Intestinal Resection and Anastomosis

Gastrointestinal (GI) foreign bodies occur when pets swallow objects that cannot be digested and are unlikely to pass normally through the stomach or intestines. These objects may include toys (Figure 1), leashes, clothing, sticks, or any other material that fails to move through the digestive tract, including human food-related items such as bones or garbage. When an object becomes stuck within the GI tract, it can make the animal severely ill. The type and severity of the resulting problems depend on:

• how long the foreign object has been present,
• where in the GI tract it is located,
• how completely it blocks the opening of the gastrointestinal tract, and
• what the object is made of. Some swallowed materials, such as older pennies or lead-containing items, can cause systemic toxicity, while others can cause localized injury to the intestinal tract due to pressure or obstruction.

Gastrointestinal foreign bodies—especially linear materials like string—can sometimes create holes in the tissue (perforation). This allows intestinal contents to leak into the abdomen. This situation can rapidly lead to life-threatening inflammation of the abdominal lining (peritonitis) and enables bacterial spread and contamination (sepsis). Although some small foreign objects will pass, many become lodged somewhere along the GI tract, causing discomfort and illness. Some objects in the stomach can be removed using an endoscope; however, most cases require surgical exploration of the abdomen and removal. In some instances, foreign bodies can become stuck in the esophagus near the base of the heart or at the diaphragm, which may necessitate thoracic (chest) surgery.

Figure 1

Clinical signs vary widely depending on the degree of obstruction, the location, the duration, and the type of foreign body. Common signs include:

• vomiting
• anorexia (loss of appetite)
• abdominal pain
• dehydration
• diarrhea, with or without blood
• fluid accumulation in the abdomen

With linear foreign bodies, a string may be seen wrapped around the base of the tongue (Figure 1) or protruding from the anus.

Signs of a foreign body or intestinal blockage can lead to dehydration and electrolyte imbalances, which may also cause generalized illness. Additionally, if the foreign object has perforated the GI tract and entered the chest or abdominal cavity, the animal may become profoundly ill and critical. These complications can result in peritonitis, sepsis, and death.

Figure 3
Your primary care veterinarian will typically recommend initial laboratory tests, including a complete blood count (CBC), serum chemistry panel, and urinalysis. Together, these tests help rule out other causes of your pet’s symptoms. Abdominal radiographs, and sometimes thoracic radiographs, are commonly performed (Figures 2 and 3). If standard radiographs do not identify the cause of clinical signs, positive contrast radiographs may be done, using barium to outline the interior of the stomach and intestines. Abdominal ultrasound can be very useful for detecting gastrointestinal foreign bodies. In some cases, advanced imaging such as a CT scan may be required.

Surgery is not always necessary for gastrointestinal foreign bodies. Sometimes the swallowed item is small and smooth enough to move through the digestive tract without becoming stuck or causing injury. In such cases, your veterinarian may recommend hospitalization with intravenous fluids and close monitoring to help the object pass. In addition, some foreign bodies located in the upper GI tract (mouth, esophagus, or stomach) may be removed by inducing vomiting or by using a flexible endoscope (a camera-equipped tube). If conservative care and endoscopy do not resolve the problem, if x-rays show the object is not progressing, if the blockage is worsening, or if there is evidence of a linear foreign body, then surgical exploration is indicated.

Foreign bodies lodged in the esophagus require thoracic (chest) surgery to access and remove them. Most GI foreign bodies become stuck in the stomach or intestines and require either a gastrotomy (surgical opening of the stomach) or an enterotomy (surgical opening of the intestine). After the object is removed, the gastrointestinal tract is closed. If the intestine has sustained severe damage, the affected section is removed and the healthy ends are reconnected (intestinal resection and anastomosis). The surgeon determines which procedure is needed after evaluating the intestines and other abdominal organs. In most cases, the final decision is made during surgery once the surgeon can directly visualize the extent of injury to the intestine and surrounding tissues.

After abdominal surgery, animals remain on intravenous fluids and have their vital signs monitored for 12–24 hours. In some cases, a small tube is passed through a nostril into the stomach to help remove accumulated gas and fluid. When intestinal damage is severe, intravenous antibiotics may be administered. Food is offered once the pet is recovering; early return to oral feeding is important for intestinal healing. Electrolytes and other blood parameters may be checked periodically during recovery. Pets can be discharged once they are eating independently and can take oral medications.

Possible complications of intestinal surgery include decreased GI motility (ileus), narrowing at the surgical site (stenosis or strictures), short bowel syndrome, or leakage into the abdominal cavity. The most serious complication is intestinal leakage. Poor healing, injured tissue, or breakdown of suture material can all contribute to postoperative leakage. Leakage may occur within the first five days after surgery. Signs can include lethargy, worsening appetite loss, vomiting, fever, discharge from the incision, or a swollen/distended abdomen. If these signs appear after GI surgery, your pet should be rechecked as soon as possible. Animals with leakage often require revision surgery and may need prolonged hospitalization.

Animals that have very large portions of intestine removed (greater than 75%) are at risk for short bowel syndrome. With extensive intestinal removal, the surface area for digestion is reduced, which can cause maldigestion and malabsorption. This may lead to persistent watery or oily diarrhea and weight loss. Treatments are available, and some animals’ intestines can adapt over time, but it is important to work closely with your veterinarian to ensure proper nutrition if this condition develops.

Overall, prognosis after surgery for a GI foreign body is usually very good. Preventing further ingestion of foreign material is important. Repeated abdominal surgeries become substantially riskier if adhesions form. To reduce risk, pets can be kept in a kennel or in a room free of foreign objects when not supervised. Animals that repeatedly ingest foreign material may need to wear a basket muzzle to prevent additional episodes.