Signalment & History
A 10 month old FS Domestic Medium Haired Cat presents with a 72 hours history of vomiting and inappetence with recent onset of diarrhea. On physical examination, she is bright, alert and responsive. Her heart and respiration rates are slightly elevated (260 bpm and 60 bpm, respectively) and her temperature is 104.2 F. When palpated, her abdomen felt soft and pliable and didn’t elicit pain.
Findings
There is a moderate amount of gas within the stomach. Particularly, a moderately gas-distended pylorus is noted in all the radiographic projections. The small bowel loops contain a moderate amount of gas as well and appear plicated. However, the small intestinal segments measure within normal limit for diameter (<12mm mucosa to mucosa of gas-filled loops and ≤2 times the diameter to L2 cranial vertebral end plate height ratio*). The abdominal serosal detail is within normal limits with no evidence of free peritoneal gas. The remainder of the study is within normal limits.
Diagnosis
You found moderately gas-filled stomach and small intestines. Particularly, a moderately gas-distended pylorus is noted in all the radiographic projections. In addition you noted that several small intestinal segments make abrupt turns, causing a bunched positioning of the small bowel in the ventral mid-abdomen, suggesting plication. Plicated small intestinal loops are highly suggestive of linear foreign body. The patient underwent exploratory laparotomy that revealed a string-like foreign body firmly anchored near the pylorus. Plication was noted along the full length of the jejunum. Approximately 20 cm of the jejunum was resected and the opposite ends anastomosed together due to decreased vascular pulses at palpation and presence of black and bruised appearance of the mid-jejunum during surgical inspection. No free fluid was observed in the abdominal cavity nor other abnormalities during the procedure. This patient recovered successfully from surgery.
Conclusions
Feline patients with gastrointestinal foreign bodies may present with a wide range of clinical signs: vomiting, diarrhea, regurgitation, ptyalism, inappetence, anorexia, depression, dehydration, abdominal pain and/or distention, palpable firm segments of the intestines, palpable intestinal dilation, etc. Linear foreign body obstruction is a particular form of intestinal obstruction seen commonly in cats. The most common causes are sewing threads alone or in combination with sewing needles and also strings, threads, nylon stockings or carpet fibers. The linear object becomes fixed around the base of the tongue or the pylorus and as the intestinal peristaltic wave attempt to move the object aborally, the intestine gradually gathers up in a pleated fashion on the foreign object that soon can become embedded in the mesenteric border of the small intestine and can erode through the intestinal wall, leading to local or generalized peritonitis due to leakage of intestinal contents.
In case of linear foreign body obstruction, intestinal loops may not become severely distended, since the obstruction is not complete, but gas commonly becomes trapped in pockets formed by the pleats. As a result the small intestine present a pattern of round, tapered, short tubular and sometimes crescent or comma shaped gas bubbles on survey radiographs. In the cat, the plication of the bowel can can cause a clumped or bunched positioning of the small intestine. The displacement of the small bowel in the middle or right side of the abdomen typically seen on radiographs in obese cats should not misinterpreted as linear foreign body!!! In the normal fasted cat, gas is rarely present in the small intestine. Animals non fasted with no GI disease or animals stressed by handling or dyspneic animals may have a more air-containing small bowel. However, most patients maintain a small intestinal linear pattern with gas in a continuous column except where interrupted by a peristaltic wave.
Gastrointestinal foreign bodies are commonly encountered in small animal practice and may present with a wide range of clinical signs depending on the location, the degree and the duration of the obstruction. In dogs linear foreign bodies are most commonly anchored at the level of the pylorus with the foreign material extending into the proximal jejunum. In cats linear foreign bodies are more frequent than in the canine population and the majority of them are found anchored around the base of the tongue. A longer duration of clinical signs, the presence of linear foreign body and multiple intestinal procedure have been associated with significantly increased mortality. Prompt presentation, diagnosis and surgical intervention showed to improve the outcome of gastrointestinal obstruction by foreign bodies.
References
Gastrointestinal foreign bodies in dogs and cats: a retrospective study of 208 cases. Hayes G. Journal of Small Animal Practice. 2009 50, 576-583.
