Case of the Month – Dec 2012

December is classically a month where we are used to seeing all sorts of things being eaten by our pets. However Monty Ward, our brave case of the month, definitely gets the prize for the most unusual this year! Monty, a young Bernese Mountain Dog, had managed to tear up the kitchen door mat one day and swallow some pieces.  Although petite for his breed at 35kg he had already managed to vomit some of the chunks up and was showing no adverse signs of his adventure.  X-rays confirmed he still had several of the swallowed fragments inside him.  But given that the torn up pieces left inside were small enough to hopefully pass on through his digestive tract naturally we decided to monitor them as they passed through his bowel, hopefully being passed in his faeces over the next couple of days.Generally if our patients are well and the material they have swallowed is not sharp or toxic it is preferable to apply a ‘wait and see’ policy with foreign bodies.  Surgery to remove any item from the digestive tract is not without risk.  Not only is there an anaesthetic to contend with but post-operative infection is a huge risk with any intestinal surgery.  The bowels contain millions of gut bacteria and although these bugs do an important job aiding in digestion they can be very dangerous if they leak into the abdominal space.  This can cause a life threatening infection called peritonitis which obviously we want to avoid at all costs. A repeat x-ray 24hours later showed that the pieces were on the move and given that Monty was his usual bouncy self we decided that surgery was not indicated at this point.  However any signs of digestive upset including lack of appetite, vomiting or straining to defecate were an indicator that things might be amiss and to come back to the practice straight away The next two weeks were uneventful with Monty being his usual playful self, eating well and not showing any signs of digestive trouble.  However he then developed a case of cystitis with lots of bacteria and white blood cells in his urine.  A routine blood test taken at the same time indicated an incredibly high white blood cell count.  This cell count was far too high to be just due to cystitis alone.  A normal white cell count in a dog is between 5.5 and 16.9 x 109 – Monty had a white cell count of 35.6 x 109.(predominantly neutrophils which are cells that fight bacterial infections). Normally with cystitis the white blood cells fighting infection are all in the urine and bladder wall so you do not find a high count on blood sampling.  Given the previous history of the door mat ingestion – despite no sign of digestive upset – we were suspicious that there might be more going on here and recommended a repeat x-ray.  Unfortunately this confirmed our fears with a piece of door mat still present within Monty’s bowel!  Amazingly he was still eating very normally and had not been sick at all. Monty was stabilised for surgery with intravenous fluids and two types of intravenous antibiotics.  Being a fit young dog he sailed through his surgery.  Very unusually and unfortunately for Monty the thick spiny hessian door mat had become wedged into his bowel lining so it was unable to move through and be passed in his stools.  This had resulted in a large abscess developing which is why his white blood cell count was so high. Thankfully the mat had lodged in such a way that his bowels had not become obstructed so he had still been able to eat and go to the toilet normally. The very smelly mat came out relatively easily via an incision through healthy bowel at the pylorus and then using forceps to extract it.  Monty had been very unlucky not to pass them in his stools.  Thankfully by operating through healthy bowel we did not have to try and remove the abscessated portion as it was incredibly close to his pancreatic duct and could have caused lots of problems post-operatively.  Best of all there was no sign of peritonitis or permanent damage to the remaining bowel. Being young and fit Monty recovered very quickly.  He remained on his broad spectrum antibiotics for 14 days, during which time the bowel healed and returned completely to normal.   The cystitis was most likely caused by dissemination of bacteria through his blood stream from the abscess and was a lucky occurrence in the end.  If he had not shown signs of cystitis the abscess could have eventually become large enough to rupture and this would have caused life threatening peritonitis. Thankfully in time for Christmas Monty had made a full recovery, with hair growing back quickly on his belly and his wound all healed he could enjoy his walks again and got to enjoy some Christmas treats just like the rest of us!  For those of you with a strong stomach (excuse the pun!) there are some photos and images of his x-rays below in the gallery – be very pleased that you can’t smell the pieces that were removed!