopramide (5 mg/mL): 0.8 mL q12h SC
- Rectal temperature: 103.2⁰F (normal until today)
- Discharged with chart and radiographs to another veterinary clinic for second opinion. Diagnosed as oxygen deprived, also given Lactobacillus acidophilus
- Transferred to third veterinarian in another city
Outcome
- Third veterinarian contacted our clinic: Patient had developed a fever, thus they performed repeat surgery 25 days after initial presentation at our clinic. A piece of a tennis ball was found in the small intestines along with signs that a perforation had occurred and later healed proximal to the obstruction; 9 inches of bowel was removed.
- Patient recovered with a healthy appetite.