Case study: Linear foreign body in feline patients

Common linear foreign bodies include string, yarn, carpet, cloth material, or leashes. Linear foreign bodies present a unique challenge as they can trail down the intestines which will result in intestinal plication and the string material can start to act as a saw on the mesenteric border of the intestines. This can result in perforation, bowel death, and septic peritonitis. Clinical signs can include anorexia, vomiting, lethargy, regurgitation, ptyalism, abdominal pain, dehydration and, as in this case study, the offending foreign object may be protruding from the anus.

Case study

Rusty, a 6-year-old orange tabby, found some sparkly string which he decided might be tasty. The owner witnessed him ingest the string 2 days prior to presentation. He had passed a few bits of string in his stools, but on this particular day, he had approximately 4 cm of string protruding from his anus and Rusty became anorexic and painful.

Rusty's radiographs confirming intestinal plication with no free air and normal serosal detail within the abdomen. (Image courtesy of Heather Timmermans)

Examination and diagnostics

Physical examination revealed normal vital signs with mild dehydration and palpation of the intestines revealed they were bunched and painful. No string was found in the oral cavity under the tongue.

Abdominal radiographs confirmed intestinal plication with no free air and normal serosal detail within the abdomen. The stomach contained a soft tissue opacity in the pylorus and a heterogenous mix of gas and soft tissue opacity within the fundus.

Blood work revealed a normal complete blood count, mild hyperglycemia at 275 mg/dL (reference range 70-150), and mild hypokalemia at 3.3 mmol/L (reference range 3.7-5.8). The hyperglycemia was attributed to stress and pain and the hypokalemia was attributed to anorexia and gastrointestinal (GI) obstruction. Intravenous fluids were started to rehydrate him prior to surgery.

Surgical procedure

Rusty was placed in dorsal recumbency, and his abdomen was sterilely prepped. He received 22 mg/kg cefazolin IV perioperatively. A 10 blade was used to make a ventral midline incision from the xyphoid process to just caudal to the umbilicus. The intestines were plicated from the pylorus to the large bowel.

Rusty's stomach exteriorized from the abdomen

The stomach was exteriorized from the abdomen and packed off with sterile moistened lap sponges. A stab incision was made into the stomach and a hemostat was used to exteriorize the wadded string from the pylorus. The string was cut caudal to the wad of string. The intestinal plication was immediately improved. The stomach was closed with 3-0 monoweb in a double inverting pattern. The intestines were gently manipulated into more normal positioning. Evaluation of the mesenteric side of the intestines revealed no evidence of perforation nor necrosis. Gentle traction on the string from the rectum did not result in movement of the linear foreign body so the distal jejunum was isolated outside of the abdomen and packed off with sterile lap sponges. A stab incision was made into the distal jejunum, the string was exteriorized and cut.

The orad portion of the string was able to be gently removed from the jejunal incision. The caudal portion of the string was able to be removed with rectal manipulation caudally. The jejunal incision was closed in a simple interrupted pattern with 3-0 monoweb. The abdomen was closed with 2-0 monoweb in a simple continuous pattern, the subcutaneous tissues were closed with 3-0 monoweb in a simple continuous pattern and then an intradermal pattern. The skin was closed with 3-0 monoweb in a cruciate pattern. Recovery from anesthesia was uneventful.

Postoperatively

Rusty was continued on intravenous fluids for the remainder of the day. He received maropitant for nausea and Zorbium topically for pain control. After a couple of days of ileus, which was treated with Mirataz ointment, oral Cerenia, and gentle syringe feeding, his appetite returned to normal. He was back to his normal self by suture removal.