Hospital Cases

Brazil Nut Bowel Obstruction

Sooty presented with a history of lethargy, weight loss and vomitting over the last few days. He had a history of swallowing foreign bodies: 6 months ago he had surgery to remove a hazel nut from his intestines.

Sooty was very dehydrated and had lost a lot of weight. A firm mass was palpable in the middle of his abdomen.

Blood tests showed the kidneys were not too happy with the lack of fluids (elevated BUN and Creatinine).

We placed Sooty on an IV drip of Hartmans. After a few hours, we anaethetised him using IV Alfaxan followed by 2% Isoflurane gas.

An exploratory laparotomy revealed a firm mass in middle of his intestines. We removed a foreign body (which was a large brazil nut) through an incision in the intestines, but on attempting to close the wound, the intestinal wall kept breaking. This was probably because the nut had been present for a few days, and caused damage to the integrity of the intestine wall.

We decided to remove the 7cm of affected intestine and suture the remaining fresh and healthy ends. We used single interupted sutures of 3-0 Monosyn to bring the ends together. The area was flushed seveal times with 0.9% saline before a local application of anitbiotic (Cepahlexin) was placed around the site. Finally, the piece of intestine was wrapped in omentum (a fatty net-like protective lining of the abdominal contents) to seal any leaks should they occur.

Sooty was given injections of antibiotic (Clavulox) and pain killers. He made a rapid recovery but was not allowed any fluids or food for 24 hrs. Later the next day, we gave Sooty a small amount of concentrated recovery diet (Hills A/D) mushed up with water.

Sooty  looked much stronger the following morning and was allowed several small meals of sloppy A/D during the day. He was discharged 2 days after the surgery and made a full recovery.

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