INTESTINAL OBSTRUCTION

GENERAL REVIEW

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Any foreign object or mass that obstructs the intestinal lumen.  Linear foreign bodies are thread, nylon stocking, rope, string, carpet etc. and cause a unique form of obstruction.

Linear foreign body:

  • becomes anchored around the base of the tongue or at the pylorus
  • peristaltic waves attempt to move the foreign body and stretch it aborally
  • intestine progressively gathers itself into accordion-like pleats along the object
  • object becomes taut and positioned on the mesenteric side of the intestinal lumen
  • foreign body irritates and then devitalizes the intestine
  • multiple full thickness perforations of the mesenteric border

 

 

Linear foreign body:

  • Reported more commonly in cats than dogs.
  • 50% of cats have the foreign body wrapped around the base of the tongue
  • Rarely discovered under the tongue of dogs
  • Abdominal palpation: foreign body itself is typically not palpable but irregularity of the intestine caused by the pleating often is palpable.

Vomiting, anorexia and depression are the most common.

 

  • Plain abdominal radiographs
    • small bowel plication is the most common finding
    • gas forming in small eccentrically located luminal bubbles instead of normal curved linear columns
  • Contrast radiography
    • pleating becoming more obvious
    • foreign body may appear as a radiolucent object in the barium filled intestine
    • after barium passes into the colon, the foreign body may retain the barium, making it more apparent

 

 

  • Conservative management
    • Stable animal
      • Presents very soon after ingestion with object anchored around the tongue
      • String is freed from around the tongue
      • Passes through the gastrointestinal tract in 1 to 3 days in about half of cats
      • Advantages if successful
        • Inexpensive treatment option
        • No risks associated with general anesthesia and surgery
      • Disadvantages if it doesn't work
        • Radiography and serial bloodwork are unreliable in determining the need for surgical intervention and the progression to peritonitis
        • Worsening clinical signs may be the only parameter upon which to abort conservative management and proceed to exploratory
        • High likelihood of intestinal perforations - delay in surgical removal may result in serious morbidity and possibly mortality
      • Conservative management is not recommended in the dog
  • Surgical Removal - the most effective and safest technique
    • Plicated area of bowel is isolated from the peritoneal cavity
    • Enterotomy incision is made midway along the site of the obstruction and the string is grasped
    • Anchor under the tongue or in the pylorus can then be cut
    • May necessitate multiple enterotomies
    • Perforations of the mesenteric border may not become apparent until the tension on the string is released and the plications relax
    • Large sections of the intestine may have multiple mesenteric perforations, necessitating resection
  • Cats
    • good for uncomplicated removal
    • mortality reported, particularly with intestinal perforations
    • only a minority of reported cats have perforation at the time of surgey
  • Dogs - more guarded
    • Twice as likely to develop peritonitis and die
    • Over 40% require intestinal resection and anastomosis

Copyright 2002 University of Pennsylvania School of Veterinary Medicine
VHUP Department of Clinical Studies
Student Web Designers: Srinivas Lingareddy, V'03 (2001) and Karen O'Connor, V'04 (2002)