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Intestinal Foreign Bodies in Dogs and Cats

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 830 V Vol. 25, No. 11 November 2003

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Intestinal Foreign Bodies

in Dogs and Cats
KEY FACTS
Aristotle University of Thessaloniki
Thessaloniki, Greece
■ Ultrasonography is a valuable
tool for diagnosis of intestinal L. G. Papazoglou, DVM, PhD, MRCVS
foreign bodies. M. N. Patsikas, DVM, PhD, DECVDI
T. Rallis, DVM, PhD
■ Proper fluid and electrolyte
administration is essential for
management of patients with ABSTRACT: Intestinal foreign bodies are some of the most common causes of intestinal obstruc-
intestinal foreign bodies. tion in dogs and cats. The size of the foreign body determines whether obstruction is partial or
complete. Life-threatening complications caused by fluid and electrolyte imbalances, hypo-
■ Asymptomatic cats with linear volemia, and toxemia may be associated with intestinal foreign bodies. Diagnosis is made on the
foreign bodies may be managed basis of clinical signs and results of radiography and ultrasonography and is confirmed by
abdominal exploration. Most foreign bodies can be removed through one or more enterotomies.
conservatively.

D
ogs and cats may ingest foreign bodies (FBs) that cause intestinal
obstruction, which is one of the most common intestinal disorders
requiring emergency surgical treatment. FBs may lodge in any part of
the intestinal tract; obstruction most often develops in the small intestine when
the luminal diameter becomes smaller.
FB obstruction may be classified1–3 on the basis of:

• Degree of obstruction (complete or partial)

• Location of obstruction along the intestinal tract (proximal or “high”; mid-
dle; distal, or “low”; and colonic)
• Pathophysiologic alterations (simple, or mechanical, versus strangulating)
The degree of obstruction is usually dictated by the size of the FB. Small irreg-
ular or linear FBs can cause partial obstruction (with limited passage of fluid or
gas), whereas complete obstruction may be attributed to large circular FBs. A
high intestinal obstruction involves the duodenum or upper jejunum; a middle
intestinal obstruction, the middle jejunal region; and a low intestinal obstruc-
tion, the distal small intestine. FBs usually induce simple (or mechanical) intes-
tinal obstruction in which no compromise in the intestinal wall blood supply
occurs. A strangulating obstruction, which is usually complete, involves impair-
ment of the blood supply of the involved intestinal segment. However, in clini-
cal situations few obstructions are purely simple because there is almost always
some form of vascular impairment in the affected region of the intestinal wall.3
Knowledge of pathophysiology is essential for correct diagnosis and quick and
systematic treatment of the patient with suspected intestinal obstruction.

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832 Small Animal/Exotics Compendium November 2003

Cause of lymphatic and venous congestion

Secretion
Absorption
Myoelectric activity Edematous intestinal wall
Bacterial overgrowth and toxins

Ingested air and fluids Gas and fluid distention Mucosal pressure causes
ischemia/necrosis

Foreign Diarrhea
Body
Vomiting
Fluid and electrolytes

Figure 1—Basic pathophysiologic mechanisms of FB-induced intestinal obstruction.

