What to do with the screw....

RE: What to do with the screw....

Edward Jones — Thu, 26 Oct 2017 09:32:55 GMT

I had a 35kg retriever in for a lump removal and met-check. Unfortunately my caudal collimation was too wide and showed a metal bottle-top in the stomach. Seeing as I had the dog already anaesthetised I recommended a gastrotomy (no endoscope).

I have no idea how long the bottle top had been there, or whether it might have passed, and I'm not sure what I would have done if I'd known the dog had swallowed the FB, but was otherwise asymptomatic (and wasn't already under a GA).

RE: What to do with the screw....

Rob Loxley — Wed, 25 Oct 2017 23:38:23 GMT

[quote user="Glenn Hodgson"]Would anyone have left him to try and pass it?[/quote]

Yes, quite acceptable IMHO, though I would have offered referral for scoping and retrieval if that's how the owners wanted to go. Have happily left fish hooks to successfully pass; all kinds of crap is eaten and passed every day that it's hard to know the exact NNT in such situations?

RE: What to do with the screw....

Julie Innes — Wed, 25 Oct 2017 18:42:38 GMT

I don't have a scope, so would have given the owners the options, with associated risks etc.

If it was my own dog, I'd have waited to see (having had 2 beagles in the past, it's amazing what will come through a dog unscathed- even a teaspoon!) I once felt something in a dogs abdomen, but dog was asymptomatic. I had it back each day and followed this hard lump further down the gut, just by palpation, until day 4 when the owner appeared triumphantly waving...a snooker ball!

Seen quite a few dogs that have eaten and passed glass, stones, and even one that ate and passed a pair of spectacles!

RE: What to do with the screw....

Glenn Hodgson — Wed, 25 Oct 2017 18:38:23 GMT

Interesting to hear that similar objects can both pass and kill them. That's the background I was after, thank-you.

It was a wood screw of some type.

I'm also too cautious to induce emesis in the likes.

I did make my own dog vomit 1kg of raw unchewed lamb chops though... Hes still with me :-)

In this case I gave the owner the option if monitoring, however made a strong recommendation to remove.

RE: What to do with the screw....

Lindsey Edwards — Wed, 25 Oct 2017 17:47:37 GMT

As said above if I had a scope I'd try and use it - don't have the coordination to be any good at it though so would advise owner of options - monitor (was always told to feed bread, hadn't heard of cotton wool to try and coat spikes!), ex lap or refer for scoping. Last few small metlic FBs have all passed through and disappeared off radiographs without intervention

RE: What to do with the screw....

Jill Butterworth — Wed, 25 Oct 2017 13:07:45 GMT

[quote user="Nicola M"]Personally I would remove it. Although I would probably also remove a sewing needle![/quote]

I have actually held my breath and 'seen' (well the owner did!) a needle pass through. It was quite a leap of faith, but everything, unbelievably, was fine.

Also, on past experience it is a devilish job actually locating a needle. It looks like it should be easy peasy, but it seriously wasn't, because ahem, all the gut was undamaged, and so you have to bend the gut to locate the needle and pierce the gut and your fingers in the process...

RE: What to do with the screw....

Anthony Todd — Wed, 25 Oct 2017 12:39:47 GMT

[quote user="Thomas Johnson"]I would probably have advised monitoring with repeated radiographs the next day,[/quote]

I can't see the point of repeat Xrays in an asymptomatic animal. I'd suggest checking the stools [thoroughly] and reassessing [and probably an ex-lap] at the first sign of abdo. discomfit or signs.

RE: What to do with the screw....

Thomas Johnson — Wed, 25 Oct 2017 08:25:00 GMT

[quote user="Virginia Campbell"]I'd probably have given it a tin of dog food and a jag of apo then scoped it if that failed.[/quote]

I would worry that the forceful emesis induced by apomorphine could cause the screw to damage the oesophagus, I would have thought that it would be less likely to cause damage if it was left to pass through.

I would probably have advised monitoring with repeated radiographs the next day, but I don't have access to an endoscope.

RE: What to do with the screw....

Virginia Campbell — Wed, 25 Oct 2017 00:12:14 GMT

[quote user="Evelyn Barbour-Hill"]

zinc plated,

[/quote]

Well that might have been relevant I suppose

I'd probably have given it a tin of dog food and a jag of apo then scoped it if that failed. I'm not very good at steering the scope so would probably take me ages ( I was always rubbish at that fairground game where you try to steer the metal grabber thing to get a teddy out of the pile in the big perspex box.)

RE: What to do with the screw....

Evelyn Barbour-Hill — Tue, 24 Oct 2017 22:25:36 GMT

You could advise the client of the advantages and disadvantages of each approach, and then ask the client which approach they would prefer.

Blinkin' 'eck, if you've got a suitable scope and skill, use it!

What size screw was it? Classical woodscrew, turbodrive, single thread, double thread? Steel, brass, zinc plated, passivated? I'd ask if it was countersink head, but I'll lay that it was, 'cos it's an effort to get anything else these days. It seems to be a matter of bung a countersink screw in, whether the hole's countersunk or not, it'll be OK. That was a shocking crime when I was learning woodwork.

RE: What to do with the screw....

Nicola Cole — Tue, 24 Oct 2017 22:23:19 GMT

Once bitten, twice shy on this one for me. Anecdote alert-options discussed, possible risks discussed, decided on monitoring. Booked in for repeat rads following day-owners didn't represent dog until a week or so later when it had been vomitting intermittently and developed lethargy since last seen-had peritonitis and subsequently died.

So for me, yes I would discuss options but I would express my concern at just monitoring-if monitoring was the plan then I would think about getting some kind of consent form signed that the owner was aware of the risks AND that they would actually come back to be monitored!

RE: What to do with the screw....

Michael Woodhouse — Tue, 24 Oct 2017 21:58:21 GMT

If I had a scope and could remove it easily I might, BUT we have expert opinion from a DC case (inexperienced vet did ex lap to remove glass) saying sharp FB will safely pass through. I wouldn't be especially worried and I wouldn't ex lap without signs.

EBVM and all that. Just because we think it's better removed doesn't make it in the dogs best interests.

RE: What to do with the screw....

Nicola Cole — Tue, 24 Oct 2017 21:48:29 GMT

Personally I would remove it. Although I would probably also remove a sewing needle!

RE: What to do with the screw....

Jill Butterworth — Tue, 24 Oct 2017 21:20:44 GMT

Considering it is ok to leave sewing needles to pass through (so long as no cotton attached) you might extrapolate that it will be ok to leave, so long as there are no signs of obstruction.

That said, I would probable radiograph periodically and discuss the pros and cons with the client.

My mum was given cotton wool sandwiches as a child, when she swallowed some sharp pieces of pottery (a jug she bit!). She was fine, not sure if it was due to the cotton wool ;)

Hey, but am only saying this cos I haven't got a scope! I would have removed by this method if it was available to me...

RE: What to do with the screw....

Stephanie Wellings — Tue, 24 Oct 2017 21:13:08 GMT

I would vote for remove. My reasoning would be because of the foreign body being sharp there is a risk of perforation. I think the time/expense is justified to not spend the week worrying about septic peritonitis.