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Journal of Advances in VetBio Science and Techniques J Adv VetBio Sci Tech, 2022, 7(2), 233-241
233
Gastrointestinal linear foreign bodies in cats: A
retrospective study of 12 cases
ABSTRACT
Gastrointestinal foreign bodies are common in animals and may present with various
clinical manifestations depending on the location, severity, and duration of the
obstruction. Linear foreign body (LFB) obstructions are more common in cats
compared to dogs, and the foreign body causing the obstruction is usually thread or
threaded needle. In this study, it was aimed to determine the radiography and the
localization of the obstruction in the diagnosis of LFB in cats, to investigate the
operative treatment options and their effects on the prognosis. The study material
consisted of 12 cats of different breeds, ages, and genders, which were referred with the
suspicion of foreign body with acute/chronic vomiting and anorexia. After the
identification of obstruction due to foreign body, the treatment was planned
considering its localization, severity and duration of pathology. All foreign bodies were
removed through surgical procedures. The most common finding was the plication in
the intestines. Four cats died in the postoperative period. As a result, an early and rapid
diagnosis of LFB positively affects the prognosis. Intestinal perforations caused by
LFB and infection due to bacterial translocation are inevitable in delayed cases.
Another issue to be considered is that extremely important to carry out a detailed
examination of the mouth in cats, which show symptoms of gastrointestinal system
origin illness. In addition, it is thought that to pull out the LFBs that protrude from the
anus increase the perforation risk of intestine.
Keywords: Cat, foreign body, gastrointestinal, linear, vomit
NTRODUCTION
Gastrointestinal (GI) foreign bodies are common in pets and may
present with various clinical manifestations depending on the
severity, location, and duration of the obstruction (Aronson et al.,
2000; Papazoglou et al., 2003). In general, complete obstruction
is associated with more dramatic clinical signs and a rapid worsening,
whereas partial obstruction may be associated with more chronic signs
of inadequate digestion and malabsorption (Papazoglou et al., 2003).
Intestinal foreign bodies are easy to treat and have a good prognosis if
diagnosed early. However, special situations may occur for surgeons due
to linear foreign bodies (LFB) (thread, fabric, tape, cord, etc.). These
foreign bodies can easily pass through the GI tract. However, these
objects are usually stuck while passing through around the base of the
tongue and pylorus (Evans et al., 1994). As peristalsis continues, foreign
bodies become tense and embedded in the mesenterium of the GI lumen.
Thus, the intestines get compressed due to LFB and causes plication. As
a result, perforation may occur in the intestines (Aronson et al., 2000;
Hayes, 2009).
How to cite this article
Parlak, K., Akyol, ET., Uzunlu, EO., Zamirbekova, Boran Çayırlı, ÜF., Arıcan M. (2022).
Gastrointestinal linear foreign bodies in cats: A retrospective study of 12 cases. Journal of
Advances in VetBio Science and Techniques, 7(2), 233-241.
https://doi.org/10.31797/vetbio.1131263
Research Article
Kurtulus Parlak1a
Eyüp Tolga Akyol2b
Elgin Orçum Uzunlu1c
Nuriza Zamirbekova1d
Ümmügülsüm Fatma
Boran Çayırlı1e
Mustafa Arıcan1g
1Department of Surgery
Faculty of Veterinary
Medicine, Selçuk University,
Konya, Türkiye
2Department of Surgery,
Faculty of Veterinary
Medicine, Balıkesir
University, Balıkesir, Türkiye
ORCİD-
a0000-0002-8656-037X
b0000-0002-9775-7557
c0000-0001-5356-8968
d0000-0003-4465-5511
e0000-0001-9131-0917
f0000-0001-8180-135X
Correspondence
Kurtulus PARLAK
kparlak@selcuk.edu.tr
Article info
Submission: 15-06-2022
Accepted: 18-08-2022
Online First: 20-08-2022
Publication: 31-08-2022
e-ISSN: 2548-1150
doi prefix: 10.31797/vetbio
• http://dergipark.org.tr/vetbio
This work is licensed under a
Creative Commons Attribution 4.0
International License
I
Gastrointestinal linear foreign bodies in cats
234
It has been reported that LFB obstructions
are more common in cats than in dogs, and the
object causing the obstruction is mostly thread
or thread-needle (Bebchuk, 2002; Evans et al.,
1994; Felts et al., 1984; Hayes, 2009). The most
common clinical manifestations are vomiting,
anorexia, and depression for both species
(Bebchuk, 2002; Evans et al., 1994).
