14 Apr 2020
Wooden skewer in a husky
Roderick Beardshall MA, VetMB, MRCVS details the case of a male dog that presented with a five-day history of lethargy and stiffness.

A three-year-old neutered male husky named Hugo was presented with a five-day history of lethargy and stiffness.
On examination he was pyrexic (40.3°C) and appeared stiff on rising, but the exam was otherwise unremarkable, including no discomfort on abdominal exam. Blood tests showed mild neutrophilia (15.2; reference range 3.7 to 13.3), monocytosis (1.8; reference range 0.2 to 0.7) and mildly raised cholesterol (8.2; reference range 3.2 to 7.9). They were otherwise unremarkable, including a normal canine pancreatic lipase immunoreactivity.
The dog was given amoxicillin and clavulanic acid, as well as meloxicam, and the plan was to perform ultrasound and possibly joint taps to investigate the pyrexia if it wasn’t resolving.
Referring to the day of the initial presentation as day 1, on day 2 Hugo was much improved – although it was noted he yelped on mid-abdominal palpation, but then relaxed and this reaction was not repeatable. Treatment was continued with amoxicillin and clavulanic acid, as well as meloxicam.
A migrating foreign body was considered and the lump was explored, but no foreign material identified. X-rays did not show an abnormality.
Samples were sent to check clotting times (normal), and for culture and sensitivity. Haematology showed an increased neutrophil count (20.2), lymphocytosis (5.9; reference range 1 to 3.6) and eosinophilia (2; reference range 0.1-1.3). Treatment was continued.
By day 7, the lump had completely resolved. The dog had vomited once and it was noted that his faeces had been a little softer. Meloxicam was discontinued.
On day 8, the culture results were received showing a heavy growth of Escherichia coli resistant to amoxicillin and clavulanic acid, but sensitive to enrofloxacin. Due to the nature of the discharge observed, it was elected to treat with enrofloxacin, and sufficient for 10 days was prescribed.
On day 16, the owner called to cancel a planned follow-up appointment reporting that all had remained under control since the previous visit.
Second presentation
On day 24, the husky was presented again, with a report he had become a little lethargic on day 17 (while still on enrofloxacin) and had remained so subsequently. He had maintained a reasonable appetite, had not vomited and had maintained a stable bodyweight.
He was reported as a little brighter when he was seen, but the owner was concerned about a sore area of skin ventrally.
An area a few centimetres across on the left side of the cranioventral abdomen was raw, ulcerative and exudative, and very painful to touch. The dog’s temperature was 40.1°C.
Investigation

The following day, Hugo was admitted for investigation under anaesthesia. The skin over the lump was extremely inflamed and several satellite lesions existed, including some intact pustules. Some sanguineous and possibly mildly purulent fluid was aspirated from the lump.
In-house cytology showed degenerate (or poorly preserved) PMNLs. Samples were sent for cytology and culture. Punch biopsy samples of pustules were taken for culture and for histology.
The lump was explored; no foreign material was identified and a tissue sample was taken for histology. Bloods showed a mild non‑regenerative anaemia (PCV 33%; red cell count 4.38; reference range 5.4 to 8.5) and a mild eosinophilia (1.4). External cytology was consistent with pyogenic inflammation with bacterial involvement. The dog was discharged with enrofloxacin and meloxicam.
Findings
Subsequent results came back on day 29 after a diagnosis had been made by other means (see further on). From pustules, a light growth of multisensitive Staphylococcus pseudintermedius existed, and histology of a pustule showed superficial perivascular dermatitis and perifolliculitis.
From the main lump, a sparse growth of a multisensitive beta-haemolytic Streptococcus existed and a sparse growth of a non-haemolytic E coli that was sensitive to amoxicillin and clavulanic acid, and doxycycline, but otherwise multiresistant, including to enrofloxacin.
Histology from tissue from the inflamed area yielded a morphological diagnosis of neutrophilic diffuse dermatitis and panniculitis with granulation tissue, fibrosis and sinus tract formation.
Differential for this picture included penetrating injury and infection, deep bacterial pyoderma/furunculosis, deep fungal infection and sterile inflammatory immune-mediated panniculitis.
On day 26, Hugo was bright, his temperature was 39.2°C, the lump was smaller and a “cleaner” looking serosanguinous discharge existed.
Foreign body
On day 29, the dog was on his way to the surgery for a scheduled check when the owner noticed a wooden spike protruding slightly from the ventral wound. On gentle exam under sedation, it was apparent this could not be easily removed.
Hugo was anaesthetised and taken to theatre for exploratory surgery, where the reason for the cause of the resistance was realised. The foreign body was a wooden skewer with a total length of 20cm, which included a flat handle of approximately 8cm × 4cm.
The handle was still in the stomach and, due to a significant inflammatory response internally, it was necessary to perform a partial gastrectomy to facilitate removal.
The site was flushed with copious saline. The stomach was closed with 2m Vicryl, the abdominal muscle with 3m Vicryl, dead space closed down with 2m Monocryl and skin closed with a continuous SC suture using 2m Monocryl. For analgesia, methadone was used as part of the premedicant and was repeated later.
Hugo was already on meloxicam and this was continued postoperatively, together with tramadol. Metronidazole was also used, together with a continuation of the course of amoxicillin and clavulanic acid.
A Penrose drain was placed, which was removed four days later. Hugo was bright and alert by mid-afternoon, and was discharged the same day. He made an uneventful recovery.
Conclusion
Remarkably, the owner was able to say that Hugo swallowed the skewer four weeks prior to him first becoming unwell.
It seems even more remarkable to consider that, based on compelling circumstantial evidence, Hugo survived a further four weeks with a foreign body penetrating through his stomach wall. Truly a remarkably resilient patient.
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