Linear Intestinal Foreign Body in a Cat

Signalment:

Age: 1 year old

Gender: Neutered Male

Species: Feline

Breed: DSH

History:

Abdominal ultrasound was requested to evaluate patient for lethargy and anorexia. Bloodwork revealed a leukocytosis of 31.6K with a neutrophilia (26.7k), monocytosis (2.4k), basophilia (0.2K) and eosinophilia (0.8K). The patient’s hematocrit was also elevated at 51%. His chemistry panel showed a mildly elevated ALT (143U/L [12-140]) and GGT (24 [0-4U/L]). Abdominal radiographs were unremarkable.

Ultrasonographic findings:

There was linear foreign material seen from the level of the ileocecocolic junction (ICCJ) extending within the lumen of the ileum and through a large portion of the jejunum causing moderate to severe plication of the small intestine. The origin of the foreign material was not determined, but it was not visualized in the duodenum or pylorus. The small intestine had normal layering and thickness (Duodenum 2.5mm; Jejunum 2.3-2.6mm). The colon had normal wall thickness (1.1mm) and layering throughout. The stomach was empty and collapsed with normal rugal folds and layering.

Multiple mesenteric lymph nodes were mildly enlarged (0.6cm depth) with rounded shape having homogenous hypoechoic echogenicity.

No free fluid or free gas was noted in the abdomen.

Arrow showing hyperechoic linear foreign body in the lumen of the jejunum:

Hyperechoic linear foreign body in the ileum at the level of the ICCJ:

Hyperechoic linear foreign body in the lumen of the jejunum causing small intestinal plication:

Abdominal ultrasound interpretation:

Intestines - the findings are moderate and suggestive of an obstructive linear intraluminal intestinal foreign body. Adhesions or evidence of peritonitis were not appreciated on ultrasound, but this does not rule it out.

Lymph nodes - the findings are mild - DDx: infiltrative neoplasia (lymphoma vs. mast cell vs. other) vs. IBD vs. infection vs. reaction vs. metastatic neoplasia

Recommendations:

Exploratory laparotomy was recommended to surgically remove the foreign body. Though lymphadenopathy was suspected to be reactive secondary to the foreign body, taking biopsies of mesenteric lymph nodes could also be considered.

Outcome:

Exploratory laparotomy was performed. A linear foreign body was located throughout the jejunum and ileum that was embedded in the wall of the intestine and beginning to perforate. An intestinal resection and anastamosis was performed. The patient made a full recovery from surgery and is doing well.

Discussion:

Patients with linear foreign bodies may present with acute severe or vague mild clinical signs including lethargy, hyporexia/anorexia, vomiting, and signs of dehydration. Peristaltic waves cause the intestine to gather around the foreign material resulting in intestinal plication. The mesenteric border of the intestine is most at risk of perforation due to the linear material becoming taut and cutting into the mucosa. Rapid diagnosis and surgical intervention can help avoid perforation and septic peritonitis from occurring. Physiologic and anatomic ileus are not always easily differentiated on abdominal radiographs. Abdominal ultrasound can more definitively diagnose this condition.