Causes: mobility of dog’s stomach when empty, leaping, running down
stairs. Lesions: viscus doubled forward, pylorus in front of cardia,
duodenum compresses cardia, liver, spleen and omentum displaced,
stomach tympanitic, lungs and heart compressed, latter gorged with
dark blood. Symptoms: tympanitic abdomen, and half thorax, no
rumbling, murmur in front of thorax, abdomen tender, patient stands,
dyspnœa, emesis impossible. Course: violent symptoms in twelve hours,
death in thirty-six. Diagnosis: sudden, severe seizure, complete
anorexia, tympany, tenderness, dyspnœa, no vomiting, arrest of
peristalsis. Obstruction. Peritonitis. Choking. Treatment: tapping,
laparotomy, replacing the viscus.
This has been demonstrated by Kitt and Cadeac who believe that it is
quite a common occurrence.
_Causes._ The predisposing cause is the extreme mobility of the canine
stomach which hangs from the œsophagus like a pear from its stalk, the
remainder of the viscus being only attached to the loose omentum,
spleen, and commencement of the duodenum all of which it can carry with
it easily when it rolls on itself. Its mobility is, however, very
restricted when full, the liver on the one side and the spleen and
intestines on the other proving almost insuperable obstacles to
rotation. But when empty it moves with great freedom and by a sudden
shock in leaping, gamboling or running rapidly down stairs the pylorus
is carried forward and to the left until it and the commencement of the
duodenum are jammed in front of the cardia. The result is the
obstruction of the cardia and duodenum by their mutual pressure in
crossing each other, and the interruption of the gastric circulation and
functions.
_Lesions._ As just stated the stomach which would normally extend from
the cardia downward and to the right is bent forward and doubled upon
itself, the pylorus lying in front of the cardia, the duodenum extending
from before backward above the cardia and tightly compressing it, the
liver drawn to the left by the hepato-duodenal peritoneum, and the
spleen displaced to the right by the traction on the omentum. The
stomach enveloped in its omentum is distended by gas to perhaps ten
times its normal dimensions and appears to fill the entire abdominal
cavity while the intestines are pushed aside and concealed. The chest is
compressed by the strong pressure on the diaphragm, and the lungs are
congested of a deep blue and the right heart distended with dark blood.
The animal appears to have perished of apnœa.
_Symptoms._ In fully developed cases the abdomen is greatly distended
and tympanitic. The drumlike resonance is met with in the anterior part
of the abdomen including the umbilical region. It extends forward over
one-half of the thorax, excepting only a space of 5 or 6 inches square
in the right hypochondrium, which represents the situation of the liver,
and spleen. Auscultation furnishes no sound in the abdomen, and only in
the anterior portion of the thorax is there a distinct respiratory
murmur. The heart may beat strongly and rapidly, or weakly and slow, and
the pulse is small and thready. The abdomen is tender. The animal
stands, dull, and breathes with great effort. If made to walk it is done
slowly, stiffly and with head extended, mouth open and tongue
protruding. There is no sign of vomiting and this cannot be brought
about by tickling the fauces, or even by giving apomorphine subcutem,
though retching may be induced.
_Course._ The disease may develop into dullness and anorexia in two
hours after boisterous health; in twelve hours there may be considerable
tympany and dyspnœa; and a fatal result is reached in about thirty-six
hours.
_Diagnosis._ This is based on the transition from vigorous health to
sudden illness, with complete anorexia, inability to swallow or to
vomit, tympany of the stomach as shown by percussion, tenderness of the
abdomen, dyspnœa, disturbed heart-functions, and inactivity of the
bowels. With intestinal obstruction on the other hand there is free
vomiting of bilious and feculent matters. With peritonitis there is much
greater and more uniform abdominal tenderness, vomiting and higher
fever, but less tympany in the anterior abdominal region, and no such
complete suspension of defecation. With choking there is no such
progressive tympany, appetite and defecation are not so completely
suspended, and liquids may often pass the obstruction in small
quantities in both deglutition and vomiting. Choking is by no means so
speedily fatal.