PATHOPHYSIOLOGY and ileal mucosa for reabsorption.2 In distal intestinal

Intestinal obstruction involves a complex interaction obstructions, some fluid moves proximally by reverse
of local and systemic factors 1,2,4,5 (Figure 1), which peristalsis and reaches a nondistended intestinal loop,
remain partly obscure. Life-threatening complications where normal absorption occurs.2 Although the patho-
result because of fluid, acid–base, and electrolyte imbal- physiology of these events has yet to be completely
ances, hypovolemia, and toxemia.4,6 defined, four major mechanisms of hypersecretion and
In complete simple intestinal obstruction, accumula- decreased absorption may exist:
tion of gas and fluid contributes to luminal distention
proximal to the obstruction.1,7 Most of the gas is swal- • Hypersecretion mediated by enteric bacterial toxins
secreted by noninvasive pathogenic bacteria that
lowed air (70% nitrogen, 10% to 12% oxygen, and 1%
bind specific enterocyte receptors and stimulate salt
to 3% hydrogen); carbon dioxide (6% to 9%) formed as
and water production via the messenger cAMP or
a result of bicarbonate neutralization in the intestinal
cyclic guanosine monophosphate pathways4,5
lumen; and organic gases (methane [1%] and hydrogen
sulfide [1% to 10%]) derived from bacterial fermenta- • Increased concentrations of bile and fatty acids and
tion.1 Gaseous luminal distention gradually increases be- products of tissue ischemia at the obstruction site4
cause nitrogen is not absorbed by the intestinal mucosa.3 • Increased blood flow in the proximal parts of the
Accumulating fluids come from two sources: an intestinal obstruction that may stimulate secretory
increased amount of secretion in the upper gastrointesti- activity10
nal tract (saliva and bile, and gastric, pancreatic, and
small intestinal secretions) and retention of ingested flu- • Release of serotonin (5-hydroxytryptamine) by
enteroendocrine cells that may be stimulated by
ids.2 Solute absorption is reduced because of lymphatic
increased luminal distention, which activates reflex
and venous congestion, increased intraluminal osmolal-
pathways that increase chloride ion secretion11
ity, and decreased enterocyte turnover rate.2,8,9 After 24
hours of obstruction, the distended bowel may lose its Moreover, chemical mediators of the enteric nervous
ability to absorb fluids, and local hypersecretion is system, such as acetylcholine, vasoactive intestinal
observed.2 Intraluminal fluid volume is increased as the polypeptide, and substance P, activate chloride ion–rich
obstruction becomes prolonged.8 In complete proximal fluid secretion by various mechanisms.5,12,13
intestinal obstructions, a large quantity of secretions and The effects of luminal distention are related to the
ingested fluids cannot establish contact with the jejunal increasing intraluminal pressure generated proximal to

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834 Small Animal/Exotics Compendium November 2003

