by Dr. Ku
Every summer I will see something that sticks in my mind and I feel I must share. This summer it was Zoe, a sweet young Weimeraner, full of energy and curiosity. One day, shortly before I was going on vacation, she came to our office after swallowing a wooden skewer at a weekend gathering. In fact, her mother explained, she actually witnessed her swallow one skewer whole, and had pulled it out of her throat. The second time, however, the skewer was swallowed before it could be retrieved. Zoe appeared unaffected by this event, and for the next few days, although she was a bit quieter than normal, she ate and did her business as usual. Zoe's owners watched for evidence that she had passed the skewer, and when they didn't see anything after a few days, they decided to have her checked by us.
On physical exam, Zoe was bright, alert and happy. Her abdomen did not appear painful or distended. Her lungs were clear; she wasn't coughing. Her tonsils were not swollen and she seemed to act just fine. We took abdominal and chest xrays just to be sure we could not see evidence of an obstructive pattern, and none was found.
The next day, Zoe didn't eat her breakfast, which for our nearly 1year old pup was very unusual. She returned on our advice for a barium GI series, as to our knowledge she had still not passed the skewer or skewer pieces. After several hours documenting the passage of barium through her GI tract through a series of radiographs, we saw what appeared to be pieces of the skewer outlined by the adherent barium. After some deliberation, we decided to go in surgically the next day and remove the pieces in case they were having trouble passing on their own.
By morning Zoe had spiked a fever of 104.0 (normal for a dog is usually 100-102). This convinced us further that we ought to attempt an exploratory procedure as a skewer piece could have perforated through a bowel wall and caused infection to spread within the abdominal cavity. We started her on IV fluids to keep her well-hydrated, and intravenous antibiotics for any potential infection. At the time of surgery, we explored her GI tract from the stomach to the colon, and to our surprise, we found nothing that resembled the skewer pieces seen on the radiographs. We could only assume that the skewer pieces had either passed in her morning stool and we had missed them, or that they had softened and could not be felt through the intestinal wall. Either way, they were unlikely to cause a perforation at that point, so we closed her up and sent her home the next day.
A few days later, Zoe came back with a firm swelling on the side of her chest by her ribs that seemed to have appeared just after her surgery. At first we thought it might have been a bruise from lying on her side, but as it increased in size, it was clearly not that. It was far enough away from the surgery site not to be related, but oddly appeared just after that event. She was already on oral antibiotics post-operatively, and so we asked her owners to cool compress the site and continue her antibiotics.
Unfortunately, Zoe did not improve as we hoped. The swelling on her side continued to grow and within a few days it was about 6-7 inches wide. She remained active, appetite was good, passing normal stool, but also had developed a slight cough. We decided to radiograph her chest again to see if we could pinpoint the cause of her coughing, and identify any correlation with the swelling since they were concurrent. Oddly enough there was a very small amount of fluid in the chest cavity that had not been present a few days earlier. The swelling appeared to be outside the chest wall musculature. Armed with this new information, it seemed possible that Zoe had a migrating foxtail that was trying to exit on her side, a relatively common site for them to migrate out of the chest cavity. No evidence of skewer could be seen, and it was highly unlikely that a skewer piece would migrate like that, as they do not have the prongs that a foxtail has to pull it along.
That afternoon we anesthetized Zoe for the second time, and we drained the abscess forming on her side. As the fluid drained away, I could feel a slight protuberance at the center and decided to probe this site for a possible exiting foxtail. I clamped onto something firm, yet mobile, and to my surprise, out came an 8 inch segment of wooden skewer, completely intact and unharmed. The skewer must have migrated out of her esophagus, managed to miss penetrating any major blood vessels and exit between the last few ribs of her chest cavity!
Our very lucky, if not overly zealous dog, Zoe, managed to fight the remaining infection left in the wake of the migrating skewer after several different courses of antibiotics. Now she is back to being the happy little dog she was before, and I imagine skewers are no longer a summertime picnic option at her house!