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Philippa J. Johnson Great Western Referrals, Unit 10 County Park, Shrivenham Rd, Swindon, Wiltshire, SN1 2NR, England.

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Nicolette J. Hayward Great Western Referrals, Unit 10 County Park, Shrivenham Rd, Swindon, Wiltshire, SN1 2NR, England.

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History

An 8-month-old neutered male domestic longhair cat was evaluated because of a 4-day history of vomiting, inappetence, and lethargy. The vomit initially contained food and then became yellow fluid. On physical examination, the cat was assessed as mildly dehydrated and lethargic with signs of some abdominal pain on palpation. Results of serum biochemical analysis and CBC were within reference ranges. Abdominal ultrasonography was performed (Figure 1).

Figure 1—
Figure 1—

Longitudinal ultrasonographic images of the left ventral mid portion of the abdomen of a 8-month-old neutered male domestic longhair cat evaluated for a 4-day history of vomiting, inappetence, and lethargy. Images were obtained with a 5- to 12-MHz linear array probe at a depth of 2.25 cm.

Citation: Journal of the American Veterinary Medical Association 236, 2; 10.2460/javma.236.2.169

Determine whether additional imaging studies are required, or make your diagnosis from Figure 1—then turn the page

Diagnostic Imaging Findings and Interpretation

Within the left ventral mid portion of the abdomen, an area of corrugated small intestine is evident (Figure 2). Layered walls of the plicated small intestine are clearly identifiable. Along the center of the plicated small intestine runs a hyperechoic longitudinal structure that is approximately 1 mm in diameter. The mesenteric fat appears hyperechoic, and there is no free fluid in the abdominal cavity. These findings are most compatible with a linear foreign body within the small intestine.

Figure 2—
Figure 2—

Same ultrasonographic views as Figure 1. Notice the plicated and tortuous path of the small intestine (a). There is a hyperechoic linear structure running through the plication (b).

Citation: Journal of the American Veterinary Medical Association 236, 2; 10.2460/javma.236.2.169

Comments

An exploratory celiotomy was performed, and a string foreign body was identified. The foreign body extended from its attachment at the base of the tongue along the esophagus and through the gastrointestinal tract to the mid portion of the jejunum. There were multiple small perforations of the intestinal wall. A gastrotomy and enterotomy were performed to remove the foreign body. The cat was discharged from hospital 3 days after surgery and recovered well without complication.

Both abdominal radiography and ultrasonography can be used in the diagnosis of linear foreign bodies within the gastrointestinal tract.1,2 In abdominal radiography, the plication of loops of small intestine of dogs or cats with linear foreign bodies is sometimes evident if there is gas within the loops of small intestine; radiographically, the affected intestine appears decreased in length and centralized. Crescent-, round-, tapered-, and tubular-shaped luminal gas and distension of the gastrointestinal tract may also be observed. In dogs or cats with linear foreign bodies and an intestinal perforation, there also may be free abdominal fluid and gas within the abdominal cavity. Radiographically, these findings can be observed as a loss of serosal detail and the presence of gas opacity accumulating at the highest point of the peritoneal cavity, respectively.2 The use of gastrointestinal contrast studies has been described if the radiographic findings are equivocal; however, if there is an undetected perforation, contrast agent may leak into the peritoneum.2

Ultrasonographic signs of linear gastrointestinal foreign bodies include a tortuous or plicated path of the intestine, with or without a hyperechoic linear structure running through the plication.1,3 More commonly in dogs than cats, a secondary intussusception can develop.2 Abdominal ultrasonography can also provide useful additional information on gastrointestinal wall compromise, thickening and loss of layering of the intestinal wall, the presence of free abdominal fluid, and lymphadenopathy, which may develop secondary to the linear foreign body.4

In a study4 on dogs and cats in which the usefulness of abdominal radiography was compared with that of abdominal ultrasonography for the detection of gastrointestinal foreign bodies, foreign bodies were detected on abdominal ultrasonographic images of all 16 affected dogs and cats but were detected on abdominal radiographic images of only 9 of 16 dogs and cats. Two of the affected small animals had linear foreign bodies, both of which were evident on abdominal ultrasonographic images, but only 1 of these 2 foreign bodies had a distinctive radiographic appearance of a linear foreign body. Additionally, compared with abdominal radiography, abdominal ultrasonography provided more vital information as to the severity of the condition, with information about the intestinal wall viability, perforation, thickness, and architecture as well as changes within the abdomen, such as the presence of free fluid and enlargement of mesenteric lymph nodes. The investigators of that study4 concluded that abdominal ultrasonography alone can be used for the diagnosis of gastrointestinal foreign bodies in small animals.

  • 1.

    Bebchuk TN. Feline gastrointestinal foreign bodies. Vet Clin Small Anim Pract 2002;32:861880.

  • 2.

    Riedesel EA. The small bowel. In: Thrall DE, ed. Textbook of veterinary radiology. 5th ed. Philadelphia: WB Saunders Co, 2007;770791.

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  • 3.

    Hoffmann KL. Sonographic signs of gastroduodenal linear foreign body in 3 dogs. Vet Radiol Ultrasound 2003;44:466469.

  • 4.

    Tyrrell D, Beck C. Survey of the use of radiography vs. ultrasonography in the investigation of gastrointestinal foreign bodies in small animals. Vet Radiol Ultrasound 2006;47:404408.

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Contributor Notes

Miss Johnson's present address is Center for Small Animal Studies, Animal Health Trust, Lanwades Park, Kentford, Newmarket, Suffolk, CB8 7UU, England. Ms.

Hayward's present address is Veterinary Diagnostic Imaging Ltd, Baytree Cottage, Dyrham, Chippenham, Wiltshire, SN14 8EX, England.

Address correspondence to Miss Johnson (philippa.johnson@gmail.com).
  • Figure 1—

    Longitudinal ultrasonographic images of the left ventral mid portion of the abdomen of a 8-month-old neutered male domestic longhair cat evaluated for a 4-day history of vomiting, inappetence, and lethargy. Images were obtained with a 5- to 12-MHz linear array probe at a depth of 2.25 cm.

  • Figure 2—

    Same ultrasonographic views as Figure 1. Notice the plicated and tortuous path of the small intestine (a). There is a hyperechoic linear structure running through the plication (b).

  • 1.

    Bebchuk TN. Feline gastrointestinal foreign bodies. Vet Clin Small Anim Pract 2002;32:861880.

  • 2.

    Riedesel EA. The small bowel. In: Thrall DE, ed. Textbook of veterinary radiology. 5th ed. Philadelphia: WB Saunders Co, 2007;770791.

    • Search Google Scholar
    • Export Citation
  • 3.

    Hoffmann KL. Sonographic signs of gastroduodenal linear foreign body in 3 dogs. Vet Radiol Ultrasound 2003;44:466469.

  • 4.

    Tyrrell D, Beck C. Survey of the use of radiography vs. ultrasonography in the investigation of gastrointestinal foreign bodies in small animals. Vet Radiol Ultrasound 2006;47:404408.

    • Crossref
    • Search Google Scholar
    • Export Citation

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