Conservative versus surgical management of gastrointestinal linear foreign bodies in the cat

Performance time and leak pressure of hand-sewn and skin staple intestinal anastomoses and enterotomies in cadaveric cats

OBJECTIVE

To compare time to construct completion and leak testing between hand-sewn and skin staple anastomoses and enterotomies in cats.

STUDY DESIGN

Ex vivo, randomized study.

ANIMALS

Fresh feline cadavers (n = 20).

METHODS

Jejunal segments (8 cm) were harvested and tested on the same day as euthanasia. From each cadaver, one segment was randomly assigned to control (C), hand-sewn enterotomy (HSE), and skin staple enterotomy (SSE) groups, and two segments were randomly assigned to hand-sewn anastomosis (HSA) and skin staple anastomosis (SSA) groups. Construct completion time, initial leak pressure (ILP), and maximum intraluminal pressure were compared. Leakage location was reported.

RESULTS

Mean time (s) ± SD was longer (p < .001) for HSA (317.0 ± 50.9) than SSA (160.8 ± 13.1) and for HSE (172.0 ± 36.5) than SSE (20.3 ± 5.0). ILP (mean ± SD) for C (600.0 mmHg ±0.0) was higher (p < .001) than all constructs. ILP (mean ± SD) for SSA (124.2 mmHg ±83.7) was not different (p = .49) than HSA (86.1 ± 51.9), but HSE (200.3 ± 114.7) was higher (p < .001) than SSE (32.2 ± 39.7). Immediate leakage from the center of enterotomy closure was observed in 7/20 SSE.

CONCLUSIONS

HSA construct completion took twice as long as SSA with no difference in intraluminal pressures. Although HSE construct completion took 8x as long as SSE, HSE had higher intraluminal pressures.

CLINICAL SIGNIFICANCE

In cats, SSA may be an alternative to HSA for intestinal anastomosis, but SSE is not recommended as an alternative to HSE for intestinal enterotomy closure.

Retrospective evaluation of surgical treatment of linear and discrete gastrointestinal foreign bodies in cats: 2009-2021

OBJECTIVES

Gastrointestinal foreign bodies (FBs) are an important cause of emergency surgical intervention in cats, but little information exists in the literature evaluating the risks and outcomes in this species. The study purpose was to describe cases of feline FBs and compare perioperative factors and outcomes between linear foreign body (LFB) and discrete foreign body (DFB) surgery in cats.

METHODS

The medical records from the University of Georgia Veterinary Teaching Hospital were searched for cats that had undergone surgery for FB removal between August 2009 and August 2021. Perioperative data were collected and described. Data were compared between cats with an LFB and cats with a DFB. A binomial probability series was used to estimate the likelihood of postoperative septic peritonitis or mortality in an additional cat in the series.

RESULTS

A total of 56 cats were included in this study; 38 cats had a DFB and 18 had an LFB. No cats developed postoperative septic peritonitis, and all cats survived. The likelihood of postoperative septic peritonitis or mortality in an additional cat was estimated to be <5.2%. Cats with an LFB were found to have a significantly higher body condition score (P = 0.047), albumin (P = 0.025), American Society of Anesthesiologists status (P = 0.027), surgery length (P <0.001) and total cost of visit (P = 0.006) when compared with cats with a DFB. Cats with LFBs were more likely to develop a surgical site infection (SSI; P = 0.007) and be administered postoperative antibiotics (P = 0.017).

CONCLUSIONS AND RELEVANCE

Cats undergoing surgery for gastrointestinal FBs had a low incidence of postoperative complications. Cats with LFBs had longer surgeries and were more likely to develop postoperative SSIs.

Conservative management of metallic sharp-pointed straight gastric and intestinal foreign bodies in dogs and cats: 17 cases (2003-2021)

OBJECTIVE

To describe the conservative management and outcome of gastrointestinal metallic sharp-pointed straight foreign bodies in dogs and cats.

MATERIALS AND METHODS

Clinical records of dogs and cats presented to a university teaching hospital between 2003 and 2021 with gastrointestinal metallic sharp-pointed straight foreign bodies (e.g. needles, pins, nails) were reviewed. Conservative management was defined as leaving the foreign body in situ. Cases were excluded if the foreign body was identified outside of the gastrointestinal tract (including oropharynx and oesophagus) or if it was removed by endoscopy or surgery as the first treatment choice. Patient signalment, presenting complaint, foreign body location, treatment, complications, gastrointestinal transit time, length of hospitalisation and outcome were recorded.

