BBBD (Bit By Big Dog) / Flail Chest

The office was closed for a staff meeting. We were stuffing pizza in our mouths and watching a power point presentation when the doorbell buzzer screeched over our heads. Everyone jumped. We need to get that thing adjusted to a gentle chime before one of us has a heart attack. Someone went to investigate, then signaled a nurse for triage and suddenly there was an urgent request for a veterinarian. Since I was neither presenting the power point speech nor suctioning the throat of a vomiting dog I was the obvious choice. I moved.


My patient was a tiny golden Chihuahua barely making weight at 5 pounds. He probably shouldn’t have mouthed off to the pit bull, but boys will be boys. He’d been BBBD (Bit By Big Dog). I examined him on the floor. This proved to be a good choice, because he promptly stood up on all 4 legs and ran away, screaming. One, he didn’t jump off the exam table and two, his legs weren’t broken. Good, we were already getting somewhere. His name was “Peru”.


His owner agreed to our basic plan : Anesthetize little Peru. This would allow us to fully assess his injuries. We could clean up his wounds, take x-rays, start IV fluids and antibiotics all without causing further discomfort. Given his continued shrieks if we even looked at him we all felt relief at this plan. His owner left and we set up for him as the meeting finished.


Initial assessment was ugly. Peru had multiple punctures over his shoulders and left flank. Two ribs were broken on his left side, one of them flopping about, unhinged. It was unnerving. We taped it loosely in place. Miraculously, although the x-rays showed some lung contusions (light bleeding into the lungs), there did not appear to be major tears into the chest cavity. Peru was such a tiny dog and so thinned skinned that you could see the purple bruises along his side where his tissue had been crushed. There was an odd lump on his belly, just behind his belly button. The skin over it was perfectly intact. I gently pressed the bump, and felt my finger slide into a hole, a hernia created when teeth ripped his belly muscles apart!  I rechecked the x-rays, looking especially hard at the edges of the rib cage where the diaphragm joins the body wall.  The diaphragm is the thin sheet of muscle that separates the chest cavity from the abdomen. The movement of the diaphragm helps to inflate the lungs. If there was a tear through the diaphragm and I opened up the belly, the lungs wouldn’t be able to expand properly and Peru wouldn’t be able to breathe on his own. He would die unless we provided assisted breathing (ventilation) for him. I couldn’t be completely certain from the x-ray.


We prepared to breathe for Peru and took him to surgery. Less than 30 minutes had passed since he entered. I carefully opened the skin over the abdomen, exposing the jagged hole punctured through his belly wall, and listened for the tell-tale sucking noise of a damaged diaphragm. For a long moment no one else in the room was breathing except Peru, and he was doing just fine. His oxygen saturation (SpO2) stayed at 99%. I cautiously explored his insides. More miracles : the diaphragm, liver and spleen were all intact. He had two jagged tears through the abdominal wall (outer skin intact!) and I connected them up and tidied the edges. This would both remove tissue directly crushed and possibly infected by teeth. Healthy tissue heals better. I “ran” the intestine through my fingers and discovered a 1 cm section of small bowel that had been pierced on each side by teeth. We tested with sterile saline and it spurted out like a geyser! Well, that wouldn’t do. Rather than resection I chose to repair the damaged bowel and sutured it.  We injected more sterile saline to test it twice – water tight. We cleaned and sutured all his other wounds and placed a protective chest wrap to support those ribs. When little Peru awakened he was happily groggy on pain medication and we all breathed easier.


By Day 2 Peru tried to jump into his owner’s arms when she came to visit. His recovery has been slow but steady, especially since I figured out that the first antibiotic made him vomit. He’ll wear his supportive chest wrap for several weeks while the ribs heal but the bruises are fading and soon enough he will be golden tan again rather than purple. But he’s still feisty around big dogs!


Christine B. McFadden, DVM




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