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Foreign Body Syndrome

Dil Mohd Makhdoomi Mohsin Ali Gazi Jalal Din Parah
Vol 2(3), 48-52
DOI-

A gastric foreign body is any item, either food or nonfood material, that is present in the stomach and does not pass into the small intestine or is vomited. The typical foreign body is a metallic object, such as a piece of wire or a nail or trichobezoar & phytobezors. Inappetence, vomiting, diarrhea, lethargy, or abdominal pains are the frequently encountered clinical sign. Abdominal x-rays, Routine laboratory tests and an abdominal ultrasound remains gold standard of the diagnosis. Some foreign bodies located in the stomach may be retrieved with the use of an endoscope; however, most require surgical abdominal exploration and removal.


Keywords : Foreign body etiology clinical sign treatment

Introduction

Gastrointestinal foreign bodies are among the most common surgical emergencies in veterinary medicine. In India higher incidence may be attributed to practice of livestock rearing based on hand feeding (Blood and Hutchin, 1955) compared to pasture rearing. Younger animals are overwhelmingly predisposed to this condition. Cats are often diagnosed with linear foreign bodies due to ingestion of string or thread. In contrast, dogs that frequently chew on objects usually are diagnosed with nonlinear foreign bodies. On the other hand Buffaloes quite commonly ingest foreign bodies (Sobti et al., 1987). In India the incidence of Foreign Body Syndrome was reported by various workers from different parts of India. Among Bovines the majority of affected cattle (87%) are dairy cattle and (93%) are older than 2 years of age. (Rebhun, 1995). In buffaloes higher incidence has been reported in recently calved buffaloes (Ramprabhu et al., 2003) and that too older buffaloes (Singh et al., 1980) compared to lactating and dry buffaloes. High incidence of TRP has been reported compared to other allied syndrome of foreign body syndrome in buffaloes. Pregnancy is not an important risk factor; though contribute to further penetration of lodged foreign body (Williams, 1955). The present review delineates the etiology, clinical symptoms, daignosis & treatment of foreign body syndrome in animals.

Etiology

Cattle are more likely to ingest foreign bodies than small ruminants since they do not use their lips for prehension and are more likely to eat chopped feed. Foreign bodies occur when animals consume items that will not readily pass through their gastrointestinal tract. These items can be a pet’s or child’s toy, leashes, clothing, sticks or any other item that fails to pass, including human food products like bones or trash. Some ingested items, like older pennies or lead material, can cause systemic toxicities while others may cause regional damage to the intestinal tract itself due to compression or obstruction. The typical foreign body is a metallic object, such as a piece of wire or a nail, often greater than 2.5 cm in length (Rebhun, 1995).sometimes non-metallic objects like stiff broom-bristles or sharp pieces of plastics and their lodgment into the reticulum, due to anatomical predisposition has also been reported (Krishnamurthy et al., 1998). Some buffaloes have metallic foreign bodies in their reticulum without signs of clinical disease and occasionally non-perforating foreign bodies may be passed out in faeces. It is likely that a predisposing factor in otherwise normal buffalo, such as tenesmus or a gravid uterus, causes migration of the foreign body into the reticular wall (Rebhun, 1995). In addition vigorous contraction of reticulum aided by the movement of diaphragm make the thin potential foreign body to penetrate through the reticular wall at different sites and in varying direction (Williams, 1955). Buffaloes are clumsy and indiscriminate feeder and they take a nail or some other metallic objects into their mouth and it passes beyond the dorsum of the tongue, they do not seem to be able to split it out and in most cases reaches abomasum. Buffaloes are prone to Diaphragmatic hernia due to foreign bodies (Deshpande et al., 1982). The anatomical differences (relatively small tendinous portion of the diaphragm resulting in innate weakness) have been attributed to such predisposition (Krishnamurthy et al., 1983 and Singh et al., 1980).  Apart from this some animals suffer from mineral deficiencies seem to relish objects with a mineral or metallic taste.

