Ingested foreign bodies

 

Your cat ate what? Intestinal foreign bodies in cats

Introduction

For this month’s topic in our Keeping Cats Safe campaign we are moving away from poisoning and touching on a cause of accidental injury. Foreign bodies are often thought to only affect dogs with their tendency to eat anything and everything, with cats assumed to have a more selective palate. However, International Cat Care recently carried out a small survey of vets and found all but one of them had treated cats with foreign bodies. In this article we have a look at some of the things most commonly reported so you can effectively advise clients on what to keep out of reach of their curious cats. 

Common foreign bodies

Linear foreign bodies tend to be considered more common in cats than discrete objects and this was echoed in our survey; however a recent study from first opinion practice showed only 33% of cases in cats were linear1. Certainly linear foreign bodies can carry a less favourable prognosis, more frequently requiring multiple intestinal incisions for removal.1,2  So what do vets report as the most common intestinal foreign bodies seen in cats? Box 1 lists the most common foreign bodies reported to the vets who took part in our survey.

BOX 1

Common intestinal foreign bodies in cats:

  • Needles and threads
  • String (particularly from around a joint of meat) or wool
  • Hairbands
  • Rubber bands (including 'loom' bands)
  • Bones
  • Tinsel
  • Coins
  • Balloons
  • Buttons
  • Earplugs
  • Fruit stones and nut shells
  • Latex teats

Needles and thread

Needles and threads feature in all case series of foreign bodies and our survey confirmed these as common foreign bodies in cats. Needle ingestion can result in dramatic presentations such as those described in the Journal of Feline Medicine and Surgery Open Reports with the needle migrating into the brainstem and globe (see http://jor.sagepub.com/content/1/1/2055116915589841.full.pdf+html and http://jor.sagepub.com/content/1/1/2055116915585018.full.pdf+html).

More commonly the needle ends up in the intestines along with the thread (figure 1a) but can become lodged in the mouth (figures 1b and c).

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String, rubber bands and fibres

Hair bands and rubber bands were mentioned frequently along with the string found around meat. Fibres and stuffing from inside cat toys, carpet fibres, ribbon, dental floss, blind cords all had a mention. Even the hair from an owner’s wig resulted in a linear foreign body in one cat with figures 2a and b revealing the impressive intestinal plication that resulted.

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Small objects

Small round objects are just the right size to cause complete intestinal obstruction and seem irresistible to some cats. Coins (figure 3a,b,c) are not uncommon together with buttons, earplugs, fruit stones, nut shells, bottle tops and almonds. One cat managed to swallow a pin badge which caused a perfect intestinal obstruction (figure 4 a,b,c) necessitating an enterectomy for removal. 

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The unusual foreign body

Most vets will have a story to tell about unusual objects removed from cats. Our vets gave us an impressive list including children’s toys (including a beheaded plastic lizard, figure 5 other plastic toys, figure 6 and the amazing xray from a cat which had eaten a small, spiky rubber toy figure 7a and b), Christmas decorations and even a SIM card. Bones can also cause a problem to bin-raiding cats (figure 8a and b) as cooked chicken bones in particular can be very sharp and challenging to remove.

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Patient signalment

In our survey the vast majority of respondents described young cats being more likely to suffer from foreign bodies. Purebreds were frequently reported, with Burmese overrepresented. Siamese and Siamese-related cats have been reported to suffer more commonly from pica, particularly wool eating and thus perhaps are at increased risk of linear foreign body ingestion.

Although not reported in published studies our research suggests that indoor cats may be more likely to ingest foreign bodies; emphasising the need for client education on environmental enrichment for cats kept solely indoors.  Resources such as Ellis et al, 20133 (http://jfm.sagepub.com/content/15/3/219.full.pdf+html) provide further information.

Clinical signs

Clinical signs resulting from partial or complete intestinal obstruction vary depending on the location of the foreign body, which in cats tends to be the proximal gastrointestinal tract.1 Vomiting, anorexia and less commonly diarrhoea are reported. In cats clinical signs of abdominal pain may be subtle with only lethargy and inappetance noted by owners.  Cats may be presented after observed foreign body consumption, prior to the development of clinical signs.

Intestinal foreign bodies may be expected to present acutely, but intermittent partial obstruction with clinical signs of over a month’s duration is reported,4 and the duration of clinical signs in Hayes 2009 was up to 30 days.1  Cats with complete obstruction are likely to present with varying degrees of volume deficits and the severe case with intestinal perforation will show signs of peritonitis and sepsis.  

Affected cats may show pain on abdominal palpation and the foreign body (or intestinal abnormality) may be palpated in up to 58 percent of cases.1 Importantly linear foreign bodies may be visualised anchored under the tongue (figure 9a), or protruding from the anus (figure 9b) and any cat with consistent presenting signs should have the base of the tongue inspected.

