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When I saw Michelle Prager and “Bob”
listed in the appointment book, I assumed that Bob was having another
flare-up of the Bartonella infection involving his eye. Regular
readers of Catnip will remember Bob the Manx from
the article “Spotlight on Bartonella” from the May 2007 issue of
Catnip. Bob’s eye, however, was fine.
“He’s been vomiting”, said Ms. Prager,
“and his appetite is off, and I caught him eating my hair bands again.”
Bob, it seems, has a well-known penchant for hair bands. No, not the
heavy metal musicians from the 80’s, but rather, the thin elastic
rubber-band type that Ms. Prager uses to keep her hair pulled back.
“He’s eaten them before”, she informed me, “and he usually either vomits
it back up, or passes them in the litter box, and then he’s fine.” This
time was different. Bob was clearly not feeling well. I warmed up the
x-ray processor, and prepared Bob for an abdominal x-ray.
Intestinal foreign bodies are a common
cause of intestinal obstruction in dogs and cats. “Linear” foreign
bodies – thread, string, ribbon, cord, rubber bands, etc. – are
particularly common in cats. These can cause serious and extensive
damage to the intestinal tract. In one study, 90.6% of feline linear
foreign bodies were thread, and 9.4% were thread with the sewing needle.
The most common linear foreign bodies reported in cats are string,
carpet, and plastic.
The reason why linear foreign bodies
can cause so much damage is the way they create an intestinal
obstruction. Usually, one end of the string becomes anchored, either by
wrapping around the base of the tongue, or by getting lodged in the
pylorus (the part of the stomach that leads to the small intestine). The
peristaltic waves generated by the intestines try to propel the free end
of the string along the intestinal tract. But the leading end is
lodged, so the string can’t be pulled along. Instead, the intestines
“climb” up the string, causing the intestines to become pleated. This
pleating or “accordion” pattern, if identified on an x-ray is an almost
sure indication of a linear foreign body.
Bob’s x-rays were unambiguous. Not
only could I see a stomach full of hair bands, I could also discern that
a few of them had passed into the small intestine. Further scrutiny of
the x-ray revealed the classic pleating pattern.
Cats with linear foreign bodies tend to
be fairly young; the average age is 2.7 years. (Bob must be reading the
text book, because that’s exactly how old he is.) Vomiting and poor
appetite are the most common clinical signs. Cats often continue to
drink small amounts of water. On physical examination, cats are often
depressed, dehydrated, and may show signs of abdominal pain. A thorough
oral examination is critical, to identify a string that may be looped
around the base of the tongue. Sometimes a string will be seen
protruding from the mouth, or protruding from the anus.
Armed with our certain diagnosis, Bob was taken to surgery. I
could feel a firm clump of material lodged in the very end portion of
the stomach. Right beyond that was the classic finding: the
pleated intestines.
When a linear foreign body is lodged in
the pylorus, as in Bob’s case, a gastrotomy (cutting into the stomach)
is necessary to release it. When I performed the gastrotomy, I
encountered a clump of thin black rubber hair bands, most of which were
removed easily. One portion of the clump however, extended
beyond the stomach and into the small intestine. Gentle traction failed
to dislodge it. When that happens, it is imperative that the surgeon
cut the string and make a new incision further down the intestinal
tract. Pulling on the string can cause it to saw through the intestinal
wall, resulting in multiple perforations. Leakage of intestinal
contents through these perforations can result in peritonitis and death.
The next incision was in the pleated
part of the intestine. There I encountered the remaining hair bands. I pulled the leading end of the hair band out of the
incision, and then the trailing end. It came out easily, and the
intestines quickly unraveled and assumed their normal configuration. I
closed the intestinal incision, and then closed up the abdominal wall
and the skin.
While Bob was recovering from his surgery, I untangled the foul-smelling
clump of material I had just removed from Bob’s gastrointestinal tract.
The final tally: 19 hair bands!
Bob recovered uneventfully from his
surgery. In general, the prognosis is better for cats (16% mortality)
compared to dogs (22%) after surgical removal of linear foreign bodies.
Ten days after his surgery, I removed Bob’s stitches. His appetite had
returned quickly after surgery, and he was acting like his old self.
Updated 7/8/10 |
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