Goals of Treating Gastrointestinal Obstructions
Sudden blockages of the gastrointestinal (GI) tract are almost always medical emergencies, especially if the blockage is complete. They usually require surgery to remove the obstruction and preserve as much of the surrounding gastrointestinal tissue as possible. The goals of treating a gastrointestinal obstruction are to stabilize the dog, restore fluid and electrolyte balance, remove the blockage, provide supportive care and save as much of the affected tissue as possible.
When presented with a dog with a known or suspected GI blockage, the veterinarian will hospitalize and stabilize the animal, typically with intravenous fluids to correct dehydration and restore proper electrolyte balance. Abdominal radiographs (X-rays) and/or ultrasound usually will be used to identify the precise location and type of obstruction and to help the medical team plan the appropriate surgical approach. Sometimes, an endoscope can be used to remove small foreign objects that are lodged in the stomach or very upper small intestine. More often, the veterinarian will need to put the dog under general anesthesia and open up the belly – and the stomach or small intestines – to find and remove the object causing the blockage. If the blood supply to the intestines has been compromised, it may be necessary to cut out the dead or dying areas of intestine and suture the remaining parts back together. This is called resection and anastomosis. When resection and anastomosis is necessary, the risk of severe post-surgical complications goes up dramatically. If the dog has bloated and torsioned (gastric dilatation and volvulus), the veterinarian will try to untwist the affected stomach, spleen and other tissues and then tack the stomach to the intestinal wall. This is called a “gastropexy,” and its purpose is to prevent the stomach and attached tissues from twisting in the future.
Before closing the abdomen, the veterinarian will flush the abdominal cavity with a sterile solution several times to try and remove infectious microorganisms to reduce the chance of post-surgical infection. This process is known as “lavage.” Broad spectrum intravenous and oral antibiotics, together with medication to relieve stomach upset and vomiting (antiemetics), are usually also recommended after abdominal surgery.
Dogs with a gastrointestinal obstruction should be kept off feed until the blockage is relieved and vomiting has stopped. After that, they should be fed a bland diet for several days, such as boiled chicken and rice or a prescription canned food that can be provided by the veterinarian. Then, they can gradually return to their normal diet.
If a GI obstruction is caught early, surgical treatment has a very good chance of resolving the problem successfully. However, the longer that the blood supply to any part of the gastrointestinal tract is compromised, the poorer the prognosis becomes. Many times, significant pieces of the intestine must be removed as part of the treatment, especially if they have already become necrotic, meaning that they have died or started dying. The remaining healthy portion of the intestines must be stitched back together. It is not always possible for the veterinarian to close the incision sites of the intestines tightly enough to prevent them from leaking, and sometimes there is just not enough healthy tissue left to restore the intestines to their normal function. Dogs that suffer from gastric dilatation and volvulus (GDV; bloat) have a much more guarded prognosis even with surgery, with a mortality rate approaching or exceeding fifty percent.