In this study, it was aimed to investigate the
role of radiography in the diagnosis of LFB in
cats, determination of obstruction localization,
surgical treatment options and their effects on
prognosis.
MATERIAL and METHOD
Animal
The study material consisted of 12 cats of
different breeds, ages and genders, which were
referred to Selcuk University Faculty of
Veterinary Medicine Surgery Clinic with
acute/chronic vomiting and anorexia, with
suspicion of foreign body. Clinical signs and
the anamnesis of the cats were recorded on the
general examination forms at admission, and
owners were asked if they witnessed swallow of
the foreign body and the time that had elapsed
occur clinical signs and admission.
Clinical Examination
The physical examination started with direct
inspection of the oral cavity in all animals and
continued with palpation of the esophagus and
abdomen. The obtained data were recorded.
Vascular catheterization on the vena cephalica
antebrachi and hematological examinations
(blood gas analysis with GEM Premier 3000,
USA and hemogram with MS4e, France) were
performed. In order to diagnose the foreign
body, radiological examination of the GI tract
(right or left lateral and ventro-dorsal positions)
were performed. Contrast-enhanced
radiography was performed with Barium
Sulfate 60% solution (2 mL/kg, PO) in cases
without intestinal perforation which do not
show signs of peritonitis in physical,
radiological and hematological examination.
Surgical Treatment
After the identification of the foreign body that
caused the obstruction, treatment was planned
considering its localization, severity and
duration of pathology. For the surgical
procedure, medetomidine HCl (Domitor®-
Zoetis, 0.025 mg/kg, IM) and butorphanol
(Butomidor-Interhas 0.1 mg/kg, IM) were
administered as preanesthetic. Subsequently,
anesthesia induction was achieved by
administering propofol (Propofol-Lipuro 1%®
1.5-3 mg/kg, IV). Then the cats were intubated
and anesthesia was maintained with isoflurane
(Isoflurane 2%-Adeka Pharmaceuticals, for
maintenance anesthesia) in 100% oxygen with a
flow of 2 L/min.
In all cases, abdominal exploration was
performed starting from the stomach to the
rectum and intestinal segments were carefully
examined. After the location of the foreign
body was determined enterotomy was used to
remove it. In a case with invagination,
resection/anastomosis was performed in
addition to enterotomy. In addition to
enterotomy, gastrotomy was performed in two
cats in which the foreign body caused
obstruction in the pylorus. In the presence of a
foreign body connected with the oral cavity,
before removal by enterotomy, the foreign body
was released from the oral cavity by an
assistant. After all foreign bodies were
removed, the incision line on the intestine was
routinely closed with a single layer of
continuous suture (parallel suture in the
antimesenteric region or transverse suture in the
stenotic segment). Polydioxanone (PDO 3/0 and
2/0) nontraumatic sutures were used as suture
material. The leak test was performed by
injecting physiological saline with the syringe
from the cranial side of the suture line. After the
closure of the incision lines, the omentum was
sutured to the cranial and caudal of the incision
VetBio, 2022, 7(2), 233-241
235
lines with simple separate sutures. Abdominal
cavity was lavaged at least twice with warm
saline and closed routinely.
Metoclopramide HCl (0.2 mg/kg, IM) to
counteract vomiting and, fluid therapy (lactated
Ringer's solution, 100 mL, ql2h, IV) were given
for correcting dehydration and improving tissue
perfusion in all cats. For postoperative
antibiotic therapy, metronidazole (Polygyl
0.5%, Polifarma 7.5 mg/kg, q24h, IV) for 3
days and cefazolin sodium (Iespor®, Ulagay
Pharmaceutical, 30 mg/kg, q24h, IM) for 7 days
were administered. As analgesic, meloxicam
(Metacam®, Bohringer Ingelheim) was
administered (0.1 mg/kg, q24h, PO) on the first
day and continued (0.05mg/kg, q24h, PO) for
the next 4 days. Soft diet intake was allowed
after temporary diet restriction for 8-12 hours
postoperatively.
RESULTS
Clinical findings
The animals included in the study were
determined as young animals with a mean age
of 15 months (6 months-5 years), and gender
distribution was 5 males and 7 females. The
breed distribution was observed as 7 mixed
breeds, 1 Blue Point Siamese, 2 British
Shorthairs, 1 Scottish Fold and 1 Siamese
(Table 1).