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Diagnosis

Diagnosis may be based on history of foreign body ingestion and clinical signs, or the finding of a linear foreign body tethered at the base of the tongue. Diagnostic imaging can be helpful in making a diagnosis of an intestinal foreign body. In this article we have shown some more dramatic and obvious radiographs but many cases are more subtle with partial obstruction not always an easy diagnosis. Non radiopaque foreign bodies can be suspected in cases with dilation of the intestine proximal to the obstruction with gas and fluid accumulation.  A study examining this diagnosis showed that if the jejunal diameter is greater than 2.5 times the length of the cranial end plate of L2 then intestinal obstruction is the most likely diagnosis.5 Partial obstructions may not always result in dilation of proximal intestine at the time of imaging however, making this a challenging diagnosis sometimes only made at surgery.

Linear foreign bodies causing intestinal plication may be suspected radiographically when the jejunum seems gathered and most of the small intestine appears bunched in one area of the abdomen leaving a space on the lateral view. On the dorsoventral view the intestine may appear bunched on the right side.

Contrast radiography may be useful, especially in cases of partial obstruction but should be used with caution if intestinal perforation is suspected.

Ultrasound has been shown to be very useful in diagnosing foreign bodies,6 although more challenging in cases with linear foreign bodies but plicated intestine or a hyperechoic line may be noted.

Treatment

Prompt presentation and treatment is desirable.  In the 2009 study by Hayes,1 the cats not surviving all had clinical signs of over 14 days duration. Cats are masters of hiding illness and owners may be reluctant to bring their cat to the surgery due to perceived stress, preventing early diagnosis and in the case of foreign bodies significantly worsening the prognosis. Client education on watching for signs of illness as well as running a cat friendly clinic (see www.catfriendlyclinic.org ) to reduce stress may therefore help improve survival.

Treatment is frequently by surgical or endoscopic removal of the foreign body alongside management of fluid and electrolyte imbalances. Conservative management is occasionally attempted, usually in specific cases such as the cat with the linear foreign body tethered around the tongue. The thread is cut and the cat should be hospitalised and monitored closely with the owners counselled and practitioners prepared to go to surgery should the cat show signs of intestinal obstruction or perforation.  The authors of one study,7 treated 19 cats in this way and 10 needed surgery subsequently.

Surgical enterotomy to remove a foreign body should be performed once a cat is stable and fluid and electrolyte abnormalities have been corrected. Discrete foreign bodies should be removed via an incision distal to the obstruction to ensure healthy gut is sutured (figure 10a). Linear foreign bodies may require multiple enterotomies to remove them (figure 10b), to avoid excessive traction and resultant intestinal damage, following release of any anchor points (tongue or pylorus most frequently).

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Conclusion

Cats can be affected by foreign bodies, commonly linear with anchor points around the base of the tongue and the pylorus. Diagnosis is based on clinical signs and diagnostic imaging and the area under the tongue should be examined in all cats presenting with consistent clinical signs. Owners should be advised on the nature of potential foreign bodies and be encouraged to store objects like needles and thread securely. Indoor cats should be provided with safe, stimulating toys and their environment examined for any deficiencies.

 

References

1.     Hayes, G. Gastrointestinal foreign bodies in dogs and cats: a retrospective study of 208 cases. J Small Anim Pract 2009; 50: 576-583.

2.     Hobday, MM, Pachtinger GE, Drobatz KJ et al. Linear versus non-linear gastrointestinal foreign bodies in 499 dogs: clinical presentation, management and short-term outcome.  J Small Anim Pract 2014; 55: 560-565.

3.     Ellis, SLH, Rodan, I, Carney, HC, et al. AAFP and ISFM Feline Environmental Needs Guidelines. J Fel Med Surg 2013; 15: 219-230.

4.     Willis, SE and Farrow, CS. Partial gastrointestinal obstruction for one month because of a linear foreign body in a cat. Can Vet J 1991; 32: 689-691.

5.     Adams, WM, Sisterman, LA, Klauer JM et al. Association of intestinal disorders in cats with findings on abdominal radiographs. J Am Vet Med Assoc 2010; 286: 880-886.

6.     Tyrell, D and Beck, C. Survey of the use of radiography vs. ultrasonography in the investigation of gastrointestinal foreign bodies in small animals. Vet Radiol Ultrasound 2006; 47: 404-408.

7.     Basher, AW and Fowler, JD. Conservative versus surgical management of gastronintestinal linear foreign bodies in the cat. Vet Surg 1987; 16: 135-138.

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