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Compendium January 2013 (Vol 35, No 1)

Clinical Snapshot: Gastric Foreign Body in a Doberman Pinscher

by Reemy Thomas, DVM, Kathy Spaulding, DVM, DACVR, John F. Griffin IV, DVM, DACVR

    Case Presentation

    A 1.5-year-old spayed Doberman pinscher presented to the Small Animal Veterinary Medical Teaching Hospital at Texas A&M University with a 1-week history of anorexia, vomiting, and melena. The patient was suspected to have ingested <236 mL (half a pint) of wood glue 8 days before presentation. Initial diagnostics included measurement of packed cell volume and total solids and a serum chemistry panel and blood gas analysis (NOVA chemistry panel, Nova Biomedical, Waltham, MA). A decreased level of total solids (5 g/dL; reference range: 5.7 to 7.8 g/dL) was the only abnormality. On physical examination, the patient was mildly dehydrated and tachycardic and exhibited pain on abdominal palpation. Ventrodorsal (FIGURE 1A) and left lateral (FIGURE 1B) abdominal radiographs were obtained.

    Figure 1. Ventrodorsal (A) and left lateral (B) abdominal radiographs.

    1. What are the radiographic findings?

    2. What is the most likely diagnosis?

    3. What other imaging modality is useful in confirming this diagnosis?

    4. What are the treatment and prognosis for this condition?

    Answers and Explanations

    1. On the radiographs (FIGURE 1), the stomach is nearly completely full, and the contents have a “honeycomb” appearance of gas and soft tissue opacities.

    2. The most likely diagnosis is gastric foreign body (bezoar) formation secondary to polyurethane glue ingestion.  

    3. Computed tomography (CT) is an alternative imaging modality that can help obtain the correct diagnosis faster. In cases without a clear history of polyurethane glue ingestion, the correct diagnosis can be elusive, leading to a higher risk of complications from gastric obstruction. In one case, appropriate treatment was delayed for 2 months due to the similarity in radiographic appearance of expanded polyurethane glue and ingesta or food.1 In this case, CT was performed to quickly differentiate between polyurethane glue and food.

    FIGURE 2A shows the CT image of the glue within the stomach of the patient in this case. It has a characteristic appearance of ingested polyurethane glue after expansion into a foam cast: a porous “honeycomb” pattern with sporadic areas of increased attenuation and diffuse speckling in the stomach. The porous nature of the glue cast can be attributed to the polymerization reaction between polyurethane adhesives and water. This reaction is an exothermic process and produces gas (carbon dioxide) that is incorporated into the polymer matrix, creating a foamy mass.2 The lack of attachment of the mass to the gastric wall and the presence of small amounts of gas throughout and/or around the mass are strongly indicative for diagnosis of a bezoar. Food is generally not interspersed with significant quantities of gas, does not have an organized pattern, and tends to settle, as shown in FIGURE 2B. In this patient, the lack of appreciable residual gas outlining the glue cast was suspected to be due to a patent duodenum and esophagus acting as escape valves for the carbon dioxide by-product.

    Figure 2. (A) CT image of the expanded wood glue in the patient’s stomach. (B) CT image of ingested food in the stomach of a different dog.

    4. Surgery soon after ingestion is the treatment of choice, and with removal of the foreign body, the prognosis is excellent.1,3 The inert, nondegradable product conforms to the shape of the distended stomach and will remain in the stomach until surgically removed. Complications that can arise if surgery is not performed soon after gastric obstruction include mild to moderate mucosal irritation, gastric hyperemia, and ulceration; more serious complications include gastric perforation and peritonitis.1,3–5 Persistent clinical signs include persistent vomiting, poor appetite/anorexia, lethargy, weight loss, diarrhea, dehydration, abdominal distention/pain, and tachypnea.3–5

    ***

    The patient was taken to surgery for gastric foreign body removal via gastrotomy. On gross examination, the dark brown, expanded adhesive retained the shape of the stomach lumen and contained grass and other ingested particles (FIGURE 3).The patient recovered without complications and was discharged the following day.

    Figure 3.The expanded wood glue after surgical removal.

    References

    1. Phelps HA, Sepulveda G, Langs LL. What is your diagnosis? J Am Vet Med Assoc 2009;235(5):507-508.

    2. Kaushiva BD. Structure-Property Relationships of Flexible 227 Polyurethane Foams [dissertation]. Blacksburg: Virginia Polytechnic Institute; 1999. http://scholar.lib.vt.edu/theses/available/etd-083199-185156/unrestricted/KAUSHIVA1.PDF. Accessed November 2012.

    3. Horstman CL, Eubig PA, Cornell KK, et al. Gastric outflow obstruction after ingestion of wood glue in a dog. J Am Anim Hosp Assoc 2003;39:47-51

    4. Lubich C, Mrvos R, Krenzelok EP. Beware of canine Gorilla Glue ingestions. Vet Hum Toxicol 2004;46:153-154.

    5. Bailey T. The expanding threat of polyurethane adhesive ingestion. Vet Tech 2004;25(6):426-428.

    References »

    NEXT: Corneal Ulcers in Horses

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