the intestinal obstruction and to the duration of the fluid lost and its metabolic effects depend on the degree,
obstruction.1 Intraluminal pressure proximal to the location, and duration of the intestinal obstruction. Fluid
obstruction increases gradually because of fluid and gas and electrolyte losses are caused by vomiting, sequestra-
accumulation (Figure 1). The arterial circulation is not tion in the intestinal lumen, diarrhea, intestinal wall
affected, but capillary bed congestion may occur and edema, and extravasation into the peritoneal cavity.3,4
lead to elevated hydrostatic pressure that produces Clinical signs of partial intestinal obstruction are
intestinal wall edema. 3 In addition, fluid can be associated with maldigestion and malabsorption of
extravasated through the serosal surface to the peri- nutrients (stagnant loop syndrome). Diarrhea may be
toneal cavity.2 Experimental studies with dogs docu- attributed to combined osmotic effects of unabsorbed
mented selective mucosal ischemia after simple intes- substances in the intestinal lumen and to secretory
tinal obstruction, when intraluminal pressure rose activity of enterocytes.6,9 FB-induced colonic obstruc-
above 40 mm Hg.14 At a pressure of 44 mm Hg, the tion is usually partly due to distensibility of the colon
blood supply to the intestinal segment may be severely and its slightly rhythmic segmentation.3 Obstruction
compromised so that blood is shunted away from intes- causes large quantities of feces to accumulate in the
tinal capillaries and into arteriovenous anastomoses. In colon and water and electrolyte absorption to take
spontaneous intestinal obstruction, full-thickness place, often prolonging the course of the disease.6
necrosis of the intestinal wall may not be seen in the
dilated proximal segment because intraluminal pressure NONLINEAR FOREIGN BODIES
is apparently below 50 mm Hg.14 Large FBs, because of Dogs, especially young dogs (mean age, 3.5 to 3.7
the pressure that they apply on the intestinal wall, may years),17 may ingest a large variety of nonlinear FBs.4,17,18
cause venous stasis and edema followed by arterial flow Young dogs commonly chew on objects, and the recent
compromise, ulceration, necrosis, and perforation. 1 disappearance of an object may raise suspicion of intes-
Also, linear FBs may cause increased peristaltic activity tinal obstruction. In dogs, the nonlinear FBs most
proximal and distal to the obstruction site and con- often encountered include stones, plastics, fabrics,
tribute to intestinal wall laceration.1 coins, rubber objects, food wrappings, toys, bottle caps,
Intestinal luminal distention causes increased myo- fish hooks, sewing needles, marbles, corn cobs, hair-
electric activity proximal to the obstruction and a balls, fruit seeds, tampons, and bones. 4,17,18 In cats,
simultaneous decrease distally.15 As the duration of however, ingestion of nonlinear FBs, except trichobe-
obstruction is prolonged, clusters of intense myoelectric zoars, is rare.19 Round smooth FBs, such as balls, may
activity that migrate distally are interrupted by periods cause complete intestinal obstruction and pressure
of absent motor activity. These periods of inactivation necrosis of the intestinal wall. Sometimes, if they move
may represent a protective mechanism because unin- down the intestine, these objects can cause intestinal
hibited hyperperistalsis may result in elevated intralu- edema.3 Sharp FBs may penetrate the intestinal wall
minal pressure that can lead to ischemia and rupture.15 and cause septic peritonitis and adynamic ileus.
Increased myoelectric activity proximal to an intestinal
obstruction appeared to be cholinergically mediated, Diagnosis
whereas noncholinergic nonadrenergic pathways may Clinical Signs and Physical Examination
mediate distal inhibition of spike bursts.16 Findings
Simple intestinal obstruction may cause an increase The clinical picture and survival associated with intes-
in the intraluminal pathogenic bacterial population as a tinal obstruction depend on the degree of obstruction,
result of stasis or loss of the migratory myoelectric com- location of obstruction, and changes in intestinal blood
plex, which helps move intestinal contents distally and flow.6 Complete obstructions are usually more acute
keeps bacterial numbers low.2,4 Prolonged and severe than are partial obstructions, proximal obstructions are
luminal distention may impair the enteric mucosal bar- more acute than are distal obstructions, and strangulat-
rier and result in increased permeability and entry of ing obstructions are more severe than are simple
bacteria and toxins into the systemic circulation, caus- obstructions.6 Common clinical signs include anorexia,
ing endotoxic shock, or into the peritoneal cavity, dehydration, depression, abdominal pain or discomfort,
resulting in septic peritonitis.1 Prompt decompression and vomiting. 17,20 Intestinal obstruction should be
of obstruction is advisable because it allows quick included in the differential diagnosis of a patient with
mucosal regeneration.14 acute vomiting, chronic diarrhea, acute abdomen, and
A significant amount of fluids and electrolytes can be weight loss. The differential diagnosis includes acute
lost in simple obstruction, which results in hypovolemia gastritis, intussusception, acute pancreatitis, peritonitis,
and electrolyte and acid–base imbalances.1 The volume of and parvoviral enteritis in young dogs.

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Compendium November 2003 Intestinal Foreign Bodies in Dogs and Cats 835

Figure 2—Lateral abdominal radiograph showing a plastic FB Figure 3—Lateral abdominal radiograph showing a peach
in the small intestine of a dog. seed (arrowheads) in the small intestine of a dog.

