Intestinal obstruction in a cat

Patient Information:

Species: Feline
Breed: Maine Coon Mix
Gender: Neutered Male
Age: 13 years old

History:

The patient presented for 24-hour history of inappetence, vomiting bile, not defecating or urinating. Bloodwork revealed leukocytosis. Abdominal radiographs showed gas-filled segments of gastrointestinal tract but no obvious foreign body.

Ultrasound Findings:

One large partially to completely obstructive cylindric hyperechoic structure casting a strong acoustic shadow was seen in a segment of jejunum consistent with a foreign body measuring several centimeters in length. The wall of the involved jejunum was moderately thickened (3.7mm), hypoechoic and lack normal wall layering. The oral segments of jejunum were moderately distended with gas and fluidy ingesta and were hypomotile to amotile. The aboral segment was empty. In addition, many loops of small intestine were mildly to moderately thickened (max: 3.7mm) with prominent disproportionate thickening of the muscularis layers. The mesentery was diffusely hyperechoic and a scant amount of free anechoic peritoneal effusion was detected.

Image 1. The jejunum was distended by a structure with a strong echogenic interface and clean distal acoustic shadowing (FB). Notice the thickening and loss of layering of the involved jejunal wall. The intestinal loop proximal to the obstructing material was distended with gas and fluid (arrow). Three empty small intestinal loops are visible in the upper portion of the image showing selective thickening of the muscularis layer (*)

Surgery:

Exploratory laparotomy was performed and large trichobezoar obstructing the mid jejunum was removed via enterotomy. Multiple biopsies were obtained for histopathologic evaluation.

Image #2. Trichobezoar

Histopathologic diagnosis:

findings consistent with small cell lymphoma invading the mucosa, submucosa and muscularis layers of the duodenum, jejunum and ileum.

Outcome:

Besides initial inappetence, the patient recovered uneventfully from surgery. The pet was referred to the oncology service and was started on a tapering dose of Prednisolone, weekly vitamin B12 injection and Chlorambucil and has been progressing well to date.

Secondary disturbances of the digestive motility pattern by the infiltrative neoplasia likely contributed to the delayed intestinal transit and hair ball formation in this case. It is suggested that biopsy specimens be obtained at time of surgery in patients suffering from obstructive hairballs to detect potential causes of gastrointestinal dysmotility.

Special thanks to Drs. Myzie and Taylor and the staff at
Animal Medical Center of Loudoun – Ashburn Farms as well as
The Oncology Service of Leesburg for their help with this case.