The dog who ate a plastic bag/el perro que se comió una bolsa de plástico

1st xray with barium (contrast)

A 18 months old, naughty cocker presented at our out of hours emergency hospital, on a Sunday after being vomiting since the previous day. His owner is 100% sure he has not eaten anything he shouldn't except a plastic bag, but that was 9 days ago. So far, he was doing okey, eating, going to the toilet, bright. My vet colleague had seen him and treated him with some antibiotics, pain relief and antiemetic. Only 5 weeks ago he went through a surgery to remove some rubber toy from his intestines!

Un travieso cocker spaniel de 18 meses se nos presenta durante las horas de urgencias de un domingo, después de estar vomitando desde el día anterior. Su dueña está totalmente seguro que no ha comido nada que no debiera, excepto una bolsa de plástico, hace ya 9 días. Hasta ahora no estaba mal, comiendo, haciendo sus necesidades, y activo. Un compañero ya lo había visto y dado unos antibióticos, analgésicos y antieméticos. ¡Hace sólo 5 semanas se le extrayó quirúrjicamente un juguete de goma del intestino! (read more)
On Sunday night he was handed over to me, bright, and his clinical examination was normal. On abdominal palpation I couldn't feel any mass or a thing, but he was a bit uncomfortable, and couldn't rely on the palpation because he was a very nervous dog and still had the stitches from the recent surgery.

Su caso pasó a mi el domingo a la noche, alerta y activo, con un examen clínico normal. En la palpación abdominal no noté ninguna masa u objeto, pero sí se sintió incómodo,se mostró nervioso, y aún tenía los dolorosos puntos que no hicieron posible un examen adecuado.

Xray after one hour

On his revision the following day (Monday), his condition is about the same. Some blood test were done by his own vet, and nothing. Abdominal palpation was still uncomfortable but, Was it due to his recent enterotomy? with a gastroenteritis? with the plastic bag he ate? or is it a new condition?
He was done a conscious x-ray, and we could not see any object or gas suggesting a blockage. Suspecting pancreatitis, the vet opted for keeping his same treatment for one more day.

En su revisión del día siguiente (lunes), no se veía mejora. Se le hicieron unas analíticas de sangre, sin alteraciones de importancia. En la palpación abdominal seguía incómodo, pero ¿se debía a su reciente enterotomía? ¿con una gastroenteritis? ¿con la bolsa que se comió? ¿o es algo nuevo?
Se le hizo una radiografía sin sedarlo, y no vimos objeto o acúmulo de gas que sujiera un taponamiento. Sospechando pancreatitis, mi colega optó por continuar el tratamiento un día más.

Radiography 2h later

On the hand over, I was informed the dog had been given a contrast of barium by mouth, he had passed indeed some barium in his faeces, and the plan was having a last xray, exlap, with the pressure that the following day there was a new graduate in charge of the surgeries. Meanwhile, I called the owner, and she was indeed 100% sure that the dog had not eaten anything he shouldn't except the plastic bag, now 12 days before.

En el cambio de turnos me informaron que, efectivamente, habia pasado parte del barium en sus heces, y el plan era terminal la serie de radiografías consciente con el contraste de barion, realizar una laparotomía exploratoria (en esencia, abrir el abdomen a ver qué encuentras), con la presión de que, al día siguiente, el veterinario para cirugías era un recién licenciado. Mientras, llamé a la dueña, quien estaba 100% segura su perro no había comido nada excepto la bolsa de plástico, hace 12 días a estas alturas.

Xray after 6 hours of barium

However, the owner would not want us perform another surgery again, so soon, "unless it is really, really, really needed". Instead, I gave him a little bit more of barium, waited for 15-20 minutes, and did the last xray, this time under sedation (he was already on buprenorphine, I added midazolam and propofol IV)

Sin embargo, la dueña seguía sin querer otra cirugía "a menos que estemos totalmente seguros". En su lugar, le dimos un poco más de barium, esperamos 15-20 minutos, y tomamos la radiografía bajo sedación.

Shadow of the foreign body

So this time I sedated him and did a proper, good abdominal palpation. At this point I did feel a mass in the abdomen, about 6-8cms long, and 2-3cms wide. On ultrasound we ruled out that the mass palpated was not an internal organ (kidney, mass tumour, lipoma), but it was in fact an object within the intestines. That way I ruled out I had grabbed an organ. It seemed that, for some days, the bag was allowing the food to pass, but reaching the narrower enterectomy, and as time went by it was plicating, and only fluids were going through the folds that run parallel to the intestine. 

Esta vez se sedó y realizamos una profunda palpación abdominal. Esta vez pude distinguir una masa de unos 6-8cms de largo, y 2-3cms de ancho. El escáner descartó que fuese un órgano interno (riñón, tumor, lipoma), sino un cuerpo extraño. Así también descartamos que estuviésemos palpando un órgano. Al parecer, por unos días la bolsa fue capaz de atravesar el lumen intestinal, pero al llegar a donde se hizo la enteretomía, más estrecho, se amontonó, y sólo los líquidos podían pasar entre los dobleces, paralelos al intestino.

Plastic bag in the small intestine

The bag was stuck just before to the area were the enterotomy he had recently had, and I guess the recent surgery narrowed the intestinal lumen (inflammation). Once in surgery again, I also found out that pancreas was very inflammated.

La bolsa se había atascado justo antes de la zona de neteretomía, y supusimos que la cirugía reciente estrechó el lumen (inflamación). Una vez en quirófano de nuevo, descubrimos que su páncreas también estaba inflamado.

If only the plastic bag had passed through all the small intestines and were in the large intestine, he would have been able to "poo" it. 

Si la bolsa de plástico hubiese pasado todo el intestino delgado, y estuviese en el intestino grueso, él hubiese sido capaz de "excretarlo" por sí sólo.