Vomiting may lead to dehydration and depression. In Laboratory Findings

these situations, signs of malabsorption and maldiges- Laboratory findings vary according to the nature of
tion are noted. In experimental complete proximal the intestinal obstruction. Packed cell volume and total
intestinal obstruction in dogs and cats, vomiting began protein levels may be elevated, and serum albumin con-
within 24 to 72 hours after obstruction. 2,8,21 Profuse centration may be decreased. Intestinal perforation may
vomiting may be seen in complete proximal obstruc- cause leukocytosis with a shift to the left. In early stages
tions, whereas vomiting is usually intermittent in par- of pyloric obstruction, vomiting of gastric juices that
tial distal obstructions and may be seen 2 to 3 days are rich in potassium, sodium, hydrogen, and chloride
after obstruction. 2 Defecation may be absent 17 or ions may result in hypochloremic, hypokalemic, and
decreased in frequency; bloody stools may occur, with moderately hyponatremic metabolic alkalosis.2 Duode-
or without mucus. Diarrhea is common in animals nal and proximal jejunal obstructions may be associated
with partial intestinal obstruction. Distal intestinal with vomiting of intestinal contents containing
obstruction is characterized by lethargy, anorexia, and hydrochloric acid and pancreatic secretions rich in
weight loss; animals can drink but not eat.2 bicarbonate, which results in mild metabolic acidosis
Careful abdominal palpation may or may not reveal and dehydration.2 In distal intestinal obstruction, prox-
the presence of an FB17,18 and intestinal fluid and gas imal intestinal secretions rich in bicarbonate are
accumulating proximally. In deep-chested dogs, abdom- sequestered at the obstruction site. Bicarbonate loss,
inal palpation is facilitated if the front legs are elevated. dehydration, and starvation contribute to development
Palpation may elicit abdominal pain,17 and sedation is of metabolic acidosis.1 In cases of chronic intestinal
required for nervous animals. Abdominal auscultation obstruction, a slight increase in the activity of alanine
may detect noise resulting from peristaltic rushes or aminotransferase, alkaline phosphatase, and lipase, as
silence in the case of adynamic ileus or peritonitis.4 well as in blood urea nitrogen and creatinine concentra-
The major cause of death in animals with proximal tions, may be noted.
intestinal obstruction may be hypovolemia and acid–
base and severe electrolyte imbalances. With no treat- Diagnostic Imaging
ment of these disorders, death usually results in 3 to 4 Radiopaque intestinal FBs can easily be seen in plain
days.1 If the animal survives, toxemia caused by bacter- radiographs (Figure 2). Certain other nonopaque FBs
ial proliferation in the obstruction site may also cause can be identified on the basis of a typical shape and
death.6 In distal intestinal obstruction, however, ani- contained gas lucencies22 (Figure 3). Diagnosis of radio-
mals may live for 3 weeks or longer if water intake is lucent intestinal FBs is based on radiographic signs of
adequate.2 Fluid loss and toxemia related to bacterial intestinal obstruction. The radiologic diagnosis of FB-
proliferation are causes of death in complete distal induced intestinal obstruction is usually based on signs
intestinal obstruction. In chronic colonic obstructions, that may include localized intestinal distention related
animals become anorectic and die of starvation.6 to gas or fluid accumulation, distended intestinal loops

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836 Small Animal/Exotics Compendium November 2003

A B

Figure 4A—The irregular curvilinear strong echogenicity that Figure 4B—A rubber ball (FB) in the small intestine. The ball
casts a “clear” shadow represents metallic wires obstructing has echogenic borders but is anechoic.
the intestinal lumen.
Figure 4—Two ultrasonographic appearances of intestinal FBs in dogs.

