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Labrador Gets Stick Stuck in Throat

Reggie, a two-year-old male neutered Labrador Retriever was admitted to Lime Trees Vet Referrals for treatment of an acute pharyngeal stick injury.
 

On admission, Reggie's vital signs were good but he was reluctant to move his neck and likely to be in severe pain despite good analgesia. There was increased airway noise centred over the larynx and a hard mass on the right mid dorso-lateral neck was identified.
 

For further investigation, Reggie was induced and as predicted intubation was challenging with a large stick exiting from a wound in the right dorsolateral pharynx, cranial to the epiglottis. A small ET tube was placed and the stick was shortened with bone cutting forceps. A 10FG urinary catheter was used as a stylet placed ventral to the small tube and a larger cuffed ET tube was slid into place as the smaller ET tube was removed. Perioperative maropitant, methadone, fentanyl, paracetamol, cefuroxime and fluids were administered.

CT confirmed a large linear stick with associated emphysema and swelling, extending from the pharynx to the prescapular region with no obvious disruption of the oesophagus, trachea or major cervical vasculature. At one point the common carotid artery was adjacent to and displaced ventrolaterally to the stick.

There was secondary pneumomediastinum composed of heterogenous emphysematous gas rather than a single large gas pocket. Several small fragmented foreign bodies were surrounding the caudal aspect of the FB. The right superficial cervical lymph node was mildly enlarged (palpable on admission). There was a patchy interstitial coalescing to alveolar pattern of the left cranial lung lobe. Atelectasis was considered most likely, however, given the other findings, aspiration pneumonia (saliva) was also considered.

Sagittal-view
Axial-view

Sagittal view: demonstrating linear FB and mediastinal emphysema

Axial view: larynx centre, FB to right. The white dot adjacent and ventro-laterally to the FB is the carotid.

Ewa, our referral veterinary surgeon, made a horizontal incision over the stick and cranially to it on the right lateral neck to gain exposure to the distal end. Slow and gentle removal with minimal traction was performed continuing in the original trajectory to minimise trauma. The neck incision was enlarged and deepened through the cervical muscles and 2 further approximately 1cm larger pieces of wood and a few (< 5mm) smaller fragments were removed by palpation and further lavage. The entire tract was visualised and no further foreign material or haemorrhage was observed.

A modified closed suction Jackson Pratt drain was placed and the lateral cervical wound was closed routinely with two layers of PDS 2-0 in the muscle and sc. The skin was closed with 2-0 blue nylon. The 4cm wound in the soft palate/pharynx was closed up to 80% of its length (to allow drainage) with Monocryl 2-0. Some oedema but no airway obstruction was visible. Robenacoxib was administered once the integrity of the oesophagus was confirmed.

Post Op

Analgesia, fluids and antibiotics were continued overnight by colleagues from Vets Now. Reggie made a purposely slow but good recovery. His drain was removed and he was discharged the following afternoon with medication. We expect Reggie to make a full recovery.

Reggie has been lucky; the carotid is surprisingly elastic and there was no significant haemorrhage or marked pneumomediastinum. There was no trauma to the larynx, oesophagus or trachea. There is a very small risk of unilateral damage to the neurovascular trunk but no evidence of laryngeal paralysis or Homer's was observed post operatively.

 

Lime Trees Vets Referrals can accept cases in dermatology, diagnostic imaging, internal medicine, orthopaedics and soft tissue surgery.

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