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Billy, a very beautiful black Labrador walked painfully into my consulting room. His back was arched in pain, he was stiff and reluctant to move. I could hear his belly grumbling from across the consulting room and he lay down as soon as he could, completely disinterested in what was going on around him. Even without examining him I could tell that this young dog was in serious trouble- no three year old Labrador should be like this!
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Billy had been brought in to see me the day before. He had been vomiting for the past couple of days and was now completely disinterested in food- a very poor sign for a Lab! As I examined Billy I asked his owner some more general questions and had a chat: often people will tell me things that may not seem relevant to them but are in fact crucial information in deciding what the problem may be, and when I am examining their pet this is often the time that these small nuggets of information come out. Perhaps they relax a little bit more while I seem completely focused on their pet.
It transpired that the vomiting had started soon after Billy's owner had given him some apples in his dinner as a treat to make the usual dry dog food more interesting. "Did you cut the apples up?" I enquired. "Oh no, he chews them" came the reply. Now I had a good idea what the problem could be. Knowing how Labradors love to gobble their food down it seemed very likely that Billy may have eaten some apples whole or in large chunks. I strongly suspected that one of the apples may be stuck!
I could not feel any obstruction in his intestines and Billy at that time seemed reasonably well so I gave him some medication to help him feel better and instructed his owner to bring him back the next day. Now it was the next day and Billy was much worse. He looked as if he had given up on life and was resigned to dying.
It was obvious that if we did not act quickly Billy would certainly die. I could not palpate the obstruction and the owner decided not to have X-rays taken so I could still not be sure that there was definitely an apple stuck in his intestines or stomach, but I knew that something had to be done quickly. Billy's owner decided to go with my hunch and signed the consent form for an exploratory laparotomy.
We admitted Billy and gave him some i/v fluids and other medication before we started the surgery. Once everything was ready we gave Billy a general anaesthetic and started the surgery. Gently feeling around inside the abdomen I was not surprised to find a hard lump in the small intestine. The wall of the gut should normally be a healthy pink but the colour over the lump was paler and there was plenty of gas build up too. I made an incision over the lump and removed a huge chunk of decomposing apple - the smell in the room was almost unbearable and the offending fruit had to be taken to the clinical waste area downstairs quickly by my nurse as I sutured my incision.
I had been relieved to find the apple chunk. The surgery had been relatively straightforward and I now knew that my diagnosis had been correct. "I will just check that there is nothing else here" I said to Caroline my nurse. It was lunch time and I was pleased that the surgery had been so easy and uncomplicated. As I felt further up towards the stomach I sighed. There was another one in here! This chunk was slightly smaller but much more putrid- I removed it and sutured once more. By this time I was starting to get hungry and my back was aching from standing working for well over an hour.
"Well that's done- lets hope there are no more" I smiled as I finished suturing the small incision in the intestine. I was really ready for my lunch break now! I gently felt in the abdomen again certain that I would not find any more- but I was wrong! I repeated the process four times in all and by the end the room felt hot and tense. At last as my hand swept around the intestines I could feel no more hard immobile blockages of apple- with a huge sense of relief I closed the abdomen and allowed Billy to wake up with large doses of antibiotics and pain relief.
My nurse was well overdue to leave and so after Billy had woken up she went home- leaving me to clear up all the surgical instruments, swabs, drapes and other paraphernalia on my own! However Billy was through the surgery and it was hugely satisfying to know that we had done everything possible to help him. Now it was up to him.
Later that night I took Billie home so that he would not be alone in the practice and I could easily take care of him overnight. He was heavily sedated and on i/v fluids so he did not really know much about it until the next morning when he woke up properly and greeted me with a wagging tail as if nothing had happened!
Being a labrador Billy was really interested in food and thought that every rustle of paper meant something to eat! However Billy could eat nothing yet and had to have i/v fluids rather than any water to keep him hydrated. However he was obviously not fluid deficient as a very large puddle around my utility room was seeping under my washing machine like a lake overflowing its banks. I sighed and started mopping.
Billy did well over the next 24 hours and went home for the weekend to be cared for by his owner because he was unhappy in his kennel at the practice. However on Monday morning a very sad and depressed dog came into the practice consulting room. He had a high temperature and looked almost as bad as he had before the surgery. This was what I had feared most of all and it seemed likely that poor Billy now had peritonitis. I had already told the owner about this and we were almost expecting it given the number of obstructions there had been in the gut but it still was very disappointing.
We sadly decided to keep Billy in the hospital again. I changed his antibiotics and his pain relief to try to fight any infection and make him comfortable. I knew that a decision would have to be made if Billy did not get over this soon because the prognosis was getting much worse now. Billy still seemed interested in food and he had had nothing to eat for 3 days. Although I feared the worst I decided to feed him a little and at least make him happy for a while in case we had to put him to sleep later in the day. Billy almost leapt on the food and it was gone in a flash- I could see how he would have easily swallowed those apples!
Slowly over the rest of the day Billy seemed to perk up and would give us a gentle wag of his tail, turning his big sad brown eyes up to us in the hope that we would give him some more food! Although he still had a high temperature and was leaking fluid from his wound he seemed so sad in the hospital kennel that it seemed kinder to send him home again to be cared for by his owner. All that could really be done now was to keep the wound clean, adhere to a strict feeding regime and give antibiotics and pain relief. The owner and I had discussed the possibility of further surgery if necessary and had agreed that because of the poor prognosis for dogs with peritonitis it would not be fair to put him through any more operations. Now all that we could do was wait and see if Billy would pull through.
Over the next few days Billie was a frequent visitor to the practice and on the fifth day he suddenly seemed to turn the corner with his temperature coming right down and his wound drying up. He made a good recovery but will have to be more careful with his diet in the future!
Sam Says;
It is more common than people think for dogs to get things stuck in their intestines. I have had cases such as Billy many times throughout my career and the objects which get stuck range from common food items such as bones, apples and brussels sprouts to more obscure things such as toy cars, socks, leads and even the plastic insides of kinder surprise eggs! If your dog likes to eat vegetables this is fine, but do cut them up before feeding- dogs are not great at chewing! The signs to watch out for if you suspect intestinal obstruction are vomiting, depression, anorexia, pain (often a hunched back, tender abdomen), lack of faeces and perhaps increased gassy sounds. If you notice some or all of these signs in your pet you should seek urgent veterinary attention.
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