Feline gastrointestinal foreign bodies

Surgical Anatomy of the Gastrointestinal Tract in Cats

In cats, the gastrointestinal tract is one of the regions in which surgical procedures are most frequently performed by veterinary surgeons; therefore, knowledge of the surgical anatomy of the feline gastrointestinal tract is of high importance. The main surgical procedures performed include gastrotomy, gastrectomy, enterotomy, and enterectomy, as well as procedures in the liver and pancreas. There are also anatomical differences between dogs and cats, increasing the need for deep knowledge of the anatomy treated in the different surgical approaches. The aim of the present review is to describe in detail the anatomy of the gastrointestinal tract in cats highlighting the anatomical regions of significant importance in different surgical procedures.

Retrospective evaluation of surgical treatment of linear and discrete gastrointestinal foreign bodies in cats: 2009-2021

OBJECTIVES

Gastrointestinal foreign bodies (FBs) are an important cause of emergency surgical intervention in cats, but little information exists in the literature evaluating the risks and outcomes in this species. The study purpose was to describe cases of feline FBs and compare perioperative factors and outcomes between linear foreign body (LFB) and discrete foreign body (DFB) surgery in cats.

METHODS

The medical records from the University of Georgia Veterinary Teaching Hospital were searched for cats that had undergone surgery for FB removal between August 2009 and August 2021. Perioperative data were collected and described. Data were compared between cats with an LFB and cats with a DFB. A binomial probability series was used to estimate the likelihood of postoperative septic peritonitis or mortality in an additional cat in the series.

RESULTS

A total of 56 cats were included in this study; 38 cats had a DFB and 18 had an LFB. No cats developed postoperative septic peritonitis, and all cats survived. The likelihood of postoperative septic peritonitis or mortality in an additional cat was estimated to be <5.2%. Cats with an LFB were found to have a significantly higher body condition score (P = 0.047), albumin (P = 0.025), American Society of Anesthesiologists status (P = 0.027), surgery length (P <0.001) and total cost of visit (P = 0.006) when compared with cats with a DFB. Cats with LFBs were more likely to develop a surgical site infection (SSI; P = 0.007) and be administered postoperative antibiotics (P = 0.017).

CONCLUSIONS AND RELEVANCE

Cats undergoing surgery for gastrointestinal FBs had a low incidence of postoperative complications. Cats with LFBs had longer surgeries and were more likely to develop postoperative SSIs.

The distribution of the jejunal arteries in the cat

The arterial supply of the cat jejunum was studied by gross dissection and polyurethane corrosion cast. The results showed that the jejunal arteries, which originate from the cranial mesenteric artery, varied from 5 to 15 in number. Their number was independent of the length of the cranial mesenteric artery as well as of the length of the jejunum. These arteries divided into branches giving rise to a series of orders of division from a minimum of 1 to a maximum of 7. The last orders of division terminated in a series of anastomosing arcades which resulted in a marginal artery coursing only a few millimeters from the mesenteric margin of the jejunum. This artery gave rise to straight arteries (vasa recta), whose mean number was 450 ± 60. According to their length, the vasa recta can be differentiated into short (vasa brevia) and long (vasa longa) branches. The vasa brevia ended branching into the mesenteric side of the jejunum whereas the vasa longa coursed beneath the serosa on the lateral jejunal surfaces, and reached the antimesenteric border. During their course, the vasa recta ramified and anastomosed with each other. Numerous antimesenteric anastomoses between opposing vasa longa were also observed. Based on the literature consulted, due to the large number of vasa recta (approximately one vessel per 2.9 mm of jejunal length) and the rich anastomotic network, the cat jejunum might have a better intramural distribution of blood flow and would seem less predisposed to ischemic phenomena than that of other mammals.

