In the literature
Garcia-Pertierra S, Das S, Burton C, et al. Surgical management of intrathoracic wooden skewers migrating from the stomach and duodenum in dogs: 11 cases (2014-2020). J Small Anim Pract. 2022;63(5):403-411. doi:10.1111/jsap.13474
The Research ...
When ingested, wooden skewers (eg, toothpicks, kebab sticks) can migrate from the GI tract to other parts of the body, creating diagnostic and therapeutic challenges and possibly leading to severe or life-threatening complications.
This retrospective study reviewed clinical presentation, management, and outcome of 11 dogs in which ingested wooden skewers migrated from the cranial GI tract to the thorax. Clinical signs included anorexia/hyporexia, vomiting/regurgitation, lethargy, pyrexia, and gait abnormalities/lameness. Median time from development of clinical signs to referral presentation was 14 days (range, 2-112 days).
The most common hematologic and serum chemistry abnormalities were neutrophilia with a left shift, thrombocytopenia, mild ALP elevation, and mild hypoalbuminemia. CT was more sensitive than other imaging modalities (ie, radiography, ultrasonography, MRI) for detecting skewers in the thorax, allowing for definitive diagnosis in all dogs that underwent CT. The stomach was the most common site of migration; only one dog had a skewer that originated from the duodenum.
The authors recommend laparotomy with diaphragmotomy as the initial surgical approach unless the skewer is in the cranial thorax, in which case a median sternotomy or lateral thoracotomy is preferred.
Although these were complex cases managed at referral clinics, overall short- and long-term prognoses were good.
... The Takeaways
Key pearls to put into practice:
Dogs with intrathoracic wooden skewers migrating from the cranial GI tract can have diverse clinical signs with widely variable duration.
CT is the preferred imaging modality for detecting migrating wooden skewer foreign bodies in the thorax.
Surgical management of intrathoracic wooden skewers migrating from the cranial abdomen typically results in a good prognosis.