History
An 11.5-week-old 2.6-kg sexually intact male domestic medium-hair kitten was presented to the emergency service for evaluation because of diarrhea, anorexia, and lethargy of < 1 day's duration. The owner had adopted the kitten 2 weeks prior to presentation, and the kitten had no previous medical history and was not administered any medications in the 2 weeks prior to adoption.
On physical examination, the kitten had a rectal temperature of 36.3 °C (reference range, 37.2 to 39.4 °C), a pulse of 200 beats/min (reference range, 140 to 200 beats/min), a respiratory rate of 36 breaths/min (reference range, 10 to 40 breaths/min), pale pink mucous membranes, a capillary refill time of 2 seconds, and weak femoral pulses. On abdominal palpation, the kitten showed signs of moderate abdominal pain and had a midabdominal mass-like structure. Three-view abdominal radiography was performed (Figure 1).
Right lateral (A), left lateral (B), and ventrodorsal (C) abdominal radiographic images of an 11.5-week-old 2.6-kg sexually intact male domestic medium-hair kitten evaluated because of diarrhea, anorexia, and lethargy of < 1 day's duration.
Citation: Journal of the American Veterinary Medical Association 260, 10; 10.2460/javma.21.02.0084
Right lateral (A), left lateral (B), and ventrodorsal (C) abdominal radiographic images of an 11.5-week-old 2.6-kg sexually intact male domestic medium-hair kitten evaluated because of diarrhea, anorexia, and lethargy of < 1 day's duration.
Citation: Journal of the American Veterinary Medical Association 260, 10; 10.2460/javma.21.02.0084
Right lateral (A), left lateral (B), and ventrodorsal (C) abdominal radiographic images of an 11.5-week-old 2.6-kg sexually intact male domestic medium-hair kitten evaluated because of diarrhea, anorexia, and lethargy of < 1 day's duration.
Citation: Journal of the American Veterinary Medical Association 260, 10; 10.2460/javma.21.02.0084
Right lateral (A), left lateral (B), and ventrodorsal (C) abdominal radiographic images of an 11.5-week-old 2.6-kg sexually intact male domestic medium-hair kitten evaluated because of diarrhea, anorexia, and lethargy of < 1 day's duration.
Citation: Journal of the American Veterinary Medical Association 260, 10; 10.2460/javma.21.02.0084
Right lateral (A), left lateral (B), and ventrodorsal (C) abdominal radiographic images of an 11.5-week-old 2.6-kg sexually intact male domestic medium-hair kitten evaluated because of diarrhea, anorexia, and lethargy of < 1 day's duration.
Citation: Journal of the American Veterinary Medical Association 260, 10; 10.2460/javma.21.02.0084
Right lateral (A), left lateral (B), and ventrodorsal (C) abdominal radiographic images of an 11.5-week-old 2.6-kg sexually intact male domestic medium-hair kitten evaluated because of diarrhea, anorexia, and lethargy of < 1 day's duration.
Citation: Journal of the American Veterinary Medical Association 260, 10; 10.2460/javma.21.02.0084
Right lateral (A), left lateral (B), and ventrodorsal (C) abdominal radiographic images of an 11.5-week-old 2.6-kg sexually intact male domestic medium-hair kitten evaluated because of diarrhea, anorexia, and lethargy of < 1 day's duration.
Citation: Journal of the American Veterinary Medical Association 260, 10; 10.2460/javma.21.02.0084
Radiographic Findings and Interpretation
Abdominal radiography revealed gas distention of the body and fundus of the stomach and severe and generalized gas distention throughout the small intestine (Figure 2). There were a few loops of mildly fluid-filled small intestine in the cranial portion of the abdomen. On all 3 views, there was decreased abdominal detail, which was attributed to the patient's young age rather than the presence of free abdominal fluid. The colon was not visible on any view. The caudal thoracic structures on all views were within radiographically normal limits.
The same right lateral (A) and ventrodorsal (B) radiographic images as in Figure 1. There is gas distension of the stomach (white double-headed arrows) and several distended loops of small intestine (black double-headed arrows).
Citation: Journal of the American Veterinary Medical Association 260, 10; 10.2460/javma.21.02.0084
The same right lateral (A) and ventrodorsal (B) radiographic images as in Figure 1. There is gas distension of the stomach (white double-headed arrows) and several distended loops of small intestine (black double-headed arrows).
Citation: Journal of the American Veterinary Medical Association 260, 10; 10.2460/javma.21.02.0084
The same right lateral (A) and ventrodorsal (B) radiographic images as in Figure 1. There is gas distension of the stomach (white double-headed arrows) and several distended loops of small intestine (black double-headed arrows).