The effects of diets varying in fibre sources on nutrient utilization, stool quality and hairball management in cats

Pet food companies use fibrous ingredients in cat foods to aid weight and hairball management. Miscanthus grass could be an alternative novel fibre source for cat foods. The objectives of this work were to determine the effects of Miscanthus grass as a fibre source on nutrient utilization, stool quality and hairball management in cats. Dry extruded cat foods (average chemical composition; digestibility trial: 94.54% dry matter-DM, 34.47% crude protein-CP, 11.67% crude fat, 7.06% ash and 13.04% total dietary fibre-TDF; and hairball trial: 94.88% DM, 34.60% CP, 11.30% crude fat, 7.02% ash and 9.77% TDF) were fed to 12 cats for a 9-day (digestibility trial) or 16-day (hairball trial) adaptation period followed by a 5-day total faecal collection period. Digestibility trial was performed as a replicated Latin square design, and the hairball trial was performed as a switchback design. In general, the cats fed the beet pulp diet (BPD) had higher DM, organic matter, gross energy and TDF digestibility than cats fed Miscanthus grass (MGD) or cellulose (CED) diet (p < .05). However, CP digestibility was lower for cats fed BPD (82.1 vs. 84.7 and 85.1%, respectively, for BPD, MGD and CED). These differences could be due to the differences in dietary fibre content and(or) composition. Faecal scores were lower for cats fed BPD (2.84) compared with MGD (3.32) and CED (3.21; p < .05). No effects due to fibre were reported on the faecal hairball variables, with the exception of less total hair weight and hair clumps per gram of dry faeces for cats fed Miscanthus grass (MGH) compared with control diet (COH; p < .05). In conclusion, Miscanthus grass could be used as an alternative ingredient to cellulose in cat diets.

Endoscopic retrieval of gastric and oesophageal foreign bodies in 52 cats

OBJECTIVES

To assess the outcomes and major complications in cats that require oesophageal and gastric endoscopic foreign body removal.

MATERIALS AND METHODS

The medical records of 52 cats with oesophageal and gastric foreign bodies that underwent endoscopic foreign body retrieval during a 13-year period (2006 to 2018) were retrospectively reviewed to characterise the clinical and radiographic signs, endoscopic findings, outcomes and major complications.

RESULTS

Endoscopic foreign body retrieval was successful in 49 of the 52 cats (94.2%). Radiographs confirmed the foreign material in 24 of the 50 cats (48%). Major complications occurred in eight of the 52 cats (15.4%) and included pleural effusion (n=2), aspiration pneumonia (n=2), unsuccessful removal of foreign material with endoscopy (n=3), oesophageal stricture formation (n=3) and cardiopulmonary arrest (n=1). Cats with oesophageal foreign bodies were more likely to experience major complications than those with gastric foreign bodies.

CLINICAL SIGNIFICANCE

Endoscopic foreign body removal in cats was associated with good overall outcomes and a low complication rate in this study sample. These results will help veterinarians better understand the outcomes of endoscopic foreign body removal in cats.

Feline abdominal ultrasonography: What's normal? What's abnormal? The diseased gastrointestinal tract

PRACTICAL RELEVANCE

Abdominal ultrasound plays a vital role in the diagnostic work-up of many cats presenting to general and specialist practitioners. B-mode ultrasonography is likely the most widely used modality for imaging the gastrointestinal (GI) tract in cats and it can help in the diagnosis of GI masses, foreign bodies and disorders of the ileocaecocolic junction.

CLINICAL CHALLENGES

Despite ultrasonography being a commonly used modality, many practitioners are not comfortable performing an ultrasound examination or interpreting the resulting images. Even differentiating between normal variations and pathological changes can be challenging for all but the most experienced. For example, while for inflammatory conditions of the feline GI tract changes are frequently identified on ultrasound, there may occasionally be no changes to the appearance of the intestine; hence a 'normal' ultrasound does not exclude the possibility of inflammatory disease.

AIM

This review, part of an occasional series on feline abdominal ultrasonography, describes the appearance of a range of conditions that affect the feline GI tract; the normal GI tract is addressed in an accompanying article in this issue of JFMS. Aimed at general practitioners who wish to improve their knowledge and confidence in feline abdominal ultrasound, this review is accompanied by high-resolution images and videos available online as supplementary material.

