At our specialty hospitals, collaboration is more than just a concept—it’s how we save lives. Bruno, a 4-year-old Labrador mix, is a perfect example of what can happen when our emergency, internal medicine, surgery, and anesthesia teams work seamlessly together. His journey through a life-threatening Addisonian crisis and gastrointestinal obstruction highlights the power of integrated veterinary care.

A Complicated History

Bruno was already a known patient of our Internal Medicine team, under the care of Dr. Alex Portanova, DVM, DACVIM (SAIM), for a chronic condition called Addison’s disease. Addison’s, or hypoadrenocorticism, requires lifelong management with steroid and mineralocorticoid supplementation. In January 2024, Bruno experienced an Addisonian crisis with gastrointestinal symptoms, requiring hospitalization and stabilization.

He responded well to initial therapy and was discharged on daily Prednisone and monthly Percorten injections to maintain his adrenal hormone balance. Bruno’s parents were educated on monitoring for signs of crisis and instructed to follow up regularly for bloodwork and dose adjustments. All seemed well—until April 2025.

A Sudden Decline

Bruno returned to our Emergency Service, this time under the care of Dr. Brittany McBrain and Dr. Mellissa Allen, after vomiting more than seven times in 20 hours. His vomit had progressed to yellow, watery bile, and he had recently ingested asparagus, mushrooms, and potentially lawn clippings—any of which could trigger GI upset or worse.

Initial diagnostics showed stable electrolytes and no immediate signs of an Addisonian crisis. Further diagnostics and tests were offered, but his owners elected to attempt outpatient therapy. However, after vomiting again in our parking lot, they pursued abdominal radiographs, which revealed suspicious foreign material. An abdominal ultrasound performed by Dr. Portanova confirmed the presence of obstructive gastrointestinal foreign bodies—one with a linear component, raising the alarm for possible intestinal plication.

From Diagnosis to Surgery

Given the severity of the findings, Bruno was swiftly transferred to our surgery team. Under the guidance of Dr. David Allen, a board-certified surgeon, along with surgery residents Dr. Connor Pyne and Dr. Annie Marquiss, an exploratory laparotomy was performed.

The surgical team found foreign material—including fabric and rubber bands—lodged in his pylorus and extending into the jejunum. The material had caused intestinal plication and bruising in the duodenal flexure. Through a meticulous gastrotomy and enterotomy, the foreign bodies were removed. A gastropexy was also performed to help prevent future gastric torsion.

Expert Anesthesia & Critical Monitoring

Bruno’s case required customized anesthetic planning and critical monitoring due to his Addison’s diagnosis. Dr. Charlotte Marquis, our board-certified anesthesiologist, ensured Bruno’s procedure and recovery were managed safely, adjusting medications to support his adrenal needs during the stress of surgery.

The morning after surgery, Bruno suffered an Addisonian crisis. In the ICU, emergency veterinarian Dr. Jake Kilgore noted signs of poor perfusion and hypotension. Rapid response measures included fluid boluses, vasopressor support with norepinephrine, and administration of fresh frozen plasma—critical interventions that stabilized Bruno’s condition and prevented further deterioration. Within a few hours, Bruno improved and was discharged the next day.

A Testament to Teamwork

Bruno’s recovery was made possible because of our departments' close communication and collaboration. From the emergency team that triaged and stabilized him to internal medicine’s in-depth diagnostics and history management to the surgical expertise and anesthetic support that safely removed his life-threatening obstruction and avoided a more severe Addisonian crisis, Bruno received compassionate, expert care throughout his entire journey.

Overland Park Veterinary Emergency & Specialty is proud to offer this level of integrated, specialty-driven medicine under one roof. Bruno is now back home with his loving family and recovering well, and we look forward to continuing his care as part of our Internal Medicine service.

Whether it’s a crisis or a complex surgical case, our patients benefit from the strength of our team, which works together each step of the way.