Pathophysiology

 The pathophysiological events are remarkably different in foreign body syndrome of ruminants and simple stomach animals. In cats and dogs foreign body in stomach or intestine results in protracted vomiting and diarrhea can cause significant metabolic changes within the body. Additionally, if the foreign body has perforated the intestinal wall and entered the thoracic or abdominal cavities, profound complications would result. The leakage stomach and intestinal contents into the abdomen cavity results infection of the peritoneum and peritonitis and sepsis occurs which adds to risk of gastro intestinal surgery, pedantic care and adequate lavage of the abdomen using medicated fluids can help reduce the risk. However if the peritonitis and sepsis is not checked, chances of leakage at the site increase, and subsequent peritonitis and sepsis carry a guarded prognosis (Blood and Hutchins, 1955) can lead to the death. In the event foreign body (whether potential or non potential) consumed by animal which penetrates the wall of reticulum & diaphragm & manifests the symptoms of Traumatic reticulites.

The seriousness & gravity of situation of traumatic reticulitis & diaphragmatic hernia doesn’t need any introduction to vetenarians. If it remains untreated, causes 100% death in all cases (Krishnamurthy et al 1985).The surgical treatment of diaphragmatic hernia is evolved about decades back (Singh et.al 1987) still in 40 % cases digestive disorders like anorexia, tympany have been found to persist which have been reported to occur due to functional stomach disorder (Kuiper and breukink, 1986; Behl et.al 1997)

These functional stomach disorders are either cranial (without abomasal reflux) or caudal (with abomasal reflux). The caudal functional stomach disorders are considered to be more serious as there is severe abomasal reflux (back flow of abomasal contents into rumen i.e. internal vomiting due to caudal functional transport failure of abomasam).Due to the back flow of abomasal contents there is sequestration of large quantities of hydrochloric acid into the Rumeno-reticulum & omasam. It causes increase in the chloride concentration of rumen but causes hypokalaemia, hypochloraemic metabolic alkalosis by lowering plasma chloride & potassium.

Ruminants with GIT obstruction develop hpokalaemia, hypochloraemic alkalosis (Behal et.al 2000).In Ruminants, saliva has been found to significantly reduce the concentration of potassium from 36hr after GIT obstruction. Therefore, it appears that the body is trying to conserve potassium ion by its higher absorption from the salivary glands. However in no way saliva helps to regulate chloride ion concentration in such animals.  Ruminant saliva has several unique functions in the body. It is essential to microbial digestion in the rumen on two accounts: to provide essential fluid environment as forestomach has no secretory glands and to preserve normal pH by neutralizing acids produced during fermentation.

There occurs a reduction in bicarbonates in pyloric obstruction both in ruminant as well as non ruminant case, however in ruminants saliva is highly buffered & bicarbonate buffering system predominates during eating & rumination. This buffering is done by high concentration of bicarbonates and phosphates present in saliva (Argenzio, 1984), the level of bicarbonate ions being several times higher than that of plasma concentrates. In addition, ruminant saliva also appears to play an important role in regulating biochemical constituents of plasma in health & disease. The ionic content of saliva of sheep has shown to be controlled in relation to electrolyte balance of the whole body (Denton, 1956). Studies in uraemic cow calves & buffalo calves demonstrated that changes in the plasma concentration of various biochemical constituents can be moderated by reciprocal changes in the saliva concentrations (Singh et.al 1984). A similar evidence was available in experimental studies on jejunal obstruction in buffalo calves (Makhdoomi, 1994).

