Snow Leopard

Snow Leopard
Snow Leopard cub (7 mos old) - Cape May County Zoo

Saturday, November 26, 2011

I Wish I Had Pictures

As I am sure you aware by now, I love to take pictures of cases I see in practice. They are fun and great for education. I've now gotten in the habit of doing it fairly routinely.  

I had a surgery that I wish I had pictures of but since I was the surgeon and it was pretty involved/intense, it didn't happen. I'm sure you understand the patient's well being comes before any thought of what would be cool for my blog. 

A young chocolate lab (lab being the key word here..number one consumer of things not meant to be eaten) came in a few weeks ago for vomiting. On her physical, another veterinarian felt what we both suspected to be an intussusception. This is where one part of the intestine telescopes into another part and can cause a partial or total obstruction.

Here's what it looks like:

This can be sliding or become adhered resulting in tissue damage/death.  

In our case, the dog was hospitalized on fluids and kept overnight. Blood work and radiographs of her abdomen were normal.  By the next morning it was gone. The dog was doing great and sent home on medications. 

What causes this? We often see it in young animals and most commonly it's anything that causes increased peristalsis or movement of the GI tract - such as parasites, dietary indiscretion, etc.  

This dog came back a week or more later. She was vomiting and losing weight. She was still a very active puppy.  When we palpated her again, we felt the intussusception. She was still so active and eating, we scheduled her for surgery after the weekend.

At that time, we thought we'd be going in to basically assess the area and likely resect the affected portion of intestine or tack the entire small intestine so that it wouldn't continue to recur. 

When I opened this dog up, I did find the intussusception in her lower small intestine. Amazingly, the tissue was healthy and it was easily undone. There were no adhesions or scar tissue present. But upon looking at the rest of her intestinal tract, it soon became clear she had a linear (string like) foreign body. Yes this was the cause of the intussusception.

I had to make an incision in 3 parts of her small intestine to get this string and the balled up wads of it out. I couldn't just pull it out of one area or I'd risk lacerating the already somewhat "angry" tissue. I felt something in her stomach but when I went in to find it, I couldn't. 

Still after closing up the other incisions, I re-ran the entire GI tract and sure enough there was a perforation where I could visibly see this string. She was on the verge of peritonitis. I attempted to pull out the string and the end that went up through the stomach would NOT budge. My boss, the vet that originally saw the case, was able to look in the mouth and found a loop of string wrapped at the base of the tongue - far back and cutting into it. She pulled it out from that way and it was a very long piece. 

Closing up the perforated area was tricky - the tissue would not hold suture well but resecting it was not an option at the time. Overall it was healthy, the dog had been under quite a while (in any dog but especially a puppy, I worry about hypothermia) and this area was right where the pancreas is located. I did not want to mess with that!   

So, we closed it all up, flushed her out and I prayed that her youth would work for her and she'd heal fast (with the help of some good antibiotics to cover her). 

We are nearly a week out and she is doing fabulous! 

This type of presentation is typical for cats - they eat string and often it gets caught under the tongue. That's why I always look under the tongue of a cat that comes in for vomiting. Dogs it's not usually they case. They may eat string or things that can become stringlike (towels, carpeting) but it doesn't typically hang up in the mouth like that. 

In any case, it was (shhh) fun to do. 

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