Case Report: Fragment Foreign Body in the Neck

Willow came to our practice as if nothing was wrong.  She was a playful and happy patient.  Who would have thought there was such a big problem lurking under the surface?

History and Exam

Willow, a three and a half year old, spayed, female Border Collie, presented to the Surgical Division of the Veterinary Referral Center with a history of “jamming’’ a part of a limb in her mouth three weeks prior.  At the time of the impalement, it was hoped that all of the stick had been swallowed and digested, but shortly thereafter a large swelling developed in the left side of the neck that did not resolve with antibiotics and some attempts to drain the area.  On physical exam, Willow was bright and alert with all normal parameters on her pre-op bloodwork.  The left cranial side of the neck had a baseball swelling that was reddened and warm to the tough with some discomfort.  A tentative diagnosis of foreign body reaction was made and surgical exploration of the area recommended.

Surgery

General anesthesia was induced using a combination of narcotics and propofol with intubation onto isoflurane gas anesthesia for maintenance.  Cervical radiographs showed no visible evidence of a foreign object and surgical exploration was pursued.  At surgery, a large abscess, fluid-filled pocket was entered and explored.  To our surprise a five-inch long by one-inch in diameter piece of wood was isolated and dissected out of the deep pocket (see the attached intraoperative photo).  Further exploration did not reveal any additional foreign material.  The area was flushed with dilute betadine solution and drains were placed to help drain the pocketed area.  Recovery from anesthesia was uneventful.  Willow was back to herself in no time and was discharged two days postoperatively.  Willow was completely recovered and excellent wound healing had occurred by her two-week suture removal follow-up appointment.  On phone follow-up at six weeks postop, Willow was completely healed and appeared to be normal in all aspects.

NOTE: Imbedded foreign objects have a tendency to leave behind residual material such as bark in this case and the owners were wise to be watchful for any recurrence of swelling or infection.  This can occur as late as six months following the incident.

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