_Treatment_ is essentially surgical. When tympany is already established
the gas must be evacuated by a small cannula and trochar. Then resort is
had to laparotomy, the incision is made on the right side large enough
to introduce the fingers, which must follow the great curvature of the
stomach as far as the pylorus which is pulled back into its normal
position on the right. The incision is now closed by an ordinary
continuous suture.
FOREIGN BODIES IN THE STOMACH. HAIR, WOOL, BRISTLE, CLOVER AND COTTON
BALLS.
Hair balls, wool balls, bristle balls, cotton balls, clover-hair
balls, oat-hair balls, paper balls, phosphatic calculi, sand and
gravel, nails, wires, needles, pins, etc., cloth, leather, whalebone,
playthings, etc. Symptoms: of catarrh or colic, dullness,
restlessness, arched back, in dog vomiting of blood, fistula.
Diagnosis. Treatment: emetic, feed potatoes, laparotomy.
=Hair Balls.= These are common in the rumen of cattle and have been
found in the fourth stomach. They are especially injurious to young
animals by reason of their irritating the gastric mucosa, but they also
occasionally block the pylorus, producing indigestion, gastric
dilatation, gradually advancing emaciation and even a fatal result.
=Wool Balls.= These are found in sheep and are especially injurious in
young lambs.
=Bristle Balls.= These are found in swine as round, or ovoid balls or
long ellipses bent upon themselves. The sharp projecting ends of the
bristles render them very irritating, especially to young pigs.
All of these are caused by licking themselves or their fellows, and
particularly during the period of moulting or as the result of some skin
affection. Lambs which are nursed by ewes with an excess of wool on and
around the mammæ, and old sheep with a disposition to eat wool are
frequent victims.
=Cotton Balls.= These have been found in lambs fed on cotton seed cake.
A certain amount of the cotton fiber is incorporated in the cake, and
this is rolled together and felted by the movements of the stomach and
agglutinated by mucus.
=Clover-hair Balls.= The fine hairs from the clover leaf have been found
rolled into balls in the abomasum of lambs producing all the evil
effects of the other pilous masses.
=Oat-hair Balls.= The fine hairs which cover the seed of the oat are
found matted together and cemented by mucus in the stomach of horses fed
on the _dust_ of oatmeal mills. They are especially common in Scotland,
where oatmeal has been so extensively used.
=Paper-ball.= In the museum of the N. Y. State Veterinary College is a
conglomerate ball of paper taken from the stomach of a hog by Dr.
Johnson, Sioux City.
=Phosphatic Calculi= have been described as found in the stomach, but
this is evidently an error, as the acid secretion would have speedily
dissolved them. The error doubtless came from mistaking the transverse
colon for the stomach.
=Sand and Gravel= arrive in the stomach of the _horse_ from pasturing on
loose sandy land, the plants being pulled up by the roots and swallowed
together with the sand adherent. Also from drinking water from shallow
streams with sandy bottoms. Feeding of grain from the ground is a cause
of swallowing sand, earth and pebbles. Licking the soil in acidity of
the stomach is another cause. Fodder that has been packed down and mixed
with earth, and that which has been blown full of sand or dust, and
roots eaten from the ground in wet weather lead to the ingestion of much
sand or earth. Shetland ponies taken from the islands pass sand for some
weeks. Dogs taught to fetch and carry, swallow stones, pebbles, marbles,
etc., accidentally.
=Nails, Wires, Needles, Pins, etc.= More or less pointed metallic
objects are often taken in with the food by gluttonous horses and though
usually arrested in the intestines they sometimes irritate or wound the
stomach.
=Fragments of cloth, leather, or whalebone= are similarly taken with the
food, or in case of depraved appetite are deliberately chewed and
swallowed.
=Playthings and small household articles= are especially taken by
puppies through mere wantonness. Rubber balls, pieces of metal, thread,
cord, cloth, bits of leather, sponge, horse hair, human hair, corks,
bits of wood and everything obtainable of small size may be swallowed
and found in the stomach.
=Pigs= swallow pieces of wood and other objects.
=Birds= habitually swallow pebbles and ordinary objects are ground down
in the gizzard. They also readily vomit feathers, bones and other
offensive matters that have proven indigestible.