None of the patient owners reported
witnessing foreign body ingestion. Only one cat
(case 10) had a history of suspected foreign
body ingestion, and another two cats (case 6
and 12) had a history of partially protruding
foreign body (thread) from the anus at certain
intervals. According to the anamnesis, it was
noted that food intake decreased after vomiting
in early period, and completely stopped with
recurrent vomiting.
Table 1. Signalements and diagnosed foreign bodies of the cases
Case
Signalements
Diagnosis
Treatment
Breed
Age
Sex
History
1
(EX)
Mix
1
year
Male
Vomiting for 2 days, no defecation
LFB (thread)
Enterotomy and
Gastrotomy
2
Siamese
6
months
Female
Loss of appetite and vomiting for 7
days
LFB (thread)
Enterotomy
3
Mix
9
months
Female
Loss of appetite and vomiting lasting
more than 1 week
LFB (thread)
Enterotomy
4
Mix
1
year
Female
Loss of appetite and vomiting lasting
more than 1 week
LFB (threaded needle),
perforation
Enterotomy
5
British
shorthair
1
year
Male
Loss of appetite and vomiting lasting
more than 1 week
LFB (thread)
Enterotomy
6
(EX)
Mix
5
years
Male
Vomiting and loss of appetite for 4
weeks, protruding LFB through the
anus
LFB (thread), seen on
the base of the tongue
Enterotomy
7
Scottish
fold
2
years
Female
Up to 30 times vomiting per day for 5
days, no defecation
LFB (thread), seen on
the base of the tongue
Enteretomy
8
Blue point
7
months
Male
Vomiting and loss of appetite for 3
days, no defecation
LFB (thread),
invagination
Enteretomy and
resection/
anastomosis
9
Mix
1
year
Female
Loss of appetite and vomiting for 3
weeks
LFB (thread),
perforation
Enterotomy
10
Mix
2
years
Female
Loss of appetite and vomiting for 5
days
LFB (thread),
perforation
Enterotomy
11
(EX)
British
Shorthair
11
months
Male
Loss of appetite and vomiting for 5
days
LFB (thread),
perforation
Enterotomy
12
(EX)
Mix
9
months
Female
Loss of appetite and vomiting for 1
week, protruding LFB through the
anus for 2 weeks
LFB (thread),
perforation
Enterotomy
LFB: Linear Foreign Bodies
Gastrointestinal linear foreign bodies in cats
236
The primary findings in the clinical
examinations of all cats were varying degrees of
vomiting, loss of appetite, tangles and matting
of the coat. Dehydration and lying in the sternal
position were observed in all cats. The absence
of defecation, which suggested a complete
obstruction, was noted in three cats (cases 1, 7,
8). Besides these clinical symptoms, abdominal
pain was observed in 50% (cases 4, 6, 8, 9, 10,
12) and retching was observed in 17% (cases 6,
7). Severe abdominal pain was observed
especially in cases with the presence of
intestinal perforation (cases 4, 9, 10, 11 and 12)
(Figure 1). In addition, the case with the needle
as foreign body were located in the intestine
also showed the abdominal pain (case 4). In the
clinical examination, foreign body (thread) was
encountered under the tongue in two cats (cases
6 and 7) (Figure 2). During the intraoral
inspection it was observed that the foreign body
extending from the mouth to the intestines. In
response to the oral examination, decreased
neck movements, and ptyalism were noted in
both cats. Lethargy, anorexia, retching, and
severe vomiting were mainly observed in cases
of the foreign body located in the mouth.
However, vomiting and anorexia were often
observed in cases of the foreign body which
located in the lower GI tract. The owners
reported that medical treatment was performed,
and no response obtained in these cats. For this
reason, only 3 of the cases (cases 1, 8 and 10)
were diagnosed in the early period.
Figure 1. Foreign body (thread) causing perforation (black arrow).
Figure 2. Looped LFB (thread) around the base of the tongue.
VetBio, 2022, 7(2), 233-241
237
Hematological Findings
Some hematological parameters were evaluated
(Table 2). Hypokalemia (42%, n=5),
hypernatremia (42%, n=5), hyperchloremia
(50%, n=6), hypochloremia (20%, n=2) and
hyperlactatemia (50%, n=6) were identified.
However, it was observed that 60% (n=3) of
cats with hypernatremia progressed with
hyperchloremia.
