Table 1.

Summary of case signalment, clinical presentation, diagnostic procedures, surgical treatment and findings and follow‐up in 11 cases treated for intrathoracic wooden skewers penetrating from the abdominal cavity

Case	Breed	Age	Neuter status	Bodyweight (kg)	Clinical presentation	Laboratory findings	Diagnostic imaging	Surgical approach	Surgical findings – summary	Surgical treatment – summary	Drain placement	Follow‐up
1	Cocker spaniel	4 years	ME	13.0	14‐day history of lethargy, hyporexia, vomiting; 6‐day history of right thoracic limb lameness and pyrexia	Left‐shift neutrophilia, thrombocytopenia, ↑ALKP, ↓Mg, ↓TS, ↑CRP, 4Dx (−)	APOCUS, TPOCUS, CT	Coeliotomy+diaphragmotomy	Wooden skewer in stomach, passing through pylorus, penetrating through anti‐mesenteric surface of duodenum, penetrating through right lateral liver lobe peripherally and dorsally through diaphragm into right caudal lung lobe	Coeliotomy performed and skewer extracted from duodenal lumen via duodenal fistula site; fistula tract subsequently excised. Circumferential diaphragmotomy with excision of fistula and adhesions. Right lateral liver partial hepatectomy. Right caudal lung lobectomy	Bilateral thoracic drains	Survive to discharge, lost follow‐up after
2	Dobermann	8 years	ME	49.3	3‐day history of lethargy, anorexia, reluctance to lay down, kyphosis, generalised ataxia	Lymphopenia, neutrophilia, thrombocytopenia, ↑ALKP, ↑Gly	Thoracic radiographs, MRI, CT	Coeliotomy+diaphragmatomy+median sternotomy	Wooden skewer penetrating from stomach, through left medial liver lobe, diaphragm and pericardium. End of skewer located at level of left atrium	Coeliotomy and identification of migrating skewer, which was broken midway to facilitate safe extraction. Sternotomy and diaphragotomy. Accessory lung lobectomy performed due to profuse haemorrhage. Pericardotomy and half of skewer extraction from pericardium. Gastrotomy and remaining skewer extracted	Unilateral thoracic drain	Survive to discharge, lost follow‐up after
3	Labrador retriever	2 years	MN	32.2	14‐day history of malaise and intermittent vomiting; 24‐hour history of panting and vocalisation	Neutrophilia, normocytic hypochromic anaemia, ↓Alb	Thoracic radiographs, thoracic US, CT	Coeliotomy+diaphragmotomy	Wooden skewer penetrating from gastric lesser curvature through diaphragm into thoracic cavity. Severe pleuritis	Coeliotomy and partial gastrectomy to retrieve the skewer and resect gastric fistula and fibrous tract to the liver. Diaphragmotomy to resect remainder of fibrous tract	Jackson–Pratt abdominal drain	Alive
4	Cocker spaniel	7 years	FN	12.4	70‐day history of malaise, lethargy; 3‐day history of regurgitation, praying stance, grunting/vocalisation when laying down	Monocytosis, ↑ALKP,↓Alb	Echocardiography, CT	Coeliotomy+diaphragmotomy	Wooden skewer penetrating from the stomach, through the hilus of the spleen and through the dorsal right diaphragm	Coeliotomy and partial gastrectomy to retrieve the skewer and resect gastric fistula. Diaphragmotomy to resect remainder of fibrous tract. Splenectomy performed due to significant scar tissue around the splenic hilus	Unilateral thoracic drain	Alive
5	Labrador retriever	6 years	MN	35.0	112‐day history of right thoracic limb lameness, marked pain on full extension of the right elbow and on palpation of the medial humerus	Neutrophilia, normocytic hypochromic anaemia, thrombocytopenia	MRI, CT	Median sternotomy	Fibrous tract from dorsal right diaphragm consisting with gastric migration. Wooden skewer lodged within the right cranial, middle and caudal lung lobes	Median sternotomy and right cranial, middle and caudal lung lobectomies. Removal of skewer and debridement of fistulous tract to the diaphragm	Unilateral thoracic drain	Euthanased
