rabbit with ET tube fragment in stomach

Re: rabbit with ET tube fragment in stomach

Martin Atkinson — Fri, 27 Jul 2012 13:23:36 GMT

Nearly had a similar disaster yesterday, dog recovering up in kennel, I started the observation, left it for a few seconds to do something else, someone closed the kennel door, no nurse specifically allocated to task, out of sight/out of mind, dog coughed tube and fortunately it came right out even though the cuff was still inflated. Got away with it this time but as ever the buck stops with me.

Re: rabbit with ET tube fragment in stomach

Hannah Wynne Richards — Fri, 27 Jul 2012 09:39:22 GMT

Congratulations Nice to hear of a successful outcome after a stressful time for all

Wynne

Re: rabbit with ET tube fragment in stomach

Rob Davis — Fri, 27 Jul 2012 08:51:41 GMT

Update: following removal of tube fragment via gastromotomy one week ago, rabbit is thankfully now doing well. First few days post op were a little stressful (predictable anorexia), but rabbit is now eating normally, passing normal droppings and gaining weight (he had lost 1.5kg from his pre-castration weight, and although his testicles were large, they weren't that big!)

Thanks as always for all the opinions, it really does help to discuss these things with colleagues.

Re: rabbit with ET tube fragment in stomach

Rajat — Mon, 23 Jul 2012 12:21:26 GMT

[quote user="Gareth Dowdeswell"]Might be wrong, I thought rabbit stomach acid was more acidic than carnivores?[/quote]

I stand corrected- looked it up and apparently pH is 1-2 in adult rabbits, 5-6 in young (upto weaning) rabbits

Thanks!

Re: rabbit with ET tube fragment in stomach

Gareth Dowdeswell — Sat, 21 Jul 2012 08:52:37 GMT

Hope all goes well OP, another vote here for contacting the VDS, they've always been very supportive on the occasions I've had to use their services.

[quote user="Rajat"]

I imagine rabbit stomach pH isnt as acidic as dogs and cats otherwise there may be some hope for dissolution?

[/quote]

Might be wrong, I thought rabbit stomach acid was more acidic than carnivores? Still be a brave vet taking the wait and see approach, especially as there's no chance of the rabbit vomitting it back out.

Re: rabbit with ET tube fragment in stomach

jamie winstone — Fri, 20 Jul 2012 18:28:36 GMT

Something similar to this happenned to me a couple of years ago. The rabbit chewed through the tube during the operation and then inhaled the remaining portion of the tube. After a very fraught lunch hour I performed a tracheotomy in the afternoon suturing up the tracheal incision with three sutures of 6-0 PDS. Much to my relief the bunny made a full recovery.

I have often wondered whether this event is a real concern when tubing rabbits or whether Rob and I were just incredibly unlucky.

In my case the rabbit was "owned" by the RSPCA which took the pressure off me, but since then we are a little paranoid when tubing rabbits.

Re: rabbit with ET tube fragment in stomach

Bob Russell — Fri, 20 Jul 2012 17:43:29 GMT

[quote user="Rob Davis"]

After speaking to VDS and an exotic referral vet locally, and taking into account opinions on here.... I was still undecided. I had approx 50% votes for leave it and 50% for gastrotomy. After discussing with the owner we decided to go for retrieval. Tried endoscopy, but failed to even find the fragment let alone grab it as the stomach was full of green slurry... Gastrotomy performed, fragment removed, rabbit now waking up. I am now crossing fingers and toes!

Thanks as always for the opinions, I'm off for the next four days (one of the reasons I was keen to sort it today rather than leave my mess for somebody else to deal with!), but I'll update you when I'm back.

[/quote]

Sensible choice IMO. The alternative is to have a walking 'time-bomb' and you would continue to worry about it!

Re: rabbit with ET tube fragment in stomach

James Laidlaw — Fri, 20 Jul 2012 17:06:39 GMT

Hope it all goes well with recovery post op.

Re: rabbit with ET tube fragment in stomach

Lorna McHardy — Fri, 20 Jul 2012 16:43:05 GMT

Good luck!

Re: rabbit with ET tube fragment in stomach

Rob Davis — Fri, 20 Jul 2012 16:40:21 GMT

Re: rabbit with ET tube fragment in stomach

Martin Atkinson — Fri, 20 Jul 2012 12:59:47 GMT

[quote user="Bob Russell"] The 'monitoring' was lax and it chewed through the tube. I managed to get my little finger inside the tube and hook it out. Very scary but lady luck was looking down on us that day![/quote] QED. However even the wary can be caught out especially if you are reversing the anaesthetic with atipamazole - they can suddenly wake up and catch even the most diligent unaware, there is a degree of 'there but for the grace of God go I' element in much of things that nearly go wrong which are other's horror stories.

Re: rabbit with ET tube fragment in stomach

Bob Russell — Fri, 20 Jul 2012 12:49:09 GMT

I don't know how this happened so am not being judgmental as to fault or not. I would accept it is the practices responsibility to sort it out!

We nearly lost a tube inside a labrador (many, many years ago). The 'monitoring' was lax and it chewed through the tube. I managed to get my little finger inside the tube and hook it out. Very scary but lady luck was looking down on us that day!

I learned a good lesson!

Re: rabbit with ET tube fragment in stomach

Martin Atkinson — Fri, 20 Jul 2012 12:39:02 GMT

[quote user="Bob Russell"]These things happen and whilst not our 'fault', remain our responsibility to sort out![/quote] I disagree it is 'our' fault someone cocked up monitoring the anaesthetic. I accept full blame for the cases I've cited earlier.

