Paul Adams (BVetMed GPCert (Ophthal) MRCVS) qualified from the Royal Veterinary College in 2007. He has worked in referral, charitable and private practice before setting up his own family run veterinary practice www.knutsfordvetsurgery.co.uk
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Daisy, our Labrador, has always eaten poo. It is a horrible habit and I am sure many of you will have heard our yells of “Daisy…leave it!” echoing around Tatton Park on an otherwise peaceful morning. She also finds dead things irresistible. This October though, it was a corn on the cob husk that she unknowingly got hold of and ended up being a surgical problem, writes Paul Adams
She had started drooling. At first, like any owner, I told myself she had just had a drink but it became small puddles on the floor where she sat which wasn’t normal. Interestingly, this was the only clinical sign Daisy really demonstrated – she was quite bright, no vomiting, not seemingly uncomfortable, following me about as usual and I’m pretty sure if I’d offered food, she’d have eaten it.
Following an apologetic phone call to Rachel who was on call that weekend, Daisy had a premed via her IV catheter and was sleepy enough to let us take conscious radiographs.
There was no obvious obstruction but a very enlarged stomach with a mottled appearance suggestive of corn on the cob.
Having removed 4 pieces of husk from the intestines of two different dogs that week, and given her history, I knew it would be better to perform an exploratory surgery at this stage rather than risk an obstruction in her intestines.
Daisy had a full general anaesthetic and was prepped for surgery with a large abdominal clip and scrub. To perform an exploratory laparotomy well, a very long incision is required to visualise all the organs. Since surgical wounds heal side to side the recovery period is not lengthened at all.
I checked all along the length of her intestines (twice) to ensure there were no obstructions present and then exteriorised her stomach, packing around it using abdominal swabs. The incision is made where fewest blood vessels pass. I removed 5-6 pieces of corn on the cob and a lot of grass.
The most difficult aspect of the procedure is potential contamination of the abdomen with stomach contents. The swabs help, but it is almost impossible to prevent completely.
Following closure of the stomach, therefore, Daisy’s abdomen was flushed repeatedly with warmed saline fluid and then removed with suction.
She was given an antibiotic injection before surgery and continued with oral tablets at home.
A gastrotomy (an incision in the stomach that is then sutured closed) carries far less risk of complications than an enterotomy (an incision in the intestines).
This is because a double layer of an inverted suture pattern is placed, minimising the chance of stomach contents leaking into the abdomen if there are problems with healing.
In an enterotomy wound, only simple interrupted sutures (multiple single stitches) can be placed otherwise during healing, narrowing of the intestinal lumen may form causing clinical signs similar to that of a foreign body.
Three to five days’ post operatively is when any clinical signs of peritonitis will develop as a result of wound breakdown so I had a few days of worrying to get through before we could give Daisy the all clear.
She has now fully recovered thankfully and can be seen sporting a Baskerville muzzle and large green ‘friendly’ collar to prevent further incidents on walks…
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