Daisy was not her normal self. A Cocker Spaniel should be full of life, have more energy and always be keen for some food. Nichola knew there was a problem that needed some investigation rather than conservative treatment. Daisy's abdomen was slightly uncomfortable but not very painful, she allowed us to feel deep inside but resented us pushing our hands towards her stomach. Her owner explained that she had vomited 2 weeks ago and had then stopped but recently started vomiting again. She had a fever and was rather listless.
We always work to a diagnostic plan. What do we need to do to determine the problem? We do not want to run every test under the sun on every case because of both the cost and emotional impact on the patient. The art of picking and choosing tests is a difficult balance and we are often anxious about missing problems by trying to cut the costs down. We usually start with blood tests to look for problems like liver or kidney disease, blood disorders or signs of infection. Daisy had a raised white blood cell count which indicated a potential infection. X-rays showed no obvious abnormalities except some loss of detail. Usually we can see most of the organs quite clearly on x-ray but in this case there was a loss of detail that could indicate fluid or inflammation in the abdomen. The next step was an ultrasound scan which showed no fluid and normal organs but she seemed uncomfortable when we pushed the scanner probe towards her stomach.What do we do next? All our screening tests suggest there is nothing serious occurring but Daisy seems quite sick. Our next step is an operation to look inside her abdomen. That's a big step in terms of being invasive and potentially causing her some pain, let alone the risk of anesthesia. We decided to go ahead and rather find nothing than leave her with a problem that could get worse.
We anesthetised her and opened up her abdomen. Everything looked normal. Had we opened her up for no reason? We explored the length of her intestine looking for an obstruction, we checked her kidneys and spleen. While we were checking her kidneys a small amount of reddish fluid was seen deep inside her abdomen and a sample taken. This was unusual, we knew something must be going on. We moved some intestines out of the way and pulled her stomach outwards. Imagine our surprise to see a kebab skewer making a small hole in her stomach and sticking out into her abdomen!After a difficult procedure to close the hole Daisy made a full recovery and is back to normal. The hole was right next to her pancreas and deep inside her abdomen. The infection she had developed required us to leave her abdomen open for a few days to allow all the infection to drain. A few days later we stitched up her abdomen and sent her home.
It turns out that Hank, Daisy's partner in crime had pulled a plate with some kebabs off the kitchen counter a few weeks earlier. Daisy swallowed one and the sharp end slowly pushed it's way into her abdomen right through her stomach. Case solved!
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