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Video 5.1 Gastrotomy and an enterotomy performed for a linear foreign body in a cat.

When considering linear foreign body removal, the appropriate site of the enterotomy incision is determined by evidence of bowel plication in response to gentle tension placed on the proximal aspect of the foreign body. When gastrotomy is performed and the proximal aspect of the linear foreign body identified, gentle traction is applied to the body as it exits the stomach. If the linear foreign body is not easily retracted into the stomach, the site of tethering within the small intestine, indicated by plication of the bowel, is the appropriate site for enterotomy (Figure 5.10). In some cases, this procedure must be repeated and additional enterotomies performed to remove the entire linear foreign body. Each enterotomy site is closed using an appositional, side‐to‐side or end‐to‐end, closure of the incision with either a simple interrupted or simple continuous pattern. Anderson et al. reported the use of a single enterotomy technique for the removal of linear foreign bodies [12]. With this technique, the foreign body is anchored to a red rubber catheter, introduced into the bowel lumen and milked in an aboral direction through the length of the GI tract and exited through the anus [12]. This technique is valuable in cases with linear foreign bodies made of material that is amenable to anchoring to the red rubber catheter, such as sewing thread or dental floss. Linear foreign bodies such as towels and clothing are not generally suitable candidates for this procedure in the authors' experience.

Figure 5.8 Luminal disparity can be corrected by transecting the smaller intestinal segment at an angle before performing the anastomosis.

Source: Brown [62]. Reproduced with permission from Elsevier.

During removal, careful inspection of the mesenteric border is crucial as compromise of the integrity of the bowel wall may occur secondary to the motion of the linear foreign body. Evidence of hemorrhage within the fat at the mesenteric border or areas of omental adhesion to the small bowel may indicate the presence of perforation and should be investigated (Figure 5.11). In the event of perforation of the intestine at the mesenteric border, resection and anastomosis are indicated, as debridement and successful closure is difficult to achieve in this area due to lack of adequate visualization and possible compromise of vascular integrity.

Following foreign body removal and before closure of the abdomen, attention should be given to the overall microenvironment of the abdominal cavity and the nutritional status of the animal. If perforation of the GI tract has been identified, need for peritoneal drainage should be considered. If the abdominal cavity has great potential for ongoing inflammation and/or infection, drainage may be indicated (see Chapter 11). Consideration should also be given to the need for nutritional support following surgery and the best method to provide this support. In some instances, a surgically placed feeding tube is indicated (see Chapter 21).