Catch & Release

Fishhook esophagus

Second in a series
A lot of important stuff happens in our chests. Adding a fishhook is not a positive. We premedicated Princess with a pain reliever and sedative, administered an IV anesthetic, passed a tube into her trachea (windpipe), and started oxygen and gas anesthesia. Her vital signs were strong. So far, so good.

Amos did a thorough prep of our patient’s chest and then wheeled her into surgery. After scrubbing, gowning and gloving, I was ready to make the incision between Princess’s ribs. Her breathing over the next hour would be carefully managed by my assistant’s gentle hands on the anesthetic breathing bag. I opened the chest and said “breathe.” After inserting the retractor, I said “breathe.” Then I packed off the lungs with warm saline-soaked lap sponges, first on one side and then the other, and repeated “breathe”. It was a careful, well-communicated dance.

I felt a lot better when I saw and then palpated the hard lump lodged in the wall of Princess’s esophagus. There was no sign of a perforation. I just needed enough space to remove the offending foreign body without causing further damage. The admonishment of the ancient Greek physician Hippocrates to “first do no harm” weighed heavily. I took it slow.

With irrigation and suction at the ready, I made a small incision just behind where the fishhook was lodged, reached inside with a curved Kelly forceps and gently maneuvered it. And it came free. Using the warm saline Amos added to a sterile bowl, while he continued breathing for our girl – on my cue, I rinsed and suctioned the esophagus and securely sutured it.

Open chest procedures don’t end when the ribs are closed. A final squeeze of the breathing bag will force much of the free air out just as the last stitch in the skin is placed but there is always more that’s left behind. I’d inserted a chest tube with a one-way valve. The suction machine withdrew more free air. All good? Not so fast.
Next week: Air – not always a good thing.
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Dr. Jeff Nichol is a residency-trained veterinary behaviorist. He provides consultations in-person and in groups by Zoom (505-792-5131). Each week he shares a blog and a video to help bring out the best in pets and their people. Sign up at no charge at Post pet behavioral or physical questions on or by US Post to 4000 Montgomery Blvd. NE, Albuq, NM 87109.