RESULTS

A total of 17 cases (13 dogs and four cats) were included in the study, being treated with primary conservative therapeutic approach (11) or following failure of endoscopy (two), surgery (three) or both (one). Clinical signs associated with the foreign body were reported in three (17.6%) cases. Conservative management was successful in 15 (88.2%) cases, with no complications reported. Patients were clinically and radiographically monitored with variable supportive care. In two (11.8%) cases, surgery was subsequently performed as the foreign body failed to progress on repeated radiographs after 24 hours. Mean foreign body gastrointestinal transit time for patients treated conservatively was 59.2 (±31.4) hours. All patients survived to discharge.

CLINICAL SIGNIFICANCE

Conservative management is a treatment option for clinically stable cats and dogs with metallic sharp-pointed straight gastrointestinal foreign bodies in the absence of perforation.

Retrospective evaluation of gastrointestinal foreign bodies and presurgical predictors for enterectomy versus enterotomy in dogs (2013-2016): 82 cases

OBJECTIVE

To evaluate preoperative diagnostics in dogs with gastrointestinal foreign body (GIFB) obstruction and to identify clinical variables associated with the performance of simple enterotomy (EO) versus enterectomy (EC).

DESIGN

Retrospective case control study from October 2013 to January 2016.

SETTING

Veterinary Teaching Hospital.

ANIMALS

Eighty-two client-owned dogs diagnosed at the time of surgery with GIFB obstruction.

MEASUREMENTS AND MAIN RESULTS

Data were collected from medical records regarding history, initial physical examination, clinicopathologic testing, diagnostic imaging, and surgical reports. Based on univariate analysis, dogs that required EC were ill (P < 0.0001) and anorexic (P = 0.0007) for a longer duration; had a higher vomiting severity score (P = 0.005); and had worse perfusion parameters (mucous membrane color [P = 0.028] and quality [P = 0.032], poorer pulse quality [P = 0.0015], relatively lower blood pressure [P = 0.0328], greater heart rates [P = 0.0011]). Dogs undergoing EC were more likely to have altered peritoneal detail on radiographs (P = 0.0014; odds ratio [OR] = 25.5; 95% confidence interval [CI]: 2.4, 275.7) and echogenic peritoneal effusion on ultrasound (P = 0.0101; OR = 12.5; 95% CI: 1.3, 120.9), compared to the EO group. Heart rate (adjusted P = 0.028; OR = 1.07; 95% CI: 1.0, 1.1) and vomiting severity score (adjusted P = 0.028; OR = 5.6; 95% CI: 1.2, 26.1) maintained significance after multiple logistic regression.

CONCLUSIONS

Multiple factors in the preoperative clinical evaluation were different between dogs undergoing EO versus EC for GIFB obstruction. However, many of these variables become insignificant with multiple logistic regression. The presence of an increased heart rate or increased vomiting severity score at presentation was independently associated with undergoing enterectomy. Prospective studies with greater number of animals are warranted to validate these results.

Outcomes of dogs undergoing immediate or delayed surgical treatment for gastrointestinal foreign body obstruction: A retrospective study by the Society of Veterinary Soft Tissue Surgery

OBJECTIVE

To evaluate gastrointestinal injury and outcomes between dogs treated with immediate surgical intervention vs those treated with delayed surgical intervention for gastrointestinal foreign body obstruction (GIFBO).

STUDY DESIGN

Retrospective cohort study.

SAMPLE POPULATION

Client-owned dogs (n = 855) from five referral hospitals.

METHODS

Medical records of dogs in which GIFBO had been diagnosed between 2007 and 2017 were reviewed for preoperative management, timing of surgery, intraoperative findings, postoperative management, outcome, and survival. Surgical intervention was classified as immediate when it occurred within 6 hours of presentation and delayed when it occurred >6 hours after presentation.

RESULTS

Outcomes did not differ between dogs treated immediately (n = 584) or over 6 hours after presentation (n = 210). Intestinal necrosis and perforations were more common when surgery was delayed (P = .008; P = .019) but became nonsignificant after controlling for preoperative differences. Risk factors for necrosis and perforations included duration of clinical signs, increased lactate, linear foreign material, and timing of surgery. Enterectomies (P = .004) as well as the duration of surgery (P = .004) and anesthesia (P = .001) were increased when surgery was delayed. Immediate surgery was associated with earlier return to feeding (P = .004) and discharge from the hospital (P < .001); (5%) dogs in each group (n = 33 immediate; n = 11 delayed) either had a negative explore or the foreign body was milked aborally into the colon at the time of surgery.

