CT findings in seven dogs with perforating wooden skewer foreign bodies from the gastrointestinal tract

Abstract

Background: Perforating foreign bodies from the gastrointestinal tract, such as wooden skewers, are reported in the small animal literature producing inflammatory/infectious lesions in the thorax, abdomen, and musculoskeletal system, which can be life-threatening in some instances. Several imaging modalities have been used, and advanced imaging techniques have shown a great advantage in its diagnosis and pre-surgical planning.

Aim: The objective of this study is to describe the computed tomographic findings in a group of seven medium to large breed dogs with perforating wooden skewers and foreign bodies migrated from the gastrointestinal tract.

Methods: The medical records database was searched for dogs with a suspected diagnosis of a perforating wooden foreign body migrated from the gastrointestinal tract in which a computed tomographic study was performed. Signalment, history, and clinicopathological findings (when available) were retrieved, and the computed tomographic studies were reviewed.

Results: Clinical signs vary depending on the anatomical regions affected through the perforating pathway. All foreign bodies were identified and showed a median attenuation of 79 HU, with the most common localization being the stomach followed by the jejunum. Peritoneal fat stranding surrounding the perforation site was the most frequent computed tomographic finding. The presence of peritoneal free fluid and/or gas was uncommon. Pleural effusion, pulmonary perforation, and pneumothorax were present in most of the cases with the foreign body traversing the pleural space. Pulmonary cavitary lesions were always reported when the ending tip of the wooden skewer was within the pulmonary parenchyma. Soft tissue abscessation was recognized in all cases where the ending tip was lodged in muscular or subcutaneous tissues.

Conclusion: Findings supported the variability of the secondary lesions caused by this type of foreign body and the utility of computed tomography in their recognition, as well as in the identification of the wooden skewer.

Keywords: Canine; Computed tomography; Gastrointestinal perforation; Ingested foreign body; Kebab stick.

Fig. 1.. Examples of fragments of wooden skewer perforating a jejunal loop. A and B. Parasagittal pre (A) and postcontrast (B) images (level 40 HU, width 250 HU) of the same patient with a fragmented wooden skewer (arrowheads) perforating the jejunum in the caudal abdomen with the ending tip penetrating the right psoas muscles. In the pre-contrast images, the portion of the foreign body embedded in the soft tissues is better visualized than in the post-contrast images, while the soft tissue abscessation is better depicted in the latter (arrows). C. Transverse post-contrast CT image (level 40 HU, width 250 HU) of another patient showing a hypoattenuating fragmented wooden skewer foreign body (arrowhead) penetrating a jejunal loop in the cranial abdomen. A marked peritoneal fat stranding is seen surrounding the small bowel loop and foreign body (arrows).

Fig. 2.. A and B. Transverse and dorsal, post-contrast CT images (level −500 HU, width 1,400 HU) of the same patient showing a hyperattenuating (112 HU), 63 mm length × 1.3 mm width foreign body (arrowheads) lodged in the right caudal lung lobe and causing a small cavitary lesion (arrow). There is an asymmetric pleural effusion, more severe on the right side (asterisks). The right pulmonary lobes are decreased in volume with an almost generalized consolidation pattern, most likely secondary to atelectasis. C. Parasagittal post-contrast CT image (level −500 HU, width 1,400 HU) of a perforating wooden skewer foreign body from the stomach (arrowheads), perforating the pleural space and right caudal lung lobe which shows a focal increased attenuation and thickening of the visceral pleura. There is a mild volume of pneumothorax (asterisks). Note that the air within the pulmonary cavitary lesions or in the pleural space aids in the identification of these foreign bodies.

Fig. 3.. Examples of gastric foreign bodies from the stomach with the ending tip in the paravertebral or thoracic wall soft tissues. A. Transverse post-contrast CT image (level 40 HU, width 250 HU) of a dog with a wooden skewer (arrowheads) extending from the stomach and ending in the left epaxial muscles. Mild fluid accumulation and emphysema are seen surrounding the ending tip of the foreign body (arrows). B. Dorsal post-contrast CT image (level 40 HU, width 250 HU) of a dog with a wooden skewer (arrowheads) perforating the gastric wall with an oblique orientation ending in the subcutaneous tissue of the left thoracic wall. A moderate bilateral pleural effusion is seen associated with this foreign body (asterisks).