Gastrointestinal Exploratory Surgeries/Foreign Bodies

Foreign bodies are non-food objects that become lodged in an area of the gastrointestinal tract. These items may be items such as string, a pet’s or child’s toy, leashes, clothing (e.g socks, underwear) and sticks. The problems that are caused vary with:

• The location of the foreign material (e.g. stomach, small intestines, etc)
• How long the foreign body has been present and obstructive
• The type of foreign material present
• The degree of obstruction that it caused (e.g. obstruction with or without bowel perforation)

Gastrointestinal foreign bodies, especially strings, can often lead to perforation of the intestinal tract and spillage of intestinal contents into the abdomen. This condition quickly leads to inflammation and allows for bacterial proliferation and contamination (sepsis), which are both life-threatening complications and require immediate intervention.

Why perform surgery when we are not sure if there is a foreign body?

Every foreign body surgery is an abdominal exploratory surgery. Sometimes we are unsure what is causing clinical signs involving the gastrointestinal tract (e.g., vomiting, diarrhea, anorexia, lethargy) and will elect to perform a surgical exploratory surgery, even if we are not 100% sure there is foreign body to remove. This is because the entire gastrointestinal tract as well as all other intra-abdominal organs (e.g. kidneys, liver, pancreas, diaphragm, bladder) is explored and sometimes sampled (biopsied) by the surgeon. If a mechanical (i.e. physical) obstruction is found (e.g. foreign body, gastrointestinal tumour, perforation, intussusceptions, etc), incision into the stomach (gastrotomy) and/ or intestines (enterotomy) is/are necessary. Sometimes the intestines are so diseased/ non-viable that a resection (removing a portion of intestines) is needed and then the intestines are sutured back together (anastamosis).

Complications and Prognosis

• Most uncomplicated gastrointestinal foreign body surgeries carry an excellent prognosis
• Many pets return to eating with a resolution of clinical signs within 1–2 days
• If resection and anastomosis is indicated, the surgery becomes a far more complicated surgery with higher intra- and post-operative risk
• The prognosis worsens if there is an increased duration of time between the beginning of clinical signs suggestive of obstructive gastrointestinal disease and surgery due to the risk of bowel perforation, septic peritonitis and systemic blood cell disorders (e.g. SIRS, DIC)
• Accidental leakage of intestinal contents into the abdomen and subsequent peritonitis is always a risk during intestinal surgery, although diligent care and thorough flushing of the abdomen with saline before closure usually prevents these complications

Aftercare

• Patients recovering from an abdominal exploratory surgery will spend on average of one to two days in hospital before being discharged.
• Restricted activity for 14 days. Short leash walks only to go to the bathroom. No running, jumping or rough plays during this time.
• Patient is monitored closely for the first week for reduced appetite, abdominal pain and swelling, lethargy, fever and vomiting.
• Pain medications, gastrointestinal prokinetics, anti-nauseants and possibly antibiotics are common prescriptions.
• An Elizabethan (E) collar (“cone”) is provided and must be worn at all times to prevent self-trauma of the surgical site. A loose fitting breathable T-shirt or post-surgical onesies may also be considered.
• Daily monitoring of the surgical site. Complications include oozing, a foul smell, swelling or pain at the surgical site. A bandage may be applied to the surgical site to be kept on for the first day (and removed thereafter) after surgery to minimize leaking from the incision.
• Dehiscence (surgical site tissue breakdown) can occur at the site of bowel surgery, or at the closure of the abdominal wall within 3-5 days of surgery. Diligent monitoring for vomiting, lethargy, anorexia, fever and abdominal pain during this time is critical to investigate and correct as soon as possible.