When Peggy, a pot-bellied pig, arrived at the Texas A&M Large Animal Hospital (LAH) showing signs of a gastrointestinal obstruction, her veterinarians employed a rare combination of equine and human surgical techniques to save her life.
The 9-month-old pig began showing signs of an obstruction, including lethargy and lack of appetite, in March 2020, leading her owner, Dan Deweese, to seek help from his local veterinarian at Alvarado Veterinary Clinic.
After they had no luck clearing the obstruction with IV fluids and medical management, Peggy was referred to the LAH.
When Peggy arrived, her veterinarians immediately began preparing a surgical plan.
“GI obstructions and obstipation (severe or complete constipation) are pretty common in pot-bellied pigs, just because their diets tend to not always be very consistent,” said clinical associate professor Dr. Jennifer Schleining, the lead veterinarian on Peggy’s case.
Joined by surgery resident Dr. Alyssa Doering and internal medicine resident Dr. Kari Bevevino, Schleining was ready to perform surgery the same day Peggy arrived, if deemed necessary. After viewing radiographs and Peggy’s diagnostic workup, they decided to proceed with an abdominal exploratory procedure.
Once the surgery began, however, they discovered that the obstruction was not caused by feed material or a foreign object inside the gastrointestinal tract, but rather by the intestine itself, a much less common occurrence.
“Her obstruction was caused by a kink in the small intestine that had been there for quite some time,” Schleining said. “It almost created a little ‘S’ from a couple of switchbacks in the intestine, so nothing could get through.”
This kink was held in place by small bands of tissue called adhesions that can make abdominal organs stick together, though the cause of Peggy’s adhesions is unknown.
Once the kink was relieved, the veterinarians faced their next challenge.
Because the obstruction had been present for a while, the circumference of the upper end of Peggy’s intestine was much larger than that of the lower end. Knowing that they would be unable to join these ends together directly using a normal approach, the surgeons employed a less common surgical technique sometimes used in horses and companion animals known as side-to-side anastomosis.
This technique involves overlapping the segments of intestine before creating a new hole to connect them. To do this, they chose to use a piece of human surgical equipment rarely used in large animal medicine.
“Because she’s a smaller pig, we were able to use a special stapling device called an ILA stapler to complete the anastomosis,” Schleining said. “It cuts down on the operative time considerably because we don’t have to hand sew everything.”
Since this equipment is designed for human bodies, it is only useful in veterinary medicine for animals with anatomy similar to a human’s. Luckily, Peggy’s intestines were the perfect size.
“It’s really fun to be able to get that instrument out and use it when we have a patient that’s the right case,” Schleining said. “We only get to use it maybe once or twice a year.”
Both the procedure and the equipment used made Peggy’s case a unique one for the LAH and a great educational opportunity for the residents involved, Schleining said. While veterinary students were not in the LAH at the time because of COVID-19-related restrictions, Schleining took extra measures to preserve the educational qualities of this case for them.
“Knowing that the students couldn’t be there with us, we were very intentional about taking pictures of the procedure throughout and then creating a little case vignette,” she said. “It’s important to show them the steps in a real-life situation based on what they had practiced with their models during the course of the semester.
“The upside to having Peggy come in and the uniqueness of her case is that she’s provided educational material that’s very relevant to the things that the students are learning in surgery classes,” Schleining said. “Even though the students weren’t able to participate, Peggy still contributes to learning opportunities by being here.”
After surgery, Peggy surprised her veterinarians by bouncing back extremely quickly, going straight back to her food with none of the complications that can show up after abdominal surgery. To be safe, she was kept in the LAH’s intensive care unit for a week, allowing her caretakers to get to know her adorable and unmatched personality.
“Pigs are funny creatures and their personalities are really what I love most about them,” Schleining said. “You’ve got some that are just like little grumpy old leprechauns that say, ‘Leave me alone,’ and others that are super friendly and talk to you when you come in the barn and demand attention; they can be little prima donnas.
“Peggy was definitely a prima donna, always wanting attention,” Schleining said. “She loved if you scratched her back and ears with a plastic fork—she would lay there and roll on her back so you could get her belly too. She was a hoot!”
Though sad to say goodbye to their new piggy friend, Peggy’s veterinarians were glad when she could finally go home with Deweese on April 9, 2020.
“(Peggy was able to leave so quickly because) we have a really dedicated owner who is committed to her care and knows that diet is important,” Schleining said. “I think her future looks really bright, largely because of her owner.”
Note: This story originally appeared in the Spring 2021 edition of CVMBS Today.
Contact Information: Jennifer Gauntt, Director of CVMBS Communications, Texas A&M College of Veterinary Medicine & Biomedical Sciences; firstname.lastname@example.org; 979-862-4216