Max--Steak Bone Foreign Body

by Dr. Kristen Jensen, DAVBP

“Max”, a 4 year old male neutered Cairn Terrier came to the emergency clinic for discomfort and a distended abdomen after ingesting some steak with a bone attached about 3 hours prior.  Max did not usually get fed bones, but was offered a small piece of steak bone earlier this evening as a special treat.  Max’s owner was unsure if he had actually eaten the bone, or just chewed on it. 

On examination, Max was a happy outgoing terrier, but his abdomen was distended and tense on palpation.  He grunted when his abdomen was palpated, but did not show any overt pain.  His heart rate was a little elevated at 152 beats per minute.  He otherwise looked stable, but there was concern that if he had ingested the bone, it may be causing some problems and discomfort.

X rays were taken to see if Max had in fact eaten the bone, and if he had, if it looked like it might have the potential to cause Max problems. 

Abdominal X-rays were taken:

From this x-ray, we could see that there were in fact small pieces of bone in Max’s stomach:

    The white densities in the bottom left of the x ray

These pieces were small.  Though they had the potential to irritate the lining of Max’s stomach and intestine as they passed through, they were not likely to cause a major problem like obstruction of the intestine.  In cases like this, we often feed a bulky diet and watch for signs of vomiting or diarrhea.  We also give medications to protect the lining of the stomach and intestine.  Drugs commonly used include antacids such as Pepcid (famotidine) or Xantac (ranitidine).  A drug called sucralfate is used to form a paste like substance that binds to stomach ulcers or sites of GI ulceration.

Much more concerning in this case was something we saw by accident in Max’s chest:

There was a bright white density in the dorsal (top) portion of Max’s chest, appearing to be in the middle of his lung fields.  This density was actually the culprit.  Max had an esophageal foreign body.  The steak bone had gotten stuck in Max’s esophagus. 

More images were taken of Max’s chest confirming our suspicions.

Dogs eating bones, whether intentionally or unintentionally, are the cause of many emergency clinic visits every year.  Many people believe that it is OK to feed thier dog bones because they have never had a problem before.  Certain bones are believed to be safer than others.  The bottom line is that any bone has the potential to cause a problem.  We often see bones stuck in the mouth:  lodged across the roof of the mouth, stuck across the space under the tongue, or lodged between teeth.  Chewing hard bones can cause tooth fractures. Bones can splinter and cause injury to the oral cavity (mouth and tongue), the esophagus, or the lining of the gastrointestinal tract.  Sharp splinters of bone even have the potential to perforate the gastrointestinal tract leading to peritonitis and death.  Large pieces of bone can become lodged in the esophagus (like in this case), be too large to pass through the stomach, or cause an obstruction in the intestine necessitating surgery. 

An esophageal foreign body needs to be addressed immediately.  Bones are not the only thing that can get lodged in the esophagus.  Other common objects causing esophageal obstruction are rawhide chews, sticks, toys, and fish hooks.  Cats can even get hairballs stuck in thier esophagus when vomiting them up.  Any object stuck in the esophagus can cause major complications.  The esophagus wants the object to move into the stomach where it belongs and will contract and spasm against the object trying to move it along.  This causes irritation to the lining of the esopagus (esophagitis).  Ulcers can form.  If the object persists for long enough, or if it is a sharp object such as this bone, it can actually perforate (puncture) the esophagus, causing a pleuritis or infection in the chest cavity.   Once the esophagus is injured, problems can erupt during the healing process.  As the esophagus heals, scars can form causing a narrowing of the esophagus, or strictures.  Esophageal strictures can cause chronic problems with eating and swallowing, and potentially make the animal more prone to another esophageal obstruction.

Max was given IV fluids and pain medications, and sent to an internal medicine specialist (Dr. Valerie Case) to see if the bone could be retrieved by endoscope.  In this procedure, Max was anesthetized and a small camera was passed down his esophagus.  Often objects can be grasped using the endoscope and removed back out the oral cavity.  While Max’s bone was visible using the endoscope, it was lodged too tightly in his esophagus to pull back out.  In this situation, Dr. Case was able to push the bone along into Max’s stomach.  Once the bone was in the stomach, surgery was performed to open his stomach to remove the bone.  This is called a gastrotomy.  A gastrotomy was performed because it was likely the bone fragment would have gone on to cause an intestinal obstruction--it was too large to pass. 

Max’s esophagus was examined after the bone was dislodged.  Esophagitis and esophageal ulcerations were found.  IV fluids, IV pain medication, and IV antibiotics were continued post operatively.  Max was given a drug called metoclopramide (Reglan) by a constant rate infusion.  This drug keeps the stomach emptying and the intestines moving.  A concern for Max would be gastroesophageal reflux (fluid refluxing from the stomach into the esophagus) causing further esophagitis and irritation.  IV antacid (pepcid) was also given to reduce the acidity of the stomach contents. 

We are happy to report that Max made a full recovery, though it is likely he won’t be chewing on any more steak bones! 

Kristen Jensen, DVM, DAVBP

Dr. Kristen Jensen graduated Magna Cum Laude in 1995 from the University of South Florida with a Bachelors in Anthropology. She earned her Doctorate in Veterinary Medicine from Cornell University in 2003. Dr. Jensen was an associate veterinariian of All Animal Clinic in Key West, Florida until joining the staff of SFAEC. In 2010, she was boarded in Canine and Feline practice through the American Board of Veterinary Practitioners.

Dr. Jensen joined SFAEC July of 2011 and is happy to be back in New Mexico, having completed her pre-veterinary curriculum and graduate anthropology classes at UNM. In her free time, Dr. Jensen enjoys perusing the farmer’s market for things to cook, hiking, and camping. She volunteers time internationally with the Humane Society Veterinary Medical Association Field Services, a group that teaches surgical and anesthetic protocols to veterinary students in developing nations, focusing on spaying and neutering.