CONCLUSION

Although outcomes were not associated with surgical timing, the unadjusted prevalence of gastrointestinal injury and, thus, the requirement for complex surgical procedures was higher in the delayed group.

CLINICAL SIGNIFICANCE

Earlier surgical treatment of stabilized dogs with GIFBO may involve fewer complex procedures and accelerate recovery.

Prevalence of 17 feline behavioral problems and relevant factors of each behavior in Japan

Undesirable behaviors exhibited by cats are regarded as feline behavioral problems. Like canine behavioral problems, feline behavioral problems are commonly reported by owners. Thus, in order to advise cat owners appropriately, veterinarians, particularly general veterinary practitioners, are encouraged to have sufficient knowledge of these problems. However, in ordinary Japanese homes, only a small number of feline behavioral problems have been investigated in terms of prevalence and relevant factors. Comprehensive survey data may improve understanding of feline behavioral problems. In the present study, we distributed an online survey including general information and questions about 17 feline behaviors which can be problematic for owners, to investigate: (1) the prevalence of feline behavioral problems, (2) the most common behavioral problems, and (3) relevant factors for each behavior. We collected 1,376 valid responses. Among all cats, 75.7% exhibited at least one behavioral problem. “Pica” and “Showing fear while on the examination table” were the most frequently reported behavioral problems. To identify factors related to the expression of each behavior, we conducted multiple logistic regression analyses, with the presence of behaviors as objective variables and cats’ general information as explanatory variables. Age, sex, breed, number of cats in the household, and type of residence were each associated with more than one behavior. The present study revealed the prevalence of 17 feline behavioral problems in Japanese homes and relevant factors of each behavior. These findings will help veterinarians understand and address feline behavioral problems.

Intestinal Obstruction Caused by Taenia taeniaeformis Infection in a Cat

An adult domestic shorthair (DSH) cat was presented with acute vomiting, anorexia, lethargy, and dyspnea. The cat’s clinical status worsened over 24 hours with conservative medical management. An exploratory celiotomy was performed. Acute intestinal obstruction resulting from infection with Taenia (T.) taeniaeformis was diagnosed. Surgical removal of the cestodes via multiple enterotomies resolved the obstruction. This paper reports, for the first time, small intestinal obstruction caused by T. taeniaeformis infection in a cat.

Gastrointestinal obstruction

For cats that present with signs of gastrointestinal disease, obstruction is a primary differential. There are numerous reasons of gastrointestinal obstruction in small animals, yet there are several specific causes that are more commonly associated with the cat. These include linear foreign bodies, trichobezoars, focal intestinal neoplasia, feline infectious peritonitis, and megacolon. Clinical signs related to gastrointestinal obstruction consist of vomiting, diarrhea, constipation, tenesmus, anorexia, or weight loss. The course and onset of disease depends on the rate at which the obstruction develops and whether the obstruction is partial and complete. The diagnosis of obstruction is typically suspected based on clinical presentation and palpation of an abdominal mass. Diagnostics tools are used for definite diagnosis and determination of location within the gastrointestinal tract. Surgical treatment is dependent on the etiology of the obstruction and various techniques are employed to remove the obstruction and prevent recurrence.

Feline gastrointestinal foreign bodies

The common presentations of gastrointestinal foreign bodies in cats are discussed in this article. The options for diagnostic imaging modalities and other diagnostic tests are detailed. The management of foreign body obstructions at different levels of the gastrointestinal tract is discussed. Particular attention is paid to the management of linear gastrointestinal foreign bodies, morbidity associated with this condition, and treatment. There is also a brief discussion on the types of gastrointestinal foreign bodies presenting to a veterinary teaching hospital at which both referral and primary cases are seen.

Gastrointestinal emergencies

The animal with a surgical gastrointestinal emergency usually requires a rapid, thorough physical examination with concurrent resuscitation. As the diagnosis is being made, the animal must be made as stable as possible before undergoing general anesthesia. During surgery, there must be a critical evaluation of gastrointestinal viability and the use of precise technical skills to achieve the best outcome. Adept postoperative management, including careful monitoring and an index of suspicion for potential complications, is vital.