I can't stop worrying

Re: I can't stop worrying

Rob Davis — Tue, 13 May 2014 14:13:04 GMT

[quote user="Anthony Todd"]Why does a swab get into the abdomen in a bitch spay? At what stage? I don't think I've ever seen anyone ever need to do that.[/quote]

I routinely pack swabs into the abdomen during bitch spays to isolate the ovaries - I find it a helpful way of keeping bowel, omentum etc out of the way. I will commonly have 7 or 8 swabs in the abdomen, but am always meticulous about counting before and after (apart from when my son is watching!)

Re: I can't stop worrying

mariette asselbergs — Mon, 12 May 2014 13:28:26 GMT

" she was a retired human theatre nurse and commented that she had seen much worse things left in human abdomens!" (Rob Davis)

My stepmother had vague abdominal pains for years on and off. Finally they became worrying enough for an exlap and out came encapsulated swabs and drains from surgery 30 years before!

Mariette

Re: I can't stop worrying

Michael Woodhouse — Sun, 11 May 2014 21:33:37 GMT

Any update on this?

Re: I can't stop worrying

Mark Holmes — Wed, 30 Apr 2014 09:05:13 GMT

[quote user="CatherineThomas"]

I once had a bitch spay start vomiting a couple of days after the op. At first we assumed it was related to the nsaids but when it didn't respond to treatment we x-rayed followed by ex-lap and found a golf ball in her stomach. She hadn't been near the golf course since before the spay.

[/quote] Same here, Labrador spayed her for a client (non practicing vet of all people) started vomiting after the surgery - assumed NSAIDS opened her 2d later to find FB. Squash ball as far as I remember. Can only have been there during the spay. Stupid thing is when I spayed her other dog it developed HGE within 48 hrs of the op. Thought briefly the same thing was going to happen (even though I'd had a sneak peak around the abdomen that time)

Re: I can't stop worrying

Hannah Wynne Richards — Wed, 30 Apr 2014 08:37:29 GMT

That's rotten bad luck

Wynne

Re: I can't stop worrying

CatherineThomas — Tue, 29 Apr 2014 21:00:57 GMT

Re: I can't stop worrying

Anthony Todd — Tue, 29 Apr 2014 17:37:03 GMT

Why not do a blind tap of the abdo fluid in case it's something weird and nothing to do with the op.

Can do a tap in the surgery, so as not to make a meal out of it, should give you all the info you need.

Re: I can't stop worrying

Virginia Campbell — Tue, 29 Apr 2014 17:31:07 GMT

Oh yeah, and if you are going to for ex lap, have a plan in mind if your spay looks perfect and there's no swab there....ie this might be your only chance to biopsy things so decide which things beforehand based on your previous testing then adapt to suit what things look like when you get in there.

Re: I can't stop worrying

Virginia Campbell — Tue, 29 Apr 2014 17:27:32 GMT

[quote user="An On MRCVS"]

If you've seen a case, what signs did they show? And how long after surgery?

[/quote]

I've seen one and she didn't do all that well from day one - came in 5 days post spay with the weight having fallen off her and looking a bit tucked up and miserable, just picking at food and temp elevated. Mind you, when I do a thing I don't like half measures...this is the only (known) case that I've left a swab in....and it was a laparotomy swab. I am not kidding. I didn't count them as I would have thought it would be impossible to leave a swab the size of a ruddy teatowel in a dog and not notice. (In my defence it was the first gastropexy I've done and my boss was swabbing for me, so I shall conveniently blame him). I Xrayed her, saw the radiolucent line, made an embarrassed phonecall to the owner and retrieved it and thankfully she did well.

In your case I'd get on and do everything in a row in one morning- bloods, Xray, ultrasound if you have one (if not try blind tapping abdo) then probably get on and ex lap anyway, no matter what you find (the point of everything else being to rule out weirdities like crashing renal failure for no apparent reason or a bleeding liver tumour...how old is the bitch btw?) If you're not the boss talk to the boss and dog owner about costs beforehand - if there's a swab there I would expect the owner to pay nothing for any testing, surgery and aftercare; work out what the owner will pay if there's pathology that's the "dog's fault" and work out beforehand what you will charge if it turns out to be unclear whether you could be at fault or not.

