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Surgical Retrieval of a Migrated Sewing Needle from Thoracic Cavity of a Dog.

Introduction

Thoracic penetrating injuries due to bullets, bite wounds or penetrating foreign body from the gastrointestinal tract pose a serious threat to dog's life and is a challenging task to the surgeon. Foreign bodies penetrating the thoracic cavity are less common and wooden stick (Pelosi et al, 2008), grass awn (Brennan and Ihrke, 1983), porcupine quill (Guevara et al, 2015) and sewing needle (Hunt et al, 1991) are usually reported. Mostly foreign bodies are seen to migrate from the stomach to thoracic region or other abdominal organs (Mahajan et al, 2012). The present case describes history, diagnosis and successful surgical retrieval of sewing needle from thoracic cavity of a dog in which the needle had penetrated transcutaneous and later got migrated to thoracic cavity within 6-7 hours.

History and Diagnosis

A seven year old male non-descript breed dog weighing 16 kg was presented with history of transcutaneous penetration of a sewing needle with loaded thread in left 6-8 intercostal space on the same day while sitting on it. The dog felt pain at site on palpation. The dog was unsuccessfully surgically explored by a Veterinarian in the morning for retrieval of needle. The thread was however, not visible on presentation. Lateral and ventro-dorsal thoracic radiographs revealed a hazy/ double image radio opaque metallic density 3.6cm long placed obliquely between 6-8 intercostal spaces and on the left side of the sternum (Fig.1a and b). The haziness/ double image doubted the foreign body to be penetrating heart or lungs. Surgical exploration was advised after explaining the possible complication to which the owner agreed.

Treatment

The dog was pre-medicated with inj. Atropine @0.04mg/kg and inj. Xylazine @ 0.5mg/kg, intramuscularly and general anaesthesia was induced using inj. Ketamine @ 5mg/kg IV. Endotracheal intubation was done and dog was further maintained on Isoflurane in 100% oxygen. The site was aseptically prepared for surgery. The previously applied skin sutures and skin was removed and exhaustive exploration of subcutaneous and muscular tissue was done in the ventral 6th, 7th and 8th intercostal spaces, but unsuccessful. While exploring the 7th intercostal space, thoracic cavity got opened. To rule out that the needle penetrating the thoracic cavity, the inside of the rib cage was palpated from that site. While palpation, the needle got touched to the back of the finger which was moving with the heart beat. The needle was retrieved through the same space with the fingers. The thoracic cavity was closed using vicryl 2-0. Before closure hyperventilation of lungs was undertaken. The thoracic muscles, subcutaneous and skin were closed in routine manner. Dog recovered from anaesthesia within thirty minutes and was discharged after one hour of surgery. Post-operative care included inj. Cefotaxime (a) @ 20 mg/kg, twice daily and inj.

Meloxicam (b) @ 0.2mg/kg once daily, intramuscular for five and three days respectively. On retrieval the needle measured 4.3cm in length (Fig. 2). Telephonic follow up at two weeks reported uncomplicated recovery after surgery.

Discussion

Penetrating foreign bodies are challenging to trace in the thoracic or abdominal organs as the exact location is difficult to assess on radiography or ultrasonography. Penetrating trauma may cause less injury to thoracic wall than an open chest wound, but more injury to the internal organs. The foreign body which penetrates the thoracic cavity can cause damage to lung parenchyma, pneumothorax, myocardial defects (Pelosi et al., 2008) and laceration of intra-thoracic vessels. Therefore, urgent surgical intervention should be taken into consideration for penetrating foreign bodies to avoid further internal damage.

In most of the cases, the penetrating foreign body is seen to migrate from abdominal cavity (stomach) to thoracic cavity or myocardium or other abdominal organs (Hunt et al., 1991, Mahajan et al., 2012). However in our case, the foreign body which was a sewing needle had penetrated transcutaneous and later migrated to thoracic cavity, rather than internal migration from the oesophagus, stomach or trachea. Radiography was considered diagnostic in assessing the site of foreign body as the double image or haziness of the needle suspected it to be moving with some organ like heart or lungs. Intercostal thoracotomy proved to be beneficial in retrieving the sewing needle from the thoracic cavity.

The case report concludes that rapid and keen radiographic diagnosis and surgical intervention (thoracic exploration) are necessary for a favourable outcome in retrieval of sharp transcutaneous penetrating thoracic foreign body.

References

Pelosi, A., Hauptman, J.G., Eyster, G.E., Beal, M.W., Anderson, L.K. and Olivier, N.B. (2008). Myocardial perforation by a stick foreign body in a dog. J Vet Emerg Critical Care. 18: 184-87.

Brennan, K.E. and Ihrke, P.J. (1983). Grass awn migration in dogs and cats: a retrospective study of 182 cases. J Am Vet Med Assoc. 182: 1201-04.

Guevara, J.L., Holmes, E. S., Reetz, J. and Holt, D.E. (2015). Porcupine quill migration in the thoracic cavity of a German shorthaired pointer. J Am Anim Hosp Assoc. 51: 101-06.

Hunt, G.B., Bellenger, C.R., Allan, G.S. and Malik, R. (1991). Suspected cranial migration of two sewing needles from the stomach of a dog. Vet Rec. 128: 329-30.

Mahajan, S.K., Anand, A., Sangwan, V., Mohindroo, J. and Singh, K. (2012). Surgical retrieval of a metallic foreign body from the spleen of a dog. Can Vet J. 53: 399-401.

Vandana Sangwan (1), Priyanka Duggal (2) and Ashwani Kumar (3)

Department of Veterinary Surgery and Radiology

College of Veterinary Science

Guru Angad Dev Veterinary and Animal Sciences University (GADVASU)

Ludhiana - 141004 (Punjab)

(1.) Assistant Professor and Corresponding author. E-mail: drvandanasangwan@rediffmail.com

(2.) Post Graduate Scholar

(3.) Associate Professor

(a) - Brand of Alkem Laboratories, Mumbai

(b) - Brand of Intas Animal Health, Ahmedabad
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Title Annotation:Short Communication
Author:Sangwan, Vandana; Duggal, Priyanka; Kumar, Ashwani
Publication:Intas Polivet
Article Type:Report
Date:Jan 1, 2018
Words:947
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