Featured Case Archive - Spring 2006

Athena Thayer - A Surprising Case of Diarrhea

Athena, a  2 year old female Doberman, presented to our hospital 3 days after she had been adopted by her new owner from a rescue situation. In the short time with her new owner, Athena was doing very well. She received updated vaccines at her first visit. One day after her vaccinations, Athena broke with diarrhea. There were no parasites found on her fecal examinations. However, she did have severe colitis (inflammation of the colon). She was treated with antibiotics, anti-inflammatories and a high fiber diet and within 2 days, she was back to normal. . .  Or so we thought.

About four days later, her diarrhea started up again. Athena had started obedience classes and we attributed this recurrence of diarrhea to the fatty treats that are given at classes. Athena was sent home with more medication and high fiber diet to help the diarrhea resolve.

Athena’s diarrhea did resolve, but four days after finishing her medication, she started vomiting. Her owner reported that she was vomiting after eating her breakfast.

The following day, Athena was taken to a veterinary hospital because her vomiting had worsened. She was becoming lethargic and her owner decided to take her to a veterinary clinic located closer to her because she was so concerned. Radiographs (x-rays) were taken and bloodwork was done. Although there appeared to be something in the intestines, it was not determined to be causing an obstruction. She was sent home for further monitoring.

Athena presented to our hospital the following day for repeat radiographs. Again, there was no obvious evidence of an obstruction, but Athena was acting uncomfortable and did appear to be dehydrated. We hospitalized her and attempted to rehydrate her and control her pain. She was feeling better later that evening after some rehydration and pain medication. She did not have any vomiting for 24 hours. The following morning, Athena was again acting very painful. Radiographs were taken again, but there was still no evidence of an obstruction. We were not comfortable with Athena’s pain level and since there was not a complete improvement, we proceeded with exploratory abdominal surgery.

Once we started surgery, it was clear that we had made the right decision. There was definitely a foreign body in the stomach extending to the middle small intestine which WAS causing an obstruction. There were two perforations (tears) in upper and middle intestine. This had caused leakage of intestinal contents (food particles) into the abdomen. All of her abdominal organs were severely irritated and infected from the leakage of food particles. There was a large amount of abnormal fluid which had accumulated in the abdomen, likely because of the perforations. It was determined that Athena had peritonitis from these perforations. Peritonitis (inflammation of the abdominal cavity) is a potentially fatal condition if not treated aggressively. The foreign body was removed and the perforations were repaired. Athena needed an incision in her intestine as well as an incision in her stomach to remove the entire foreign body.  Athena recovered from surgery at an emergency hospital overnight. She was treated aggressively with fluids, pain medication and antibiotics and a special diet. The day following surgery, Athena was eating very well and no longer vomiting. She was acting like a new dog.  Athena’s surgery was successful in that we were able to remove the foreign body that was causing her vomiting, pain and likely diarrhea. We were also successful in treating her life-threatening peritonitis.

The foreign body was primarily a large piece of a sweatshirt. There was a sharp piece of plastic and some grass as well that appeared to be caught up on on the sweatshirt. It was later discovered that Athena had probably eaten part of the sweatshirt shortly before she went to her new owner’s home. Unbeknownst to her, her new owner took her home, and immediately removed any remnants of her previous bedding, including part of the sweatshirt.

Athena’s case is important and interesting for several reasons:

1. Diarrhea in young dogs is often caused by diet changes, stress, or inappropriate eating. Athena had all of these in a short period of time. She was in a new home, had a sudden diet change and was likely under some degree of stress in her new living situation. In Athena’s case, her diarrhea was likely caused by the foreign body and the peritonitis.
2. Uncontrolled vomiting is usually a sign of a foreign body obstruction in a young dog. Initially, Athena actually presented with diarrhea, rather than vomiting and yet she was indeed obstructed. Her vomiting actually stopped for over 24 hours while she was hospitalized, but she still needed surgery. This means that even if a dog’s symptoms cease, this does not completely eliminate the possibility of a foreign body obstruction.
3. Cloth foreign bodies, such as a sweatshirt, are rarely visible on a radiograph, therefore making it difficult to diagnose their presence. Sometimes giving a patient barium (a contrast material) can be helpful in making a diagnosis of a cloth foreign body obstruction. However, it can be very dangerous to use barium is there is a perforation as the barium will then leak into the abdomen.
4. Symptoms of foreign body obstructions usually occur within several days of ingestion of the offensive object. However, as in Athena’s case, it is possible that it could take much longer for symptoms to occur. In Athena’s case, it took several weeks for her to begin vomiting. Sometimes, as foreign objects are passing through the gastrointestinal tract, they can cause partial obstructions. These partial obstructions can also present with vomiting and diarrhea as well as  abdominal pain.  Other times a foreign object may pass out of the stomach, only to later get “stuck” further down the intestinal tract.
5. Cloth, string, plastic, rubber and grass material foreign body obstructions can be very difficult to diagnose. Sometimes we need to take a “wait and see” approach before we know whether we need to proceed with surgery.  It is not unusual to evaluate a dog or cat for 24-36 hours before making a decision to go to surgery. Even if we are not 100% certain about a obstructive situation, a persistently painful or vomiting patient, will likely need surgery.
6. Dogs and cats that eat inappropriate objects need to be monitored closely. It is not unusual for a patient to continue to eat cloth materials or other objects even after a surgery has been done. Some animals may do this out of boredom. Others eat inappropriate objects due to a compulsive behavior condition. Athena’s previous owner wanted to find a new home for her because he was unable to give her the attention she needed. She was left home alone for long periods of time. This may have triggered her tendency to eat inappropriate objects. All animals, especially young and energetic animals, need mental stimulation as well as regular physical activity to keep them healthy. Compulsive disorders or behaviors that develop out of boredom can lead to serious health problems. Regardless of the reason, it is very important that the house be “pet proofed”.  In Athena’s case, we would want to make sure that any clothing is not easily available to her.

Athena’s surgery was several months ago and she continues to do very well. She is a healthy, happy and thriving dog who no longer has diarrhea. We know that Athena’s new owner will provide her with the loving home, caring attention and medical care that she deserves.