Jack, a 5 year old, neutered male, Yorkshire terrier presented to the Pet Emergency Center for vomiting. He had vomited several times that afternoon and was lethargic.
Jack had been seen at the Pet Emergency Center for diarrhea and abdominal pain 1 week earlier. At that time, Jack was treated with pain medications, anti-diarrhea medication, Pepcid, and a bland diet. Jack responded quickly and seemed back to normal within 24 hours of that visit. Jack had been switched back to his usual diet that morning before the vomiting started.
On this visit for vomiting, since the vomiting had just begun and Jack had just been switched back to his usual diet, Dr. Beck and Jacks owners agreed it was reasonable to hold off on diagnostic testing and to monitor Jack a little longer at home. Jack was treated with subcutaneous fluids to keep him hydrated and was taken home by his owners to be monitored overnight with no food or water and to start small, frequent meals of a bland diet the next morning if Jack had stopped vomiting.
Jack vomited multiple times over the next few hours at home; and Jacks owners in consultation with Dr. Beck, decided it was time to start a workup. Jack returned to PEC that evening for abdominal radiographs (x-rays) and blood work.
Abdominal radiographs showed that Jacks stomach was full of curvilinear structures; the appearance of which is best described as the appearance of a thin rope coiled up in his stomach. Given the number of times Jack had vomited and the number of hours that had passed since Jack had eaten, Jacks stomach should have been empty. Moreover, the material in Jacks stomach was not food and was highly suspicious for a linear foreign body causing Jacks vomiting.
Jacks CBC (complete blood count) showed a high white blood cell count with possible causes including infection, inflammation or a normal response to stress.
Based on the x-ray findings, Dr. Beck and Jacks owners agreed to take Jack to exploratory surgery.
Jack was anesthetized and taken to surgery. During surgery he received IV fluids and his blood pressure, ECG and oxygen saturation levels carefully monitored.
At surgery Jack was found to have a large wad of hair elastics filling his stomach. Several of the intertwined hair elastics had moved out of the stomach and into the upper small intestine (duodenum). Fortunately, the duodenum was in good condition and not yet incurred the injuries that are typical of linear foreign bodies. All hair elastics were removed via two incisions: one in the stomach and one in the duodenum.
Jack recovered quickly from surgery and spent the next 36 hours in the hospital on IV fluids, IV antibiotics, and injectable pain medications. Jack was monitored carefully for any post-operative complications. In particular, Jacks temperature, heart rate, pain level, appetite, blood glucose, and serum albumin were monitored for any evidence of peritonitis (infection in the abdominal cavity), which can occur after intestinal surgery. Jack recovered well, was eating well, and comfortable on oral pain medications when he was discharged on the second day after surgery.
Jacks owners report that they had noticed that hair elastics had steadily been disappearing, but they suspected the cat had been stealing them. They were surprised to learn Jack was the culprit. Jack most likely had been acquiring and eating the hair elastics gradually and it is possible that these hair elastics were the cause of the abdominal pain the week before as well as the cause of occasional bouts of vomiting over prior months. On last report, Jack was doing well at home.