_Symptoms._ In =horses= there are no especial symptoms, though the
foreign bodies sometimes cause gastric catarrh, and in other cases
produce wounds and ulcers or block the pylorus causing violent colic.
Most commonly the foreign bodies pass on into the intestines, where they
may directly wound the walls, form nuclei for the deposition of earthy
salts in the form of calculi, or in case of fibrous materials (cords)
roll into firm balls.
In =dogs= the foreign bodies may cause gastric catarrh, or puncture or
abrasion of the mucosa, and they may be rejected by vomiting. The more
rounded, smooth bodies may lie for a length of time in the stomach
without doing any manifest injury, as in the case mentioned by Nichoux
in which a dog carried in its stomach for twelve years a four franc
piece and a large sou. Sometimes the objects block the pylorus. Then the
subject is dull, depressed, inclined to lie on the right side but
continually changing his position, gives a stifled yelp when he lies
down or occasionally when he stops walking. He carries the back arched,
and the abdomen tucked up, and drags his hind limbs. Vomiting, is
frequent and accompanied by violent and painful retching. The vomited
matters may be mixed with blood. The epigastrium is tender to pressure.
Death may ensue in twenty-four hours or not until after weeks or even
months.
In other cases there is gastro-enteritis with vomiting, colic, anorexia,
trembling, hyperthermia, constipation or diarrhœa, and finally the
passage of the offending agent per anum, when recovery ensues.
In other cases sharp pointed bodies perforate the walls of the stomach,
and determine the formation of abscess or fistula opening at any point
around the abdominal cavity. This may be followed by recovery, by
gastric or intestinal fistula, or by chronic disease of some important
organ like the liver.
In =dogs=, _diagnosis_ is often possible by manipulation of the stomach
through the walls of the abdomen. If the belly is very lax it may be
compressed between finger and thumb, or between the two hands; if more
tense, pressure with both hands just behind the sternum may detect the
resistance of a solid body.
_Treatment._ In the =horse= this is hopeless.
In the =dog= much may be expected from the use of emetics, (ipecacuan,
tartar emetic, apomorphine, tepid water, tickling the fauces). In some
cases of sharp pointed bodies an exclusive and abundant diet of well
boiled potatoes proves successful. The object is to pass much of the
starchy matter through the small intestines undigested, so that it may
envelop the sharp body and protect the mucosa. When it reaches the
colon, the ingesta as a whole becomes more solid and invested by this,
the body is often passed without danger. Other methods failing
laparotomy remains. The dog is stretched on his back on a table with the
forelimbs held well apart. The skin of the epigastrium is denuded of
hair and washed with antiseptics (mercuric chloride solution 1:500).
Hands and instruments are also made aseptic. Then an incision is made in
the epigastrium or in the situation where the offending body has been
felt, and the finger is introduced to locate the body. At this point a
thread is passed through the walls of the stomach, and these are drawn
well out through the abdominal wound and incised to the extent of an
inch or more. Through this orifice the foreign body can be easily felt
and extracted. Then in case the stomach is over-filled it may be
emptied, and the edges washed with the antiseptic and carefully sutured
with sterilized catgut. The usual care must be taken to turn the mucosa
inward and bring the muscular and serous coats in accurate opposition.
Finally the abdominal wound is closed by a continued suture of silk or
catgut.
The greatest care must be taken to prevent the escape of any of the
gastric contents into the abdominal cavity, to render both wounds
aseptic and to protect the external wound especially against infection.
A wash of carbolic acid (1:100) with a little of some intense bitter
(quassia) will often succeed in preventing licking or gnawing.
Even greater care must be given in the matter of diet. At first a few
teaspoonfuls of cold water only need be given. After twenty-four hours a
little well strained beef tea; later milk or gruel may be added, and by
degrees more solid food. In three weeks the ordinary food may usually be
resumed.
In case the foreign body has escaped into the peritoneal cavity, the
same method may be pursued, the edges of the gastric or intestinal wound
being made raw, treated antiseptically and carefully sutured, and the
abdomen washed out with an antiseptic solution (aluminum acetate
solution) and closed.