Citation: Journal of the American Veterinary Medical Association 260, 10; 10.2460/javma.21.02.0084
The same right lateral (A) and ventrodorsal (B) radiographic images as in Figure 1. There is gas distension of the stomach (white double-headed arrows) and several distended loops of small intestine (black double-headed arrows).
Citation: Journal of the American Veterinary Medical Association 260, 10; 10.2460/javma.21.02.0084
The same right lateral (A) and ventrodorsal (B) radiographic images as in Figure 1. There is gas distension of the stomach (white double-headed arrows) and several distended loops of small intestine (black double-headed arrows).
Citation: Journal of the American Veterinary Medical Association 260, 10; 10.2460/javma.21.02.0084
Treatment and Outcome
Top differential diagnoses for the generalized ileus were small intestinal mechanical foreign body obstruction, viral enteritis, or mesenteric volvulus. Dysautonomia was considered less likely because of the lack of concurrent clinical or radiographic findings. Surgical exploration of the abdomen had been recommended on the basis of concern for an obstruction; however, the owner declined surgery and elected euthanasia with approval for a necropsy.
Necropsy revealed a 720° mesenteric volvulus originating from the root of the mesentery, causing necrosis of the length of the small intestine and a small amount of peritoneal effusion. An intestinal foreign object was not observed. The mass-like structure palpated on initial examination was likely the root of the mesentery.
Comments
There is limited information on mesenteric volvulus in cats. Affected cats have signs similar to those in dogs, namely a sudden onset of anorexia, vomiting, diarrhea, and signs of abdominal pain.1,2 Radiographic changes are reported to be similar for cats and dogs, with both species having generalized small intestinal ileus with loops of intestine lying parallel to each other and a loss of serosal detail.3,4 For the kitten of the present report, there was initial concern for a foreign body obstruction of the small intestine because of the palpable mass-like structure noted on triage examination and the kitten's sudden gastrointestinal signs. The diagnostic plan was made to evaluate the abdomen, including survey abdominal radiographs. Mesenteric volvulus had not been considered as the primary differential because so few instances had been reported in cats. Several breeds of dogs have been reported to develop mesenteric volvulus, especially large- and giant-breed dogs such as German Shepherd Dogs and English Pointers.3,4 To the author's knowledge, intestinal volvulus has been reported in 2 cats2 but with no outstanding breed or underlying diseases related to the conditions in these patients.
Presurgical diagnosis of mesenteric volvulus can be challenging, as the physical examination and clinical signs are nonspecific. Survey abdominal radiography is the imaging modality used most often in the diagnosis of mesenteric volvulus.3,4 A mechanical obstruction was suspected in this case because mesenteric volvulus is rare and has not been reported in kittens. However, abdominal radiography has revealed changes consistent with mesenteric volvulus in both dogs and cats such as, most notably, evidence of severe ileus, with gas-distended loops of small intestine lying parallel to each other and loss of abdominal detail.3,4 Additional imaging, such as abdominal ultrasonography or CT, may be used but are not always helpful in diagnosing mesenteric volvulus. In addition to radiography, CT has been helpful in the diagnosis of colonic torsion and mesenteric volvulus in dogs but seems not often used, as it could delay surgery.5 Mesenteric volvulus should be considered in young cats with sudden onset of gastrointestinal signs and severe small intestinal ileus; exploratory laparotomy would be warranted as the small intestine may become necrotic within a short period from the onset of clinical signs. Because of this fast progression, even with emergency laparotomy, the prognosis is poor in dogs.3,4 Surgery was recommended for the kitten of the present report but was declined by the owner.
References
- 2. ↑
Knell SC, Andreoni AA, Dennler M, Venzin CM. Successful treatment of small intestinal volvulus in two cats. J Feline Med Surg. 2010;12(11):874–877. doi:10.1016/j.jfms.2010.09.007
- 3. ↑
Junius G, Appeldoorn AM, Schrauwen E. Mesenteric volvulus in the dog: a retrospective study of 12 cases. J Small Anim Pract. 2004;45(2):104–107. doi:10.1111/j.1748-5827.2004.tb00211.x
- 4. ↑
Cairó J, Font J, Gorraiz J, Martin N, Pons C. Intestinal volvulus in dogs: a study of four clinical cases. J Small Anim Pract. 1999;40(3):136–140. doi:10.1111/j.1748-5827.1999.tb03058.x
- 5. ↑
Barge P, Fina CJ, Mortier JR, Jones ID. CT findings in five dogs with colonic torsion. Vet Radiol Ultrasound. 2020;61(2):190–196. doi:10.1111/vru.12830
