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Veterinarian Technician December 2012 (Vol 33, No 12)

Final View: A Brush With Danger

by Danielle Roth, CVT, Trisha Young, DVM

    During an overnight shift at our hospital, an owner called, saying that his puppy had chewed on a toilet-brush handle and had a piece stuck in his throat. However, we were not prepared for what we saw when the patient arrived at the hospital.

    Rocco—a 14-week-old, 8.9-kg (19.6-lb), intact male pit bull—had a whole toilet brush handle firmly lodged in his esophagus, with only the brush protruding from his mouth (FIGURE 1). On presentation, he was in obvious respiratory distress, as demonstrated by tachypnea and pronounced upper respiratory stridor. The brush handle was palpated at the thoracic inlet. An intravenous catheter was placed, and Rocco was immediately sedated using propofol (FIGURE 2). To help prevent aspiration and support airway patency and respiration, the patient was intubated, and anesthesia was maintained with isoflurane.

    Initial cervical and thoracic radiographs showed no evidence of an intrathoracic foreign body (FIGURE 3). After a discussion of the risks of manually removing the brush, including esophageal tearing, the owners elected to proceed. The plastic handle was gently manipulated, pushed caudally, turned, and eventually removed (FIGURE 4). A subsequent oral examination revealed severe swelling of the soft palate and the pharynx. Thoracic radiographs (FIGURE 5AFIGURE 5B) revealed a patchy interstitial pattern in the right cranial lung field, concerning us that aspiration had occurred.

    For recovery, Rocco was placed in the oxygen cage of the intensive care unit and given maintenance intravenous fluids, sucralfate (0.5 g PO in a slurry q8h), and a single dose of dexamethasone sodium phosphate (0.9 mg IV) to treat pharyngeal inflammation. He recovered well from anesthesia and became bright and alert. During the night, he developed a soft, productive cough. The next day, repeat thoracic radiographs (FIGURE 6AFIGURE 6B) showed (1) clear lung fields with no evidence of aspiration, (2) a small amount of gas within the esophagus, and (3) no evidence of free gas around the esophagus that would indicate a tear. Esophagoscopy was recommended to ensure that no esophageal lacerations had occurred, but this procedure was declined by the owner. Administration of clindamycin (75 mg PO q12h) was initiated, and Hill’s Prescription Diet a/d Canine was fed. Rocco ate well but had mild difficulty swallowing.

    Rocco was sent home with sucralfate, tramadol, meloxicam, and clindamycin. The owners were advised to feed soft food for 2 weeks because of the patient’s significant oropharyngeal trauma. Home care included careful monitoring for difficulty eating or swallowing, discharge from the mouth or nose, or swelling of the neck.

    In a follow-up phone call with the primary care veterinarian 1 week after presentation, Rocco was reported to be doing well and had started to receive his puppy vaccinations.

    Let's See Your "Final View"

    Do you have a unique, visual case to share through the popular Final View series? All you need is a high-resolution, clinical image(s) or video with a 100- to 300-word description, including the patient's treatment and recovery. E-mail your submission to editor@vettechjournal.com. Authors receive $75 per published case! 

    NEXT: Small Animal Dental Procedures: Anatomy of the Tooth

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