that lie in layers parallel to each other and are con- be used for the study.26 Barium-impregnated polyethyl-
nected with sharp hairpin turns, and unequal gas–fluid ene spheres were developed to assist in the diagnosis of
interfaces seen in a standing lateral projection.7,23 Distal intestinal obstruction in dogs and cats. Radiopaque
intestinal obstruction may produce greater distention spheres may have a high sensitivity for diagnosis of
with more accumulation of fluid or gas compared with chronic partial intestinal obstruction. In acute simple
proximal intestinal obstruction.20 The differential diag- intestinal obstruction, however, spheres are of limited
nosis should include other intraluminal, extraluminal, use because they cannot differentiate functional intes-
or intramural causes of intestinal obstruction. Ady- tinal obstruction from simple.27
namic ileus produced by parvoviral enteritis in young Ultrasonography appears to be a valuable adjunct to
dogs may be considered.23 radiography for detection of FBs (Figure 4). Acoustic
Diagnosis of intestinal distention may be aided by patterns vary, depending on the physical properties of
use of the ratio of maximum intestinal diameter to the the FB and interaction with the ultrasound beam. FBs
height of the body of the fifth lumbar vertebra at its that transmit sound can be accurately detected; strongly
narrowest point. Values higher than 1.6 indicate the attenuating FBs produce acoustic shadows that, if seen
presence of distention; values higher than 2 indicate a in association with the intestinal lumen, can be a useful
high probability of obstruction.24 No intestinal disten- indicator of an FB.28
tion may be evident in cases of partial obstruction, but
accumulation of indigestible material proximal to the Treatment
obstruction may be noted (“graveling” sign).4 Conservative
In questionable cases, diagnosis requires examination Some small, sharp FBs, such as pins, sewing needles,
of the intestinal tract with contrast enhancement. A and fish hooks, that are found in asymptomatic animals
radiolucent area surrounded by contrast material out- may be treated conservatively and will pass unevent-
lining the FB may be visualized. Prolonged gastric fully, possibly because of the generation of local intes-
emptying or small intestine transit time or complete tinal dilation (mural withdrawal reflex) in response to
stasis (depending on the degree of obstruction) charac- contact between the mucosa and this kind of FB.4 FB
terizes simple intestinal obstruction.25 Dilution of the transit through the intestinal tract should be monitored
barium suspension can be seen in a distended, fluid- radiographically, and the animal should be evaluated
filled, proximal intestinal segment.25 Contrast studies clinically on a regular basis to ensure uncomplicated FB
may be repeated at 6-hour intervals after barium passage.3,20 Movement of the FB through the ileocolic
administration for diagnosis of most proximal small junction is not an indication of complete elimination
intestinal obstructions; for repeated studies of most dis- because colonic or rectal perforation is still possible.3
tal small intestinal obstructions, 24-hour intervals are Occasionally, a nonlinear FB that causes a large intes-
needed.20 In cases of suspected intestinal perforation, a tinal obstruction may be dislodged endoscopically.
water-soluble contrast agent rather than barium should Conservative treatment of hairballs in long-haired cats

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838 Small Animal/Exotics Compendium November 2003

may include administration of semisolid petrolatum- characterizes the distended intestinal loops. The affected
based laxatives for lubrication and easy aboral elimina- intestinal segment is exteriorized and isolated from the
tion of the hairball and introduction of a commercial other viscera by moistened laparotomy sponges. Intesti-
diet to facilitate passage of ingested hair (e.g., Hill’s Sci- nal viability may be best assessed after decompression of
ence Diet Hairball Control formula).19 the distended loops and removal of the FB.
An enterotomy distal to the FB is performed in the
Surgical antimesenteric border, and the FB is removed. Incisions
Treatment of FB-induced intestinal obstruction is over the FB or proximal to the obstruction in the dis-
achieved by exploratory celiotomy. Preoperative stabi- tended intestine may interfere with normal intestinal
lization of the patient includes antibiotic prophylaxis healing, possibly because of some degree of vascular
and management of fluid, acid–base, and electrolyte compromise of the intestinal wall, and therefore such
imbalances. Prophylactic antibiotics are indicated in incisions are not recommended.20 The enterotomy is
animals with intestinal obstruction for two reasons: (1) closed in a single layer with a simple interrupted or
surgical techniques involving entrance to the intestinal continuous approximating pattern,31 by using 3-0 or 4-
lumen are considered clean-contaminated, and (2) the 0 synthetic absorbable sutures (polydioxanone, polygly-
risk of contamination is high because of bacterial over- conate). Monofilament nonabsorbable sutures such as
growth. For proximal and midintestinal surgery, first- polypropylene or skin staples may also be used. Suture
generation cephalosporins (e.g., cefazolin at 30 mg/kg bites are spaced 2 to 3 mm from the incision edges and
IV) should be administered. For distal small and large 3 to 4 mm apart.32 After closure, the enterotomy is
intestine surgery, second-generation cephalosporins lavaged with warm sterile saline, and omentum is put
(e.g., cefoxitin at 30 mg/kg IV) are recommended. Ide- around the incision to prevent leakage. Serosal patch
ally, antibiotic prophylaxis should commence preopera- reinforcement is advised for the contused intestinal wall
tively, approximately 30 minutes before the surgical to prevent postoperative leakage. For enterotomies in
incision, at the time of anesthetic induction; a second an intestinal loop with a small diameter, a transverse
dose may be given if surgical time exceeds 1.5 hours.29 closure is preferable to a longitudinal one to avoid
Fluid therapy aims at correcting dehydration and stenosis. On rare occasions, FBs such as needles, bones,
improving tissue perfusion. The fluid volume and rate and hairballs that are entrapped in the colon wall
of fluid administration depend on the degree of dehy- require colotomy for removal. Most colonic FBs can be
dration and the presence of shock. Acid–base and elec- milked distally to a point where they may be retrieved
trolyte values, if available, determine the type of fluid by using long forceps inserted through the anus.
to be administered. In the case of pyloric and proximal In most cases of simple intestinal obstruction, intes-
intestinal obstruction, administration of 0.9% sodium tinal viability is preserved, and the appearance of dark
chloride supplemented with potassium chloride (20 distended loops improves as soon as decompression and
mEq/L) is recommended because of possible alkalosis. FB removal are achieved.2 If nonviable tissue is present,
Otherwise, lactated Ringer’s solution supplemented intestinal resection and anastomosis are required. Clini-
with potassium chloride (20 mEq/L) is the appropriate cal criteria for intestinal viability assessment may
replacement fluid.4 In an experimental study of dogs include wall color, presence of arterial pulsations, or
with intestinal obstruction, colloids were better than peristaltic contractions induced by a mechanical stimu-
crystalloids when large volumes of fluids were required lation such as a pinch.2 However, these criteria do not
for volume expansion.30 Plasma oncotic pressure and give consistently accurate results.26 Fluorescein dye (20
net loss of fluid into the dilated intestinal lumen were mg/kg injected IV) viewed by a Wood’s lamp may assist
decreased after crystalloid administration, whereas with in the appreciation of intestinal wall vascularity.20 If via-
colloids the plasma oncotic pressure increased tem- bility is questionable and a significant length of intes-
porarily and the jejunum was allowed to maintain nor- tine is not involved, intestinal resection and anastomo-
mal absorptive capacity.30 sis would be safer and easier to perform.
A ventral midline celiotomy of sufficient length to Finally, the abdominal cavity is lavaged with warm
allow adequate inspection of the abdomen should be sterile saline and the celiotomy incision is closed
performed. The FB can be localized by evaluation of the routinely.
entire intestinal tract. The most common obstruction
sites in order of frequency are the jejunum, ileum, and Postoperative Care and Complications
duodenum.17,18 When complete intestinal obstruction is Maintenance fluid and electrolyte therapy should
present, marked intestinal distention proximal to the continue until the patient starts eating again. Usually,
obstruction may be seen, and congestion or cyanosis food and water are started 24 hours after surgery, pro-