Clinical Signs

Clinically animal is anorexic, with abdominal distention, loss of defecation & deprived milk yield. There are significant alterations in BUN, protein, albumin, calcium, glucose and phosphorus levels in the affected animals. The prominent clinical signs include pale mucous membrane, absence of rumination and reduced ruminal motility. Rectal examination reveales pellet mucous coated dung. (Hailat et al. 1996; Igbokwe et al. 2003; Reddy et al. 2004). There is significant decrease in the haemoglobin, PCV and total erythrocytic count with leukocytosis and neutrophilia may be due to presence of foreign bodies (Hailat et al., 1996).  BUN (Blood urea nitrogen) value may also be elevated be due to faulty rumen fermentation and reduced microbial activity (Hobson, 1988). Dietary malnutrition may further lead to Hypoproteinemia and hypoalbuminaemia (Mayer et al., 1992). Hypoglycaemia might also be seen due to inadequate intake of feed (Ramakrishna, 1994). Regurgitation, kyphosis, abduction of elbows (Matteson et al., 1953; Pinset, 1962) .Recurrent bloat, Brisket edema, muffling heart sounds are some other important symptoms observed in same (Ramprabhu et al. 2003).

Diagnosis

Pinching the withers to cause depression of the back and eliciting a grunt is an effective diagnostic aid except in large adult cows and bulls; for these the sharp elevation of a solid rail held horizontally under the abdomen is a useful method for eliciting a grunt (Wither test). The grunt is usually heard 2-3 sec before primary ruminal contraction can be felt through the left flank (Williams, 1955). This is also known as ‘wire grunt’ (Hansen, 1953). Arching of the back occurs in some of cases along with the appearance of tenseness of the back and the abdominal muscles so that the animal appears gaunt or ‘tucked-up’. Defecation and urination cause pain and accompany usually with grunting. This results in constipation, scant feces and in some cases retention of urine. Palpations is done using short, sharp pushes with the closed fist or knee and also have a degenerative left shift. In chronic cases, a mature neutrophilia is common (Rebhun, 1995). Routine laboratory tests and an abdominal ultrasound may also be recommended to rule out other conditions, such as liver, pancreatic, or kidney diseases that can cause vomiting.  If a gastric foreign body is suspected, abdominal x-rays are commonly recommended. A contrast study (gastrogram) of the stomach may be performed if a foreign body is suspected but not found on plain x-rays. In a gastrogram, barium or some other agent is administered orally to help highlight any foreign material. In some cases, foreign bodies are found during examination of the stomach with an endoscope (gastroscopy) or during exploratory surgery. Abdominocentesis for evaluation of TRP should be performed at the ruminal-reticular recess to increase the chance of obtaining a diagnostic sample (House et al., 1992). Metal detectors were used at one time to aid in the diagnosis of traumatic reticuloperitonitis (Luenberger et al., 1978). Ultrasonography helps to detect adhesions of segments of intestine to the abdominal wall (Tucker et al., 1996) and left displacement of abomasum which presents similar symptoms to foreign body syndrome (Braun et al., 1997).

Treatment
Surgical intervention is not always required with gastrointestinal foreign bodies. Occasionally, the item ingested is small and smooth enough to pass through the gastrointestinal tract without causing damage or becoming lodged. Additionally, few foreign bodies may become lodged in the upper gastrointestinal tract (mouth, esophagus, and stomach) and may be removed with the use of a flexible endoscope. Esophageal foreign bodies require thoracic surgery to gain access for removal. Most gastrointestinal foreign bodies become lodged within the stomach or intestines and require a gastrotomy or enterotomy respectively. Many linear foreign bodies and completely obstructed intestines are damaged severely enough that multiple enterotomies or an intestinal resection and anastomosis will be required in such cases. The choice of treatment is largely governed by economics and the facilities and time available for surgery. Since reticular foreign bodies often migrate back into the lumen of the reticulum, conservative treatment can have good results. Conservative treatment consists of instillation of a magnet to recover or immobilize the metal foreign body, by administration of antibacterial drugs like ampicillin, or tetracycline. The animal should be immobilized for sometime or kept in slanting fashion. The immobilization facilitates the formation of adhesions and removal of the foreign body (Sharma et al., 1994). In case of TRP, if a magnet is already in place or conservative therapy is not successful, an exploratory laparotomy/rumenotomy is indicated for removal of the foreign body. (Rebhun, 1995; Ducharme & Fubini 2004). If the animal do not come up then rumenotomy is the best option with us.

Refrences

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