Podcasts

Sewing needle foreign bodies in dogs & cats| VETgirl Veterinary CE Podcasts

In today’s VETgirl podcast, we review sewing needle foreign bodies in dogs and cats. Should we treat these with endoscopy, surgery or medical management?

In human medicine, 65% of ingested sharp objects pass without incident, with 15-35% developing perforation. Minimally invasive removal is recommended (such as endoscopy). If this isn’t possible, treatment recommendations in humans should be based on clinical signs. In human medicine, if clinical signs progress or the needle hasn’t moved in 3 days, surgical recommendation is warranted.

So what about in veterinary medicine? Recommendations in veterinary medicine typically are based on clinical or anecdotal experience, as there hasn’t been anything published about this in veterinary medicine.

Therefore, Pratt et al out of University of Pennsylvania wanted to evaluated this. They retrospectively evaluated 27 dogs and 38 cats that had ingested a sewing needle, and cataloged the clinical signs, diagnostic evaluation, location of the needle, rate of perforation, and outcome. Overall, this study found that 89.2% (58/65) of patients had clinical signs associated with needle ingestion, while 10.8% of patients had the needle identified as an incidental finding on radiographs.

Approximately 1/3 of patients had needles identified in the oropharynx (33.3% dogs, 29.7% cats), while approximately half of patients (47.6% dogs, 51.4% cats) with clinical signs had the needle identified within the proximal gastrointestinal tract (esophagus, stomach).

Clinical signs seen with having a sharp needle stuck in the oropharynx included retching in dogs, and  retching, anorexia, and cervical swelling in cats. More often, the needle was actually visible during physical examination more often in cats than in dogs with needle in oropharynx.

Overall, 89.7% of animals had definitive treatment. In general, time from witnessed ingestion to treatment was associated with more distal location in gastrointestinal tract, but no statistical significance was able to be assigned. In 17.2% of cases (10/58 animals), gastrointestinal perforation occurred; there was no significant difference between this occurring in dogs versus cats. Perforation  was more common when owners did not witness/suspect ingestion of the sewing needle.

Overall, the prognosis for sewing needle foreign bodies was excellent, with 98.1% (51/52) of animals that received definitive treatment making a complete recovery. 1 patient was euthanized due to an esophageal perforation and septic mediastinitis.

This study also found that dogs were significantly more likely to have an incidental needle foreign body diagnosed (e.g., on radiographs). Of those that had an incidental sewing needle foreign body, 4/7 received treatment, while 3 did not.  All 7 recovered without any reported complications during the study period.

So, what can we take away from this VETgirl podcast?

Overall, the treatment of sewing needles ingestion was highly successful (98.1%). Treatment should be aggressive, as we can see perforation of the gastrointestinal tract approximately 18% of the time (which is similar to human medicine). Most importantly, if you notice a dog or cat presenting to you for anorexia, retching and/or cervical swelling, make sure to rule out a sewing needle foreign body!

When in doubt, these UPENN authors support adoption of guidelines from the American Society for Gastrointestinal Endoscopy Practice Guidelines, which recommends endoscopic removal of amenable ingested sharp objects. For patients that are not good endoscopy candidates, they recommend ‘intensive monitoring for signs of perforation and daily radiography. Surgical intervention is indicated when the patient has an acute onset of clinical signs or the sharp object fails to advance for 3 consecutive days.’

When in doubt, if it’s sharp, take it out! Check out our VETgirl video for a cool example of the importance of the oral exam here:

[jwplayer playlistid=”6777″]

References:

1. Pratt CL, Reineke EL, Drobatz KJ. Sewing needle foreign body ingestion in dogs and cats: 65 cases (2000-2012). J Am Vet Med Assoc 2014;245(3):302-308.

2. Ikenberry So, Jue TL, Anderson MA, et al. American Society for Gastrointestinal Endoscopy Guideline: Management of ingested foreign bodies and food impactions. Gastrointest Endosc 2011;73:1085-1091.

 

Only VETgirl members can leave comments. Sign In or Join VETgirl now!