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Compendium November 2003 Intestinal Foreign Bodies in Dogs and Cats 839

vided the animal is not vomiting. A bland diet is The pathogenesis of linear FB intestinal obstruction
offered in frequent, small feedings during the day. Early involves fixation of the FB at a cranial site of the diges-
food introduction may provide a source of fluids and tive tract. Usually, the linear FB either wraps around
electrolytes and may stimulate intestinal motility. the base of the tongue or is entrapped in the pylorus.
The most common and serious complication after Peristaltic waves continue to move the free end of the
FB removal is dehiscence of the enterotomy incision FB in a distal direction in the small intestine, with
with subsequent leakage of intestinal contents into the resultant pleating or gathering of the intestine around
peritoneal cavity, resulting in peritonitis. In a study of the FB. Occasionally, secondary intussusception may
dogs that underwent enterotomy for FB removal, the occur. Intestinal pleating may be explained by the fact
postoperative mortality rate in the dehiscence group that peristaltic waves cause movement of the intestine
was 73.7%.33 Signs of peritonitis may be vague at early and intestinal contents in an opposite direction. The
stages. Persistent vomiting, pyrexia, tachycardia, small intestine forms circular loops because of mesen-
abdominal pain, and leukocytosis may be seen and teric restriction, and the linear FB, being under ten-
indicate peritonitis. Diagnosis can be based on history, sion, tends to arrange in a straight line. The mesenteric
clinical signs, and results of abdominocentesis or diag- border thus becomes firm and edematous as the linear
nostic peritoneal lavage. Abdominal exploration, copi- FB is forced against the intestinal wall. Perforation of
ous lavage, resection, and anastomosis of the dehisced the affected intestinal