Re: I can't stop worrying

Clare Tapsfield-Wright — Tue, 29 Apr 2014 10:23:11 GMT

If you think it highly unlikely you left a swab in then it is more likely to be something else altogether. Approach this case with an open mind and do a full work up . Wouldn't be the first bitch in my experience to develop something like lymphoma in the post operative stage . Completely understand your worries , I hated operating on animals of friends and relatives .

Re: I can't stop worrying

Anthony Todd — Tue, 29 Apr 2014 10:09:24 GMT

[quote user="Michael Woodhouse"]I can't see steroids will help in this case, so we are left with an ex-lap............[/quote]

If it's not one of my favourites it's the other....

Re: I can't stop worrying

Martin Atkinson — Tue, 29 Apr 2014 09:54:42 GMT

The fact the owners are relatives should mean they'll be a bit more understanding. Go back to the beginning and make a list of differential diagnoses of which the swab is one: X-ray, ultrasound, blood test as appropriate. If you then need to do an ex lap to progress then get on with it, if it is a swab it will be most likely straightforward and the dog will recover fine. Once you've made these decisions you'll stop worrying.

Re: I can't stop worrying

Michael Woodhouse — Tue, 29 Apr 2014 01:32:16 GMT

I can't see steroids will help in this case, so we are left with an ex-lap............

(might be the only way you settle down and know for sure)

Re: I can't stop worrying

Mark Holmes — Mon, 28 Apr 2014 18:39:11 GMT

[quote user="Anthony Todd"]

[quote user="Evelyn Barbour-Hill"]My primary precaution is to put nothing into the abdomen, unless it's attached to something that leads to the outside. Any swab that goes inside has to be gripped by artery forceps, that's the rule. I have also used those swabs with strings on.[/quote]

Um, I thought everyone did that?

Why does a swab get into the abdomen in a bitch spay? At what stage? I don't think I've ever seen anyone ever need to do that.

[/quote] Sometimes it helps keep bowel and Omentum out of the way. Don't do it often but it helps occasionally.

Re: I can't stop worrying

Anthony Todd — Mon, 28 Apr 2014 17:24:01 GMT

Um, I thought everyone did that?

Why does a swab get into the abdomen in a bitch spay? At what stage? I don't think I've ever seen anyone ever need to do that.

Re: I can't stop worrying

Hannah Wynne Richards — Mon, 28 Apr 2014 16:11:16 GMT

I always use the massive laparotomy swabs (1 per kit) for all canine abdomens, os anything feline that's done mid-line. More expensive, but the peace of mind is priceless. With only 1 swab per kit, there's no need to count - it's either there - or not.

Wynne

Re: I can't stop worrying

Evelyn Barbour-Hill — Mon, 28 Apr 2014 16:02:17 GMT

If we are drifting on to preventive precautions..........

My primary precaution is to put nothing into the abdomen, unless it's attached to something that leads to the outside. Any swab that goes inside has to be gripped by artery forceps, that's the rule. I have also used those swabs with strings on.

Re: I can't stop worrying

Rob Davis — Mon, 28 Apr 2014 15:56:09 GMT

One case many years ago: I palpated a mobile mid-abdominal mass in an Airedale at a routine vaccination check. Ex-lap revealed a mass within the mesentary which I resected and submitted for histopathology. It wasn't until I received the histo results that I discovered it was a swab. The only previous surgery she had was when she was spayed five years previously. She never showed any clinical signs as far as I'm aware. The owner was great - she was a retired human theatre nurse and commented that she had seen much worse things left in human abdomens!

Since then I have been meticulous about counting swabs. My only error (that I know of...) was when my son came to work with me for the day. He was watching me spay a bitch, and I forgot to count the swabs before closing the abdomen (I blame him for distracting me). I remembered just as I was starting to close the skin, and typically this was the one time I had left one behind, so had to remove all my sutures, retrieve the swab and reclose. My son was most amused to see Dad cocking up!