EQUIPMENT

Ultrasound facilities are readily available to most practitioners, although use of ultrasonography as a diagnostic tool is highly dependent on operator experience.

EVIDENCE BASE

Information provided in this article is drawn from the published literature and the author's own clinical experience.

Endoscopic and surgical removal of oesophageal and gastric fishhook foreign bodies in 33 animals

OBJECTIVES

To describe the location, retrieval, frequency of surgery and complications associated with fishhook foreign bodies.

MATERIALS AND METHODS

Retrospective evaluation of the medical records of cats and dogs admitted between 2010 and 2016 after fishhook ingestion.

RESULTS

A total of 33 cases (2 cats and 31 dogs) were included. The most common locations were the proximal oesophagus [12/33 (36%)] and stomach [11/33 (33%)]. Endoscopic retrieval was successful in 27 of 33 cases (82%); oesophageal perforation was the only recorded complication, occurring in six of 33 (18%) cases. Surgery was performed in six cases (18%), and no early complications were recorded. The survival rate was 100%.

CLINICAL SIGNIFICANCE

The endoscopic removal of ingested fishhooks is highly successful. In the present study, survival to discharge was 100%, even in cases of oesophageal perforation or in cases requiring surgery.

Chronic oesophageal foreign body in a cat

An 11-year-old cat was presented with an approximately 2-month history of dysphagia, intermittent regurgitation and weight loss. An oesophageal foreign body was identified on plain radiographs, and an oesophagotomy was performed to remove a large V-shaped bone from the caudal cervical oesophagus. A gastrostomy feeding tube was placed to allow nutritional support postoperatively. Medical treatment for oesophagitis was initiated after surgery. No complications were encountered and the cat was discharged 4 days after surgery.

Ultrasonography of small intestinal obstructions: a contemporary approach

OBJECTIVES

To assess the accuracy of intestinal ultrasound for diagnosis of intestinal obstruction in dogs and cats.

METHODS

A prospective clinical study was performed. Inclusion criteria were dogs and cats with clinical signs suggestive of gastrointestinal obstruction. Animals with no obstruction detected on ultrasound were excluded if they could not be monitored for 48 hours to confirm absence of obstruction. Sonographic diagnosis of small intestinal obstruction was based on identification of at least two findings suggestive of intestinal obstruction.

RESULTS

Ninety-two patients suspected of having intestinal obstruction were included. Correct diagnosis of intestinal obstruction was made in 21 cases (23%), and in 68 (74%) this diagnosis was excluded. Interpretation of the images on prospective analysis had sensitivity, positive predictive, specificity and negative predictive values of 100%, 87.5%, 95.8% and 100%, respectively.

CLINICAL SIGNIFICANCE

Ultrasonography is an excellent method for investigation of animals with gastrointestinal disorders, and is particularly useful for excluding obstructive processes.

Successful surgical management of a perforating oesophageal foreign body in a cat

CASE PRESENTATION AND SURGICAL INTERVENTION: a 3-year-old cat was presented with a recent history of dysphagia and intermittent regurgitation. Radiography revealed a bony oesophageal foreign body at the level of the thoracic inlet. Endoscopic retrieval was attempted but resulted in severe dyspnoea due to the development of pneumomediastinum, pneumothorax and subcutaneous emphysema secondary to perforation of the oesophageal wall. Immediate surgical exploration was carried out. Extensive necrosis of the oesophagus resulting from the presence of the foreign body led to a decision to perform an oesophageal resection and anastomosis.

CLINICAL RELEVANCE

this is the first clinical report of a cat treated successfully by oesophagectomy following oesophageal perforation due to an obstructive foreign body. The authors suggest that prompt surgical intervention, the ability to convert to a surgical procedure under the same anaesthetic as a non-surgical retrieval, placement of a gastrostomy tube and the availability of advanced anaesthetic and critical care support are important factors to consider when managing feline patients with a perforating oesophageal foreign body.