A late January blue moon lit the familiar path as I made my 50-yard dash in 14-degree weather at 4 a.m. from my back door to my hospital. Bathrobe and slippers were not quite adequate for deep winter, but as soon as I was in my veterinary barn, it would be warm and nobody would see me except Bradley Cooper, my patient.
Bradley was my latest ICU challenge, a gorgeous young dog with doe eyes and a shy face that made you forgive him any action, no matter how stupid. In this case, he was recovering from complicated abdominal surgery prompted by a tube sock he had eaten. Problem being, however, that last January, he had done the same darn thing. Multiple abdominal surgeries put Bradley at risk for more complications.
When his family had returned from a skiing vacation, Bradley frolicked in the kids’ dirty laundry. He treated himself to a dinner of stinky, moist ski sock, tasty with toe sweat and ripe with the sweet scent of evergreens edging cold snow. If they wouldn’t take Bradley on their trip, he would eat some of it.
Time to Go to Surgery Again
Last year’s intestinal surgery was rather straightforward. We took Bradley to surgery, found and removed a sock, and sewed him up. He went home on a recommended SF (sock-free) diet.
Bradley followed his SF diet with resolve until the temptation became too overwhelming and he ate another sock, thereby losing his 12 months of SF-living recovery.
Any bowel surgery for removal of a foreign body carries risk. Even with perfect surgical technique, you are cutting into a compromised intestine filled with fecal material and suturing up that bowel (enterotomy), or cutting away bowel and suturing 2 pieces of bowel back together (anastomoses).
Now think about the dog or cat who has to have multiple intestinal surgeries because they continue to eat foreign objects that obstruct the bowel. One of the biggest challenges a surgeon faces on a 2nd or 3rd surgery is dealing with the presence of abdominal adhesions.
Abdominal Adhesions
Abdominal adhesions are a type of scar tissue. Bands of fibrous tissue can form between abdominal tissues and organs after any surgery. This means you can find a loop of intestine adhered (attached) to another loop of bowel, to an organ, to other abdominal tissue or to the body wall itself.
Any time an intestinal surgery is performed, there is inflammation. Bradley’s intestine was angry and inflamed because it was harboring a sock. Once it was removed, the incision had to heal. This healing process does not happen without more inflammation. A certain degree of scarring or adhesion formation occurs throughout the abdominal cavity.
In a study of human patients undergoing abdominal surgery, 93 percent developed abdominal adhesions. Most of the time, these adhesions do not cause people or pets problems. If, however, that patient needs a second surgery, the surgeon may encounter scarring and adhesions that make the surgery much more difficult.
A Complicated Surgery
In Bradley’s case, when I went in to retrieve this year’s sock, it was lodged in the same place as last year’s sock. The intestine had adhered to another loop of intestine amid a whole bunch of other adhesions. Think of sausage links stuck together and caught up in sticky cobwebs.
To make matters worse, whenever a surgeon breaks down these adhesions, more inflammation and adhesions are created. The order of the day is to remove the obstruction, try to create as little turmoil as possible in the surrounding bowel and get out of there.
Brad’s initial surgery was as routine as possible. A simple incision was made in the intestine, the sock removed and the intestine sutured closed (an enterotomy). Think of cutting into a sausage casing vertically, removing some of the contents, and sewing it back up.
Brad’s next surgery, because of the adhesions, required the removal of a section of the damaged intestines. Think of cutting 2 sausage links right down the middle horizontally and then sewing them back together end-to-end (an anastomoses).
Not for the faint of heart: Watch this vet surgeon remove a dog’s intestinal obstruction:
Keep Your Pets Safe (a.k.a. Clean Up)
When pets have a propensity for dangerous behaviors and get into trouble time after time, clients often say to me, “Maybe he’ll learn this time.”
Not a chance. Pets will not learn to avoid traffic. Dogs will not stop getting porcupined. And many pets will never stick to a safe diet. The parents of Bradley, of my triple-run underwear-eating standard poodle and my 3-time award-winning pantyhose-eating cat can attest to that.
Bradley’s family has learned the hard way that he must be carefully watched. He looked on with those adorable, devilish, twinkling Bradley Cooper eyes of his as his people had a family meeting about never leaving socks on the open floor again.
Beautiful Bradley went home feeling great, thanks to the Patron Saint of Adhesion Surgery, Saint Abdominus Imperfectus. But please, Saint Abdominus, do me a solid — I never want to see the inside of Bradley Cooper’s abdomen again.
This pet health content was written by a veterinarian, Dr. Debora Lichtenberg, VMD. It was last reviewed Feb. 21, 2018.
