September's Case of the Month

Intestinal Intussusception in a cat

Patient Information:

Age: 3-month-old

Species: Feline

Breed: Domestic short hair

Gender: Female


History:

Previously healthy kitten. The patient presented with a 2-day history of vomiting, progressive lethargy and anorexia. A thickened loop of intestine was felt on palpation. Abdominal radiographs were unremarkable.

In one study of 20 affected cats with intestinal intussusception, 10 were <1 year of age and 9 were ≥6 years of age. Siamese cats were overrepresented. No sex predisposition was noted. A wide range of acute and chronic gastrointestinal signs have been reported. Abdominal ultrasound is the preferred method of diagnosis.


Ultrasound Findings:

Segments of small intestine (intussusceptum) were seen invaginated within the colon (intussuscipiens) in the right cranial abdominal quadrant. The cecum and a portion of the mesentery were seen adjacent to the intussusceptum within the lumen of the intussuscipiens. The walls of the affected colon and small intestine appeared moderately thickened and hypoechoic with indistinct wall layering most likely due to congestion and edema.

Image 1 (found below). Transverse ultrasound image of a typical target-like mass consistent with an intussusception using a high frequency probe. Multiple loops of small intestine (arrows) were located eccentrically within the colon (cross) along with the cecum (arrowhead) and a portion of the mesentery (asterisk).


Surgery:

The patient was referred for emergency surgery. The intussusception was identified and reduced by manual manipulation. The ileum was markedly bruised with serosal tearing, but no intestinal leakage was appreciated. The remaining small intestine appeared normal and no foreign material or mass was identified. Empirical deworming with Fenbendazole was performed following surgery.

Although spontaneous reduction can occur, most intussusceptions require surgical reduction. Once reduced, involved intestines are evaluated for perforations and viability. Intestinal resection and anastomosis may be necessary in some cases. Enteroplication (i.e. entero-enteropexy) can be performed to prevent recurrence but this procedure is controversial due to a complication rate approaching 20%.


Outcome:

The exact cause of the intussusception could not be clearly established in this case. The patient recovered uneventfully from surgery and has been growing normally without evidence of recurrence to date.

In one report, 10/13 cats that underwent corrective surgery survived to discharge. If the underlying cause of the intussusception is not adequately addressed, risk of recurrence increases. Any condition responsible for hyperperistalsis can predispose to an intussusception. Causes include intestinal parasitism, foreign bodies, acute enteritis (e.g. viral, bacterial), intestinal neoplasia, prior abdominal surgery, inflammatory bowel disease, metabolic disorders, etc. The intussusception can also be idiopathic.




Barreau P: Intussuscpetion: Diagnosis and Treatment. World Small Animal Veterinary Association World Congress Proceedings 2008.

Burkitt JM, Drobatz KJ, Saunders HM, et al: Signalment, history and outcome of cast with gastrointestinal tract intussusception: 20 cases (1986-200). J Am Vet Med Assoc 2009 Vol 234 (6) pp. 771-6.



Sonographer: Anne Desrochers, DVM DACVIM

Image 1 . Transverse ultrasound image of a typical target-like mass consistent with an intussusception using a high frequency probe. Multiple loops of small intestine (arrows) were located eccentrically within the colon (cross) along with the cecum (arrowhead) and a portion of the mesentery (asterisk).

Special thanks to the staff at Adam’s Mill Veterinary Hospital for their help with this case.