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Saturday, February 24, 2007

Eating baseballs and such...

This week was tough. Good.... but tough. Saw a young American Bulldog - adorabale, but not the brightest bulb - that tore a baseball apart and swallowed it. This guy apparently eats whatever he can find. I took radiographs (x-rays) which were strongly suggestive of an obstruction, and the barium series confirmed it. The barium series was almost superfluous but I wanted to be near 100% CERTAIN that something was indeed there (a negative exploratory surgery IS STILL DIAGNOSTIC!). You can't always trust the history!
Barium is a contrast medium that is given by mouth and should normally pass from mouth to butt within a specific period of time. Radiographs are taken every half hour or so after the barium is administered. In cases of obstruction, the barium simply does not pass beyond the obstruction. In this case, the barium did not leave the stomach, even after one hour. This is not normal. I therefore had to open the dog up.

This radiograph demonstrates barium passing normally.

I found that a huge portion of the jejunum (part of the small intestine) was folded up like an accordion. This is classic for foreign bodies such as string and other linear things (rope, pantyhose, tinsel, etc.). I had to make three small incisions in the intestine to fully remove the obstruction, which was indeed the inside of a baseball. I examined the rest of the gut and lo and behold: there was more in the stomach. I had to make an incision in the stomach as well and successfully took out the rest of the shredded ball. The surgery took about two and a half hours. Ten days post-op and he's doing great, though still trying to suck up anything he can get his jaws on.

My patient


Allison Zwingenberger said...

Dogs seem to have an unfortunate affinity for pantyhose, socks, and rope, that end up lodging in the stomach and trailing down the small intestine, creating the "accordion" effect, or plication. Radiographs, upper GI studies and ultrasound can all help to make the diagnosis.


Dr. Zwingenberger,

I am humbled by a comment from an ACVR/ECVDI-certified radiologist. Thank you so much for visiting my blog.
I did my radiology rotation at the OSU in '99. Fantastic. Went back for a residency interview in 2004 (hardly an interview - I can tell you all about it another day...)
May I please be invited to read your blog?