On arrival, the patient was quiet, uninterested, but responsive. He initially trotted into the consult room but then displayed an altered gait in both fore limbs, with the right forelimb suddenly too weak to support his weight. He was also paddling with his fore limbs when lying in lateral recumbency. His neurological examination showed no abnormalities. His vitals showed tachycardia with a HR of 160bpm, RR 24bpm and temperature 38.1°C. His mucous membranes were pink and moist with CRT <1 second. His abdomen was comfortable on palpation, but he was showing signs of nausea.
He was admitted to start investigation and supportive treatment. Fluids were started to treat his compensatory hypovolaemic shock; his vitals and blood pressure were measured regularly to monitor this, and he was provided with opioid analgesia.
His haematology revealed a high end of normal PCV, leukocytosis with neutrophilia and monocytosis. Biochemistry showed marked azotaemia, increased total protein, with both albumin and globulins raised, and a slightly increased total calcium. An ultrasound scan and radiographs of the abdomen revealed large stomach filled with ingesta, a lack of intestinal motility, a large amount of intestinal gas. The amount of fluid and gas obscured parts of the abdomen on the imaging so a stomach tube was passed to remove the fluid and repeat imaging now showed an irregular radio-opaque structure in the ventral-cranial abdomen.
A foreign body was suspected so an exploratory laparotomy was performed once he was stable, and a hard, foreign object was found in distal duodenum. The object – a pinecone – was removed, and the enterotomy site was closed routinely using absorbable material. The site was omentalised and the rest of gastrointestinal track was checked and confirmed not to have any further foreign objects or abnormalities. Mild peristalsis was observed before celiotomy closure.
The patient recovery was smooth, drugs used included maropitant, metoclopramide, methadone, and paracetamol. Repeat blood work showed a return to normal. He started eating the following day and was released home from hospital. Wound healing was unremarkable, and the patient returned to his normal activity 10 days after the surgery.