A case of an old dog and a dangerous toy

"Jack just isn't right" she said. "He isn't acting like himself. I've been racking my brain but I don't know what it is"

Jack is an eleven year old white pit bull with adorable splotches of coffee spilled over his face and back and mismatched eyes-- one brown and other blue. I've known him since he was a two month old puppy, and for the first time in many years he isn't goosing me or trying to bark human words. And he flunks one of my most reliable and sophisticated of diagnostic tests--he refuses liver treats he normally demands and inhales.

I've known Jack's mom for over 15 years. She is as good of a pet mom as any dog could ever want--observant, loving and not prone to under or overreaction. she is absolutely certain that the worst that jack could have eaten would have been spicy chicken meat she served her party guests the day before, who might have secretly indulged him--because who can refuse jack's adorable eyes pleading for human food?

But it has been many years since he showed interest in chewing up anything and besides, there is nothing anyone can think of that he could have swallowed. At eleven he is many years past the age of exploring the world by tasting and chewing it, swallowing objects curious puppies do. His examination is unremarkable except for intangible spark that's missing from his eyes.

The most challenging foreign objects are the kind that don't show up on X-rays

Socks, bras, tampons, pajama bottoms, ropes, toys, and corn cobs that puppies we've operated on swallowed are called radiolucent because Xrays pass right through them. Jack's X-rays show some weird gas patterns in the caudal abdomen where I feel something that could just be stool or something foreign but Jack doesn't show any signs of pain when the area is palpated and even wags his tail. There is no dilated gas-filled bowel that we often see upstream of an invisible blockage, but the intestinal gas pattern on the films is just strangely not right. There is certainly no dense object like a rock, glass marbles, jewelry we've removed from dogs' insides glaringly obvious on X-rays.

Considering the spicy chicken Jack might have possibly been given when mom wasn't looking, we submit blood-work to rule out pancreatitis greasy spicy foods can cause hospitalizing Jack on IV fluids.

The tests show low potassium IV fluids can easily correct but are otherwise frustratingly boring--pancreatic enzymes and the rest of the metabolic and hematological tests, suggest Jack is just fine, except that it is obvious that he isn't. To our horror he vomits something putrid smelling and looking like diarrhea that should have come out of the other end. So, exploratory abdominal surgery, while really disturbing to his family because of his age and anesthetic risks becomes inevitable, in spite of a possibility we will perform it and find nothing.

Jack ate what?

It is 8:30pm and we have been closed for over an hour. Jack is shaved, prepped and anesthetized comfortably with a fentanyl infusion running on a pump. His vitals look great, his heart rate stable, his end tidal CO2 at 36-38 and his pulse oximeter settled at 98-100%.

Unfortunately, we find 8 inches of devitalized purple intestine leading up to a bulging hard 2" by 2" firm object about to perforate through the gut, requiring removal though a surgical procedure called anastomosis.

When dogs swallow objects that can be removed from the stomach or intestines through an incision, the rate of complications is far lower than it is where the gut loops are cut and sutured back to each other end to end. Two hours of meticulous suturing later, Jack is awake loaded up on morphine with a look of relief on his face. But we are nowhere out of the woods yet. Significant risks of leakage and life-threatening peritonitis occurs 25% of the time after this procedure, and worse yet, in these cases we call dehiscence, leakage can occur up to five days after surgery.

The foreign object turns out to be a 2" piece of thick rubber he chewed off the top of his Kong toy so many years prior that the normally red rubber turned grey. It was not causing any symptoms while sitting in the stomach for many years until it inexplicably started moving down the intestines and got stuck. In spite of his age, Jack recovers uneventfully and resumes his normal life, minus the super expensive piece of Kong. We all breathe a sigh of relief when he returns for staple removal demanding a full jar of his favorite liver treats.