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The Punctured Poodle

By: John Donges Date: Jul 7, 2016

It was the kind of freak accident that is completely unexpected and fills the heart with dread and fear.

The Broome household was bustling on a Saturday morning in May. Bob and Lori Broome were hosting family for their grandson’s baptism. Bob was outside playing fetch with Belle, the Broome’s two-year-old Standard Poodle. When she didn’t return with the ball, Bob grew concerned. During a brief search, he found her lying under their camper. She emerged with an injury that was almost impossible to believe.

A screw rod from a scissor jack had impaled the left side of her chest.

“When I saw the rod sticking out of her, I thought, ‘Oh my God, my dog’s going to die,’” said Bob.

The Broomes immediately brought Belle to their primary care veterinarian at nearby Middletown Veterinary Hospital. There, radiographs revealed that the rod had entered Belle’s chest cavity. She also had some air in her chest, a condition called pneumothorax. Belle was kept calm and given pain medication.

Belle's radiograph revealed that the rod had entered her chest cavity.Belle’s veterinarian did not attempt to remove the rod, instead referring the Broomes to Ryan Hospital’s Emergency Service for further diagnostics and treatment. A friend of Bob’s drove him and Belle to Philadelphia, an hour away, while Lori stayed behind with the family.

“I held Belle on my lap on the way up,” Bob recalled. “She was calm. She never complained, or whined, or was snappy.”

CERTIFICATIONS OF DISTINCTION

Belle’s primary care veterinarian alerted the Penn Vet Emergency Service that she was on her way, and emailed the radiographs. Dr. Amanda Thomer, Resident in Emergency and Critical Care, was standing by. “I was excited to be able to help Belle, but also concerned about the damage the rod may have caused,” she said.

Thankfully, Belle had come to the right place. Ryan Hospital is the region’s only certified Veterinary Trauma Center and Level I Facility. These prestigious distinctions reflect Ryan Hospital’s comprehensive depth of resources available to animals suffering traumatic injuries, like Belle’s.

Belle at Ryan Hospital's Emergency ServiceEven though Belle had a large rod protruding from her chest, Thomer’s priorities were the same as for any patient that comes through the Emergency Service: assess stability by evaluating the cardiovascular system, respiratory system, nervous system, and urinary system, then pursue treatments aimed at stabilizing any abnormalities found upon examination.

“Surprisingly, the only difference the rod made was that it was imperative we move Belle very carefully and that she remain sedated,” explained Thomer. “If the rod moved, it could cause life-threatening conditions such as hemorrhage or a collapsed lung due to pneumothorax.”

Meanwhile, Belle’s surgeons were alerted and came to see her. Thomer gave Belle’s medical history to Dr. Chloe Wormser, Surgery Lecturer, and Dr. Katherine Meyers, Surgery Resident, and they examined her.

“It was astonishing to see a giant metal rod going through her chest,” said Meyers. “I’ve seen sticks in the chest before, but never something of this magnitude.”

Belle was in respiratory distress due to mild pneumothorax. Thoracocentesis, a pleural tap, was performed by Thomer to remove air from her chest cavity. Belle’s breathing rate and blood oxygen levels soon improved. An ultrasound of Belle's chest and abdomen revealed that the metal rod did not penetrate the diaphragm, which was a good sign.

Now Belle’s surgeons could begin thinking about their surgical approach.

A SURPRISE INSIDE

“Our biggest concern prior to taking Belle to surgery was the location of the rod. It was in an area with a lot of vital structures—the aorta, lungs, and esophagus—and we really couldn’t tell based on the x-rays how much damage we would find once we were in surgery,” explained Wormser. “We can see animals that look relatively stable before surgery and then find a lot of damage, or have significant bleeding during the procedure, so there was some question of what we’d have to do to help Belle.”

Wormser and the surgical team went through Belle’s sternum to open up her chest in order to give them access to her entire chest cavity and have room to maneuver. The surgeons discovered that the rod had tunneled under the skin, between two of Belle’s ribs, and was sitting adjacent to her left lung. Fortunately, it had not damaged the major vessels in her chest.

Belle is prepped for surgery.They found evidence of bruising on the aorta, and the tip of the rod was pressed against the diaphragm, but had not penetrated it. However, the rod had damaged the left caudal lung lobe and caused a fracture of the eighth rib. The lung lobe would need to be removed.

“Because the end of the rod was blunt, it didn’t cause any other injuries. If it had been sharp, it would have been a very different situation,” said Meyers.

“Belle was very lucky,” Wormser added. “It could have been much worse.”

While the lung lobectomy was performed without complication, removing the rod was tricky. With Belle on her back for surgery, the rod pointed downward, under the surgical drapes. Wormser and Meyers enlisted Dr. Owen Fink, Surgery Resident, to pull the rod out, from under the drapes, while they watched from above. As the rod exited the chest cavity, they made sure that nothing started to bleed. In addition, they carefully evaluated the lungs and other vital structures to ensure no damage had been done. 

The team debrided and cleaned the entry wound and placed a suction drain. Belle also received a chest tube prior to closure. After recovering from general anesthesia, she recovered in the ICU.

INTENSIVE CARE

Ryan Hospital’s Intensive Care Unit is staffed 24 hours a day, 365 days a year, by a team of board-certified faculty and specialty-trained technicians. While Belle was in surgery, the ICU team prepared for her arrival.

“With Belle, we were concerned about what organs the rod might have injured inside the chest,” said Dr. Lori Waddell, Clinical Professor of Critical Care Medicine. “Once the surgeons saw that only a lung lobe was injured, we were relieved.”

Primary post-operative concerns were infection and pain management. Because of the large incision required for entry into the chest cavity, Belle would require a good analgesic plan to alleviate pain.

Belle made a quick recovery. She remained comfortable and ate well during her time in intensive care. Her suction drain and chest tube were removed after two days, and she was transitioned to oral medication the following day without complication.

“This was a pretty unique case. We don't see penetrating thoracic trauma like this very often,” said Waddell. “Belle was a fantastic patient, and I think the fact that she was a young, otherwise healthy dog was in her favor.”

“Belle is recovering nicely,” said Meyers. “When she left Ryan Hospital, she was bright and alert. I think, all things considered, she was very lucky.”

R&R AT HOME

Belle did well recuperating at home, though it was a challenge for the Broomes to restrict the energetic dog’s activity. An incision as large as Belle’s requires six to eight weeks of rest to allow for adequate healing and to prevent any complications.

“It was tough to keep her calm,” said Bob. “She wanted to run and play like nothing happened. But she’s fine now. She didn’t lick her incision area or chew her stitches. She never even tried.”

Belle at home, recovered from her terrible accident.Belle recovered so well that she was able to join the family on a well-deserved camping trip during the Fourth of July weekend.

“I’m thankful that there’s a place like Penn Vet to help your pets,” said Lori. “Belle is our family. We love her and we couldn’t think of doing anything but helping her get through this.”