Table 2: Hematological and biochemical values
Case
pH
(mmol/L)
(7.35-7.40)
pO2
(mmHg)
(35-100)
K+
(mmol/L)
(3.5-5.8)
Na+
(mmol/L)
(135-152)
Cl-
(mmol/L)
(106-115)
cLac
(mmol/L)
(0.6-2.2)
WBC
(x103/L)
(5.5-19.5)
HCT
(%)
(30-57)
1
7.39
40.2
3.6
159
122
1.4
18.4
56.2
2
7.49
40.7
2.9
162
107
2.5
20.1
61.3
3
7.36
43.0
3.4
145
113
7.2
37.4
19.2
4
7.31
38.2
2.8
140
103
5.6
10.5
59.2
5
7.54
28.0
2.1
162
89
2.5
35.9
67.5
6
7.37
55.4
4.4
149
120
3.7
8.9
54
7
7.48
42.5
4.2
151
124
1.5
12.4
61.6
8
7.40
30.1
4.1
159
122
1
29
40.8
9
7.38
38.2
3.9
151
121
1.5
7.2
57.4
10
7.37
31.0
3.6
170
126
1.9
18.5
52
11
7.51
56.2
3.1
148
106
2.4
17.3
57.7
12
7.33
33.7
4.8
137
109
1.5
10.4
36
Radiological Findings
Direct radiographic examination was performed
for all cases. The barium sulfate was used in
cases requiring contrast-enhanced radiography
(cases 6, 8). However, severe vomiting, the
vomiting reflex that developed after ingestion
of barium sulfate prevented contrast-enhanced
radiography. As a result of radiographic
examinations, foreign body (needle) was clearly
observed in 1 case (case 4). In the other cases
after detection of obstruction and plication
findings (Figure 3) experimental laparotomy
decision was taken and the foreign body was
determined during the surgical procedure.
Figure 3. Plication (arrows) and obstruction (arrowhead) findings on contrast-enhanced radiographs.
Gastrointestinal linear foreign bodies in cats
238
Surgical Findings
In two cats (cases 6 and 7) the foreign body was
detected to locate in upper GI tract, in other
cases it was seen in lower GI tract region. In the
present study encountered foreign bodies were
thread but only one threaded needle found in
one case (case 4).
All foreign bodies were removed using one
or more of the surgical procedures such as
gastrostomy, enterotomy and resection/
anastomosis following laparotomy. Intestinal
plication was evident in ten cats (Figure 4). In
the present study, intestinal perforation in five
cats (cases 4, 9, 10, 11 and 12) and intestinal
invagination at three points in one cat (case 8)
were observed (Figure 5). Intestinal
perforations were caused by ingested foreign
bodies that are sharp and elongated, such as
needle and thread. In cases with perforation due
to thread, there was excessive plication in three
cats. However, plication was not observed in
two cats with intestinal invagination (case 8)
and perforation due to thread as foreign body
(case 9). Four cats died in the postoperative
period (cases 1, 6, 11 and 12).
Figure 4. Typical plication of intestines.
Figure 5. Invagination on the different three sites (black arrow).
VetBio, 2022, 7(2), 233-241
239
DISCUSSION
Direct radiographs are used in the diagnosis of
foreign bodies. However, it was not always
sufficient for a definitive diagnosis (Elser et al.,
2020). Although direct radiographs are very
helpful in the diagnosis of needles and similar
radiopaque materials, they are quite insufficient
in the diagnosis of radiolucent foreign bodies
such as threads. The fluid or gas accumulation
can be observed in the intestines or stomach,
these findings are not pathognomic for the
foreign bodies, and contrast-enhanced
radiography or USG examination are needed in
accordance with the literature (Codrenau et al.,
2019; Madany et al., 2020).
Hypochloremia, metabolic alkalosis,
hypokalemia and hyponatremia have been
reported in dogs with various GI foreign body
cases, and LFB cases have generally been
associated with serum sodium changes. While
these changes were generally accompanied by
hyponatremia, they were accompanied by
hypernatremia in other foreign body cases.
However, the observed biochemical changes
were not associated with foreign body
localization (Boag et al., 2005). In our study,
hypernatremia was observed in five cats and no
hyponatremia was encountered. This situation
showed inconsistency with the literature data.
