New technique for incision site selection in laparoscopic-assisted minilaparotomy for canine fistula

Abstract

A 4-year-old neutered male Shar-Pei, weighing 20 kg, presented with a subcutaneous chest wall mass in the right thorax. The mass measured 12×7 cm with a soft texture and rounded contour. Fineneedle aspiration (FNA), radiography, and computed tomography (CT) revealed a foreign body, suspected to be a wooden skewer, compressing the area between the ribs and diaphragm and extending its impact to the abdominal cavity, thoracic cavity, and subcutaneous tissues. The patient’s primary symptom, the right thoracic mass, was identified as a granulomatous abscess caused by a gastrosubcutaneous fistula resulting from the migration of the foreign body. A surgical plan was established for the exploratory laparotomy and foreign body removal. The mobile end of the foreign body was drawn towards the abdominal wall, and a port was placed at the location where it contacted the abdominal wall. Exploratory laparoscopy was then performed, during which the stomach was exteriorized using laparoscopic assistance, followed by the removal of the foreign body. The foreign body removed was confirmed to be a 145 mm long wooden skewer. The patient was discharged in healthy condition after 4 days of hospitalization. This report presents a case of a gastrosubcutaneous fistula caused by the migration of a wooden skewer-shaped foreign body that was successfully treated using a novel surgical approach involving exploratory laparoscopy and minimally invasive foreign body removal.