What is a gastrointestinal foreign body and how is it treated?

We all know that dogs and cats like to chew and swallow things that are not edible. Some of these items can cause serious and life threatening problems. Common items in dogs include underwear, socks, rocks, corncobs, and other small things. Common items in cats include strings, ribbons, earplugs and small toys. The variety is almost limitless. I have seen radiographs of large knives in the esophagus and stomach of dogs. There is even a veterinary journal article series entitled “They ate what?” dedicated to radiographs of gastrointestinal foreign bodies. It can be interesting to see a radiographic image of Mickey Mouse in a dog’s stomach.

The problems arise when this foreign material cannot pass through the gastrointestinal tract. Some become lodged in the stomach, others just into the small intestine, and still others well into the small intestines. In the case of linear foreign bodies like strings, they often become trapped under the tongue or in the stomach and extend well into the small intestines. These linear foreign bodies often allow the small intestine to crawl up the object causing the intestines to bunch together severely. As the intestines do not hold still, there is often a sawing motion of the intestine against the foreign body that will cause holes to form in the intestine.

There are 3 basic ways to deal with GI foreign bodies. Induce vomiting to try to get the object to come back out the way it went in, try to allow it to pass with the feces, or go in and remove it with endoscopy or surgery. The type of foreign material dictates which options are appropriate.

The best place to have a foreign body would be the stomach. Symptoms usually include vomiting and decreased appetite. Occasionally, these objects can be removed by making the patient vomit. If endoscopy is available, some objects can be removed this way. If endoscopic removal is not possible or is unsuccessful, surgery may be required. Surgery, called a gastrotomy, has the lowest risk of complications of the foreign body surgeries. The stomach is opened and the foreign material is removed.

Once the foreign body enters the intestines, surgery is usually required. Symptoms usually include severe vomiting, often brownish or greenish, fetid fluid, anorexia, depression, and severe dehydration. The intestines have a very small diameter compared to the stomach, so even relatively small objects often become unable to pass. The dilation of the intestines often causes compromise of the intestinal wall. Sometimes this is limited to inflammation and bruising, but sometimes a portion of the intestine dies and has to be removed.

Intestinal incisions, called enterotomies, have frequent complications. Often, the intestine is compromised to some extent, even when not grossly obvious. Even with good surgical technique, about 20% of intestinal incisions will dehisce (fall apart). Resections carry the highest risk of complication. Linear foreign bodies tend to have higher risks due to the sawing actions of the foreign body in the intestines. The longer the foreign body is present, the greater the risks for complications.

In the past week (as of this writing), I have helped treat 2 dogs with intestinal obstructions from foreign bodies that had each had surgery for the same problem 2 to 3 weeks previously. This is in addition to the at least 3 other patients presenting with foreign bodies. Of these 5 cases, only 3 of them are still alive.

GI foreign bodies have many risks associated with them, including death, not to mention that this type of surgery and hospitalization is expensive. It is best to try to avoid this problem. Try to train your pet to play only with appropriate toys. Teach your pet to drop anything in its mouth on command. Keep likely objects, like socks, underwear, small toys, needles and thread, dirty wash cloths, garbage cans, and potentially even towels and blankets, away from your pet.

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