Literature data have been reported in dogs. In
this study, which evaluated cats, it was
observed that species differences were an
important factor in biochemical data. However,
foreign body localization and duration of
pathology differed, and no variation was
observed among the cats. In accordance with
the literature data, foreign body localization did
not cause specific biochemical changes.
The survival rate in LFB cases in cats has
been reported to be 84-92% (Basher & Fowler,
1987; Felts et al., 1984). These rates were
observed in the cats with the duration of clinical
findings between 1-10 days. However, the
mortality rate was reported to be quite high in
cases with symptoms over 14 days (Hayes,
2009). Clinical findings lasting up to 30 days
have been observed in some cases. In our study,
the clinical findings were similar to the periods
in the literature and were observed
predominantly for 7 days (2-30 days). The
survival rate in our study was 66% (n=8) and it
is consistent with the literature data. Although
mortality rates were generally associated with
more than one enterotomy site in these studies,
it was thought that the effect of chronic partial
obstructions caused by LFB may also contribute
to the mortality rate. In addition, perforation in
the lower GI tract and subsequent peritonitis
have also been associated with deaths (Aronson
et al., 2000; Basher & Fowler, 1987). The
association of chronic partial obstructions with
mortality is consistent with the presence of a
14- and 30-days foreign body history in two of
the cats that died in our study. This may cause
an increase in mortality in chronic cases
(Aronson et al., 2000). It was thought that the
mortality rate could be observed in acute cases
as well as in chronic cases, depending on the
severity of the obstruction.
It has been reported that partial obstruction
usually occurs in LFB cases (Aronson et al.,
2000). Similar to this, partial obstruction was
encountered in most cases, while complete
obstruction was encountered in only one case in
our study. This case died after surgical
treatment. This showed that complete
obstructions can also be encountered in cases of
LFB, suggesting that this may be more fatal
than in cases of non-LFBs.
The owners’ observation in foreign body
located in the oropharyngeal region is very
important. In our study, the findings of
ptyalism, tenderness in the cervical region and
loss of appetite before the clinical examination
suggested the presence of a foreign body in the
mouth. In this situation, a simple intraoral
control is done by animal owners could
accelerate the diagnosis and contribute to a
better prognosis. In our study, the foreign body
Gastrointestinal linear foreign bodies in cats
240
(thread on the base of the tongue) detected in
the oropharyngeal region at a rate of 17% (n=2)
and it was similar to the literature data (Neamtu
et al., 2021; Pratt et al., 2014). Anorexia,
retching and vomiting were frequently observed
clinical findings. Severity of these clinical
findings were associated with the interest of the
animal owner. In this study, a case was
admitted to the clinic after 30 days later of
ingested foreign body when the clinical
symptoms became more severe. The increase of
the mortality rate has also been associated with
the patient's admission time to the clinic.
In a previous study, it was reported that the
location, severity and duration of the
obstruction were not associated with the
survival rate (Hayes, 2009). Severity,
localization and duration of obstruction due to
the LFB were varied in this study. Nevertheless
75% of the cats were survived after the surgical
treatments. The cats with chronic and complete
obstruction were died. It has been observed that
the localization of the foreign body has no
effect on the mortality rate, which is consistent
with the literature. However, contrary to the
literature, it was thought that the severity and
especially the duration of the obstruction may
have an effect on the mortality rate.
CONCLUSION
As a result, early and rapid diagnosis of LFB
positively affects the prognosis in the post-
operative period. Secondary infection caused by
LFB should be avoided in delayed cases. LFBs
that protrude from the anus should not be made
to pull out. This increases the risk of plication
and perforation. Cat owners should be warned
about this. Another issue to be considered is
that it is extremely important to carry out a
detailed oral examination if the conditions are
suitable, in cats that have symptoms generally
originating from the GI system, such as
vomiting, loss of appetite, and irregular
defecation.
ACKNOWLEDGMENT
This manuscript was presented in the Second
International Congress on Biological and Health
Sciences (ICBH) (Online, 24-27 February 2022),
presentation type (oral), publication type (abstract),
with the title of “Gastrointestinal Linear Foreign
Bodies” by Kurtuluş Parlak.
Ethical approval: This study was approved by the
Selcuk University, Faculty of Veterinary Medicine,
Laboratory Animal Production and Research Center
Ethics Committee (SUVDAMEK) with the decision
date (06.01.2022) and number (2021/146). Patient
owners of all cases signed an informed consent
form.
Conflict of interest: The authors declared that there
is no conflict of interest.
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