Foreign Body Obstruction in Dogs: Comparing Outcomes of Enterotomy With Intestinal Resection & Anastomosis

In the Literature

Lopez DJ, Holm SA, Korten B, Baum JI, Flanders JA, Sumner JP. Comparison of patient outcomes following enterotomy versus intestinal resection and anastomosis for treatment of intestinal foreign bodies in dogs. J Am Vet Med Assoc. 2021;258(12):1378-1385.

The Research …

Intestinal foreign body obstructions can be removed either through enterotomy or intestinal resection (IRA) and anastomosis of a bowel segment, depending on the viability of the associated intestine. Risk factors for postoperative intestinal dehiscence (eg, septic peritonitis, low serum albumin levels, intraoperative hypotension) are well established,^1-4 but published dehiscence rates for enterotomy and IRA vary.^2-6 

This study sought to clarify the risk for dehiscence in dogs undergoing IRA compared with enterotomy and evaluated use of early enteral nutrition administered via nasogastric tube to improve clinical outcomes. Nasogastric tubes were placed intraoperatively at the surgeon’s or resident’s discretion and were used to administer a commercial liquid diet during the first 24 hours postoperatively. 

Retrospective analysis of 227 foreign bodies removed from the small intestine of 211 dogs at a veterinary teaching hospital found a dehiscence rate of 3.8% with enterotomy and 18.2% with IRA. The odds of dehiscence after IRA were 6.09 times greater than with enterotomy; however, multivariate analysis of factors that may influence intestinal healing revealed that only older patients and those with an American Society of Anesthesiologists (ASA) score >3 were significantly associated with increased risk for intestinal dehiscence, regardless of procedure. The odds of dehiscence increased by 1.24 for each year of age increase. 

Benefits of early enteral nutrition could not be accurately assessed, as the hospital switched to routine use of nasogastric tubes for foreign body surgery, but data revealed that longer periods until voluntary food intake significantly increased the odds for intestinal dehiscence.

Limitations of the study included retrospective data collection, nonrandomization of nasogastric tube placement, and the inherent inability to randomize the procedure used for foreign body removal. Suture types, sizes, and patterns were not included in statistical analyses and may have affected reported outcomes because they influence intestinal healing.^1,7 Analgesia protocols (eg, whether opioids were administered during the postoperative period) were not studied. Pure mu-agonist opioids decrease gastric emptying time, diminish propulsive intestinal motility, and cause nausea and vomiting.^8,9 Further study is needed to evaluate whether postoperative opioid use delays time to first voluntary food intake and subsequently influences intestinal dehiscence rates.

… The Takeaways

Key pearls to put into practice:

• IRA for foreign body removal has a significantly higher rate of postoperative dehiscence than enterotomy.

• Older patient age and an ASA score >3 may increase the risk for intestinal dehiscence, regardless of procedure used, and may be predictive of a patient's ability to heal.^6,10

• Early voluntary food intake after foreign body surgery may decrease the risk for intestinal dehiscence. Methods to improve appetite (eg, preanesthetic administration of maropitant, reduced reliance on opioids due to use of locoregional anesthesia or lidocaine and ketamine CRIs, postoperative administration of a ghrelin agonist) warrant consideration.^9,11-13

• Results of this study should guide understanding of potential postoperative sequelae, not dictate procedure selection. If poor intestinal viability warrants IRA, or if there are other risk factors (eg, low serum albumin, intraoperative hypotension, old age, higher ASA score), the owner may need to be informed about the need for aggressive and prolonged 24-hour care and monitoring.