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Tuesday, August 17, 2010

Always Double Check

On Sunday one of my associates saw a puppy who had swallowed some rocks.  The abdominal radiographs showed the rocks clearly and one was somewhat large.  Since the puppy was acting normal, she recommended that he come back the following day to repeat the x-rays and see if the rocks had passed through the gastrointestinal tract. 

I saw him on Monday, repeated the radiographs, and noted that the larger stone and one other were still in his stomach.  This was concerning because it should only take 2-3 hours for the stomach to empty and less than a day for everything to pass through the other end.  Here were were a full day later and the rocks remained.  This meant that we were going to have to go in surgically and remove them to prevent further problems.  Since he was still acting normal I scheduled them for today and had them watch him overnight.

A principle I learned long ago is that when dealing with a GI foreign body that you plan to surgically remove, always double-check that it's still there just prior to surgery.  So when the puppy came in this morning I took one more x-ray to make sure the rocks were still in the stomach.  Lo-and-behold, the rocks had moved!  They were out of the stomach and into the small intestine.  And the puppy was still eating, active, and looking perfectly normal.

This is why we need to double-check in situations like this.  If I had just jumped in and started the surgery not only would I have put him through it potentially unnecessarily, but the rocks wouldn't have been in the stomach where I would have looked.  By a simple repeat of the radiographs I was able to save a surgery and the ensuing risks.

Now the puppy isn't completely out of the woods as he could still obstruct.  But he's in good enough shape that we're going to give him another 48 hours and re-evaluate whether we need to do surgery at that point.  And before we do, we'll definitely repeat radiographs one more time!

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