Re: I can't stop worrying

Rob Davis — Mon, 28 Apr 2014 15:51:06 GMT

Double - posted by mistake

Re: I can't stop worrying

Bob Russell — Mon, 28 Apr 2014 14:44:39 GMT

A locum left a swab in a bitch spay (many years ago). It caused no problem for several years but the dog started vomiting. I sent it for ultrasound, telling the owner that I was suspicious of a soft FB! It was not at all the kind of FB I was expecting!

The locum was extremely good (except this occasion!), experienced so it shows it can happen to us all!

Ever since we have used pre-packed swabs (in 5's), X-ray identifiable and count them in and count them out (witnessed!) for my peace of mind. VDS came into their own and patient and client are still with us to this day!

Re: I can't stop worrying

Tim Charlesworth — Mon, 28 Apr 2014 14:23:23 GMT

Hi, I've seen half a dozen or so of these, one of which I left in so it does happen. The range of symptoms that retained swabs cause is really variable, I've seen a few dogs just a bit unwell/with nonspecific abdo pain, sometimes spinal pain (which I presume to be referred pain), all of which resolved following swab retrieval. The longer standing cases (mths to yrs) tend to be waxing/waning PUO or sometimes even palpable abdominal mass if they have formed the classical fibrous reaction ("gossypiboma") which we've mistaken for tumours before, resected and then cotton fibres have been found either when cutting into them or on histology. I suspect that the degree of reaction you see in the short term relates to the sterility of the procedure, the size of the swab and where it is placed. The case where I left a swab in def had 10 swabs counted out (twice) but we think there was a cheeky 11th hiding between the swabs when I counted them in (and now I always separate the swabs when counting in/out rather than just counting the corners). We also made the practice decision to only use radio-opaque marked swabs in cavity (abdominal/thoracic) surgery from then on. It can be hard to be objective when it's your own case but the best advice I can give you is to pretend that somebody else did the original surgery and work it up as a new case but just bare in mind the recent surgery as has already been said. Feel free to PM me if you need any advice,

Tim

Re: I can't stop worrying

Joyce Whitehead — Mon, 28 Apr 2014 12:27:19 GMT

I've only seen one, in an incidental finding in a dog having an ex lap for an entirely unrelated condition, the swab had likely been there from a previous gastric dilatation surgery many years before performed at another practice. I too thought it was an encapsulated abscess when I found it. He did fine afterwards.

Re: I can't stop worrying

Kate Richardson — Mon, 28 Apr 2014 12:24:48 GMT

[quote user="sandpiper"] I suggest you adopt a logical approach [/quote]

Put a swab on the list of differentials, but totally agree, take a logical approach. Do you have access to ultrasound? Firstly find out why the abdomen is distended- is it fluid or say an enlarged spleen? What's her age/breed? If there is fluid there, sample it, that will tell you a lot. Don't rush in to open her up because you are worried about a swab- it might even be better to ask a colleague to assess her as they may be able to be more objective?

Re: I can't stop worrying

sandpiper — Mon, 28 Apr 2014 11:57:25 GMT

Hi Anon, no experience of one myself though rough signs as you describe could be consistent.

My thoughts would be to trust your method and routine, though I understand the worry. It will most likely be something unrelated, coincidences do happen.

A retained swab has a pathognomonic xray appearance, any radio-opaque strip may also help. If she does come in tomorrow, I suggest you adopt a logical approach from the start, but preferably xray her, for diagnosis but more for your peace of mind.

Re: I can't stop worrying

Gillian Mostyn — Mon, 28 Apr 2014 11:53:07 GMT

[quote user="An On MRCVS"]If you've seen a case, what signs did they show? And how long after surgery?[/quote]

Yes - saw a case approx 13 years ago. AOK for a couple of weeks and then showed PUO, lethargy and cranial abdominal pain after what I think was 3-4 weeks. The practice didn't use swabs with markers so swab picked up at ex lap - the operating vet thought it was an encapsulated abscess until he cut into it.....!!!

(Luckily for the rest of us, the boss had done the op! )