6	English springer spaniel	6 years	MN	23.0	9‐day history of vomiting, hyporexia, pyrexia and tachypnoea	Neutrophilia, monocytosis, ↑ALKP, ↑Chol	Thoracic US	Coeliotomy+diaphragmotomy	Wooden skewer in gastric fundus and pylorus, penetrating through greater curvature of pyloric antrum and into the right hemithorax. Septic peritonitis evident	Coeliotomy and partial gastrectomy to retrieve the skewer and resect gastric fistula. Diaphragmotomy to resect remainder of fibrous tract	Unilateral thoracic drain. Jackson–Pratt abdominal drain	Alive
7	Crossbreed	2 years	MN	9.6	14‐day history of cranial abdominal pain, vomiting	Neutrophilia, normocytic hypochromic anaemia	Echocardiography, CT	Coeliotomy+median sternotomy	Wooden skewer penetrating from stomach, through diaphragm and into pericardium. End of skewer located at the level of the left ventricle	Coeliotomy and partial gastrectomy to retrieve the skewer and resect gastric fistula. Median sternotomy and subtotal pericardectomy for retrieval of wooden skewer	Unilateral thoracic drain	Alive
8	Pug	9 months	MN	10.4	5‐day history of reluctance to sit down and hyporexia	Neutrophilia, ↑ALKP, ↑AMYL	CT, oesophagoscopy	Coeliotomy+diaphragmotomy	Wooden skewer in stomach penetrating from cranioventral aspect of the fundus, through dorsal left aspect of the crus of the diaphragm into the pleural space, exiting in the 12th intercostal space	Coeliotomy and partial gastrectomy to retrieve the skewer and resect gastric fistula. Diaphragmotomy to resect remainder of fibrous tract	Unilateral thoracic drain	Survive to discharge, lost follow‐up after
9	Labrador retriever	10 years	FN	25.4	7‐day history of vomiting, cranial abdominal pain, pyrexia, tachypnoea	NA	Thoracic radiographs, echocardiography, CT	Coeliotomy+median sternotomy+diaphragmotomy	Primary care surgical findings: wooden skewer identified in stomach fundus. Gastrotomy revealed wooden skewer perforating through diaphragm craniodorsally Referral surgical findings: abscessation of the previous penetrating tract in the left dorsal paraspinal musculature of the thorax	Surgery performed by referring vet: coeliotomy and partial gastrectomy to retrieve the skewer and resect gastric fistula. Diaphragmotomy to resect remainder of fibrous tract Revision surgery by specialist surgeon: median sternotomy and caudal thoracic dorsal paraspinal abscess and penetrating tract debrided	Ventral thoracic drain	5 years follow‐up; euthanased for reasons unrelated to this study
10	English springer spaniel	1 year	MN	10.0	14‐day history of lethargy and vomiting 2‐day history of draining sinus tract over the left parasternal region	NA	Thoracic radiographs, thoracic US, MRI	Coeliotomy+diaphragmatomy+median sternotomy+sinus tract excision	Wooden skewer in fundus of stomach penetrating from lesser curvature into the left hemi‐diaphragm, the ventrocaudal pericardium and exiting at the level of the fourth sternebra. Extensive adhesions between the gastric lesser curvature, the left medial hepatic lobe and left hemi‐diaphragm present	Coeliotomy and partial gastrectomy to retrieve the skewer and resect gastric fistula. Diaphragmotomy to resect remainder of fibrous tract. Median sternotomy and subtotal pericardectomy for retrieval of wooden skewer. Parasternal sinus tract debrided	Unilateral thoracic drain	Alive
11	Crossbreed	4 years	MN	17.5	21‐day history of lethargy, pyrexia and swelling over the left thoracic wall	Neutrophilia	CT	Coeliotomy+diaphragmotomy+sinus tract excision	Wooden skewer identified in stomach lumen, perforating through the lesser omentum, the left diaphragm, left caudal lung lobe and subcutaneous tissues of the 11th intercostal space	Coeliotomy and partial gastrectomy to retrieve the skewer and resect gastric fistula. Left 11th intercostal space swelling and sinus tract debrided	None	Alive

ME Male entire, ALKP Alkaline phosphatase, Mg Magnesium, TS Total solids, CRP Canine reactive protein, APOCUS Abdominal point of care ultrasound, TPOCUS Thoracic point of care ultrasound, Gly Glycaemia, MN Male neutered, Alb Albumin, US Ultrasound, FN Female neutered, Chol Cholesterol, AMYL Amylase, NA Not available.

All CTs and MRIs assessed both thorax and abdomen.