To our knowledge, this is the only existing case report of an enterocutaneous fistula caused by gauze used during a canine spay. A 6-year-old spayed female German shepherd mix was presented for a draining tract on her left flank. This tract was biopsied and explored before presentation, but biopsy showed only marked, chronic, regional, neutrophilic, and pleocellular nodular dermatitis and panniculitis. This suture line eventually dehisced, and subsequent surgery was performed and drains were placed. The area did not heal and continued to drain a purulent discharge despite administration of antimicrobials. The dog then had ultrasonography that showed a poorly defined mass in the left retroperitoneal space. Fistulography was performed using a water-based, iodinated contrast agent injected directly into the fistula. The study showed that communication existed between the fistula and a small irregular retroperitoneal pocket, leading to a jejunal lumen. Exploratory surgery was performed. A large adhesion involving the left kidney and ureter, descending colon, caudal mesenteric artery, and 2 segments of jejunum was found. The jejunum was perforated and was communicating with the retroperitoneal space. The jejunum was resected and anastomosed, the left kidney and ureter were removed, and the mid descending colon was also resected due to concern about the blood supply because of damage to the caudal mesenteric artery. The cutaneous fistulas were removed surgically 1 week later. Histopathologic analysis of the mass revealed a large granuloma formed around a piece of
gauze. The dog recovered completely and was disease-free 3 years after surgery.
COMMENTARY: The incidence of surgical foreign bodies in humans is estimated to be 1 in 1000 to 1500 intraabdominal procedures; however, the risk in veterinary medicine has never been formally addressed. These authors speculated that risk to veterinary patients may be lower than in humans due to less complex procedures and smaller intraabdominal cavities. This article emphasizes the importance of diligence in surgical technique, and perhaps even suggests the necessity for radiopaque or large lap sponges to be used routinely in intraabdominal procedures.—Heather Troyer, DVM, Diplomate ABVP (Canine & Feline Practice)
Enterocutaneous fistula in a dog secondary to an intraperitoneal gauze foreign body. Frank JD, Stanley BJ. JAAHA 45:84-88, 2009.