Re: rabbit with ET tube fragment in stomach

Hannah Wynne Richards — Fri, 20 Jul 2012 11:44:21 GMT

I'm with Bob on this cowardly I know but a second GA in rapid succession on a rabbit is something I'd rather someone else did

Wynne

Re: rabbit with ET tube fragment in stomach

Rajat — Fri, 20 Jul 2012 11:09:42 GMT

I am with Mark R on this one- remove endoscopically (shouldnt be tough with the right gvrasper which should be available if ordered within a few days)

In dogs I find the rigid graspers better and easier for gastric fb

I can't see how one would get the big ones into a rabbit(even a giant one) but smalle rrigid forceps(long!) maybe able to be passed

I would also do a gastrotomy if this doesn't work. I imagine rabbit stomach pH isnt as acidic as dogs and cats otherwise there may be some hope for dissolution? Better to do it while the bunny is well rather than it lead to obstruction or ileus then there are several other things to worry about!

As for it being evidence for not tubing rabbits hmm.. really?

Re: rabbit with ET tube fragment in stomach

Bob Russell — Fri, 20 Jul 2012 10:49:15 GMT

As a practice owner, this is one I would hand over to someone more expert than me, bite the bullet and cover the bill. It is sometimes better to sleep well at night with an empty bank balance than have sleepless nights worrying about the patient and the owners reaction to a practice mishap!

These things happen and whilst not our 'fault', remain our responsibility to sort out!

VDS would be a good call to make because owners tend to blame rather than understand.

Re: rabbit with ET tube fragment in stomach

Mark Rowland — Fri, 20 Jul 2012 09:57:58 GMT

This is a tough call. If it stays in the stomach, that could be fine. If however it does get into the intestines you could be in a world of hurt. Informed consent is what you need so that if for example the rabbit gets post op ileus or adhesion formation you have covered yourself. If you leave it there it may do nothing, but will you be xraying this rabbit every time it gets some sort of abdominal issue? I suppose if it were me and endoscopic retrieval were not possible I would consider a gastrotomy on a well rabbit to be superior to an enterotomy on an unwell rabbit. You could talk to Michael Stanford at the VDS to get them informed and get some extra advice but I would consider an elective gastrotomy over doing nothing if endoscopic retrieval is not possible

Goodluck

Re: rabbit with ET tube fragment in stomach

Martin Atkinson — Fri, 20 Jul 2012 09:21:21 GMT

I've not had one like this but I would leave it for now and see what happens. Had a dog which chewed through an ET tube and got stuck in the trachea, we re-anaesthetised it and put a small tube down inside, inflated the cuff and hoiked it out. On the theme of similar disasters I have now had 2 patients where an IV cannula has been cut and part left in the cephalic vein...eek. I left them both and they've been fine. This is something I have not done in 30 years of vetting and then managed it twice in 12 months!

Re: rabbit with ET tube fragment in stomach

Rob Davis — Fri, 20 Jul 2012 08:54:48 GMT

I agree that in theory removing it endoscopically would be ideal, but I doubt whether I will be able to grab it end on and hold onto it. The grabbers we have are, I suspect, too flimsy to hold it. I have taken a conscious DV view this morning and can see the fragment, but can't tell whether or not it's in the stomach still. I have kept the rabbit in for monitoring (and to give me some time to decide what to do....).

[quote user="Mark Rowland"]Given the morbidity associated with laparotomies in rabbits, I would at least have a go with a gastroscope first if it were me. Goodluck[/quote]

If you couldn't remove it endoscopically, Mark, would you leave it or go for gastrotomy? At the moment the owners are being very understanding, but I'm aware that this could change if things end badly....

Re: rabbit with ET tube fragment in stomach

Michael Woodhouse — Fri, 20 Jul 2012 00:26:55 GMT

Leave it alone and see what happens. I know of a cow with the end of an aggers pump in its rumen and a good friends dog has a large stone in the stomach (incidental on rads). Both have been there 3+ years and no bother.

I'd be amazed if it caused a problem.

Re: rabbit with ET tube fragment in stomach

Mark Rowland — Thu, 19 Jul 2012 22:59:53 GMT

Given the morbidity associated with laparotomies in rabbits, I would at least have a go with a gastroscope first if it were me. Goodluck

Re: rabbit with ET tube fragment in stomach

Rob Loxley — Thu, 19 Jul 2012 22:44:17 GMT

[quote user="Rob Davis"] do gastrotomy?[/quote]

If you have a small bronchoscope could you not retrieve it from the stomach without a laparotomy?

Anyone using the metal-reinforced ET tubes (and accepting the smaller ID for the same OD size)?

Re: rabbit with ET tube fragment in stomach

Joyce Whitehead — Thu, 19 Jul 2012 19:49:36 GMT

Had a labrador many years ago who did this on recovery, removal not quick enough and he chewed through the tube. Similar sized piece visible in stomach, Xrays repeated over the next few days (dog completely normal), passed it on the fourth day if I recall correctly.

Not sure a rabbit will pass it so easily though. Sympathies.

Re: rabbit with ET tube fragment in stomach

Mark Holmes — Thu, 19 Jul 2012 19:48:14 GMT

Excellent evidence to support not routinely tubing rabbits perfect !

Re: rabbit with ET tube fragment in stomach

David Mills — Thu, 19 Jul 2012 19:22:47 GMT

Take it out tomorrow, FOC, quick 20 minute op, don't tube it during the GA.