Endoscopy Case Study

Courtesy of
Mike Willard, DVM, Dipl ACVIM
Department of Small Animal Medicine
Texas A&M University
College Station, TX

Endoscopic Foreign Object Removal

A 1 year old, castrated male Irish wolfhound weighing 110 lbs was referred to TAMU because of a 24 hour history of vomiting and anorexia. The dog was drinking excessive amounts of water and then vomited the water. There was no food or bile or blood reported in the vomited material. The referring veterinarian suspected a splenic torsion and referred the dog to TAMU. At physical examination, the dog was relatively normal, although it may have guarded its anterior abdomen a little more than normal. However, there was no obvious abdominal pain. Two sets of plain abdominal radiographs taken 12 hours apart failed to reveal any significant abnormalities. However, abdominal ultrasound the following day revealed what appeared to be a foreign object in the stomach.

Endoscopy was performed shortly after ultrasonography, on the third day of hospitalization with a pediatric colonoscope (11 mm outer diameter). A foreign object was seen in the antrum of the stomach; it was entering the pylorus. The tip of the endoscope was advanced beside the foreign object so that it also passed through the pylorus and entered the duodenum. The foreign object was seen to extend as far as the middle to distal one-third of the descending duodenum. The distal end of the foreign object was grasped and pulled retrograde out of the duodenum. Four attempts had to be made before the foreign object was completely removed (Figure 1).

After removing the foreign object, the intestines were inspected. At least two areas were found in which the duodenal mucosa was partially cut (Figure 2). Post operative abdominal radiographs were taken, and there was no evidence of perforation (e.g., free air in the abdomen). The patient recovered uneventfully and was discharged the following day.

This case demonstrates that linear foreign objects can sometimes be removed endoscopically. It would have been better for the dog if the endoscopy had been done earlier, but, as is often the case, plain abdominal radiographs did not reveal clear evidence of the obstruction occurring secondary to the linear foreign object.

We have removed several linear foreign objects with endoscopy. Other techniques that can be used include cutting the linear foreign object with endoscopic scissors or pushing the linear foreign object completely into the duodenum so that it is no longer fixed at the pylorus. In this case, the entire foreign object then passed in the feces.

For further information, contact:

M. D. Willard
979-696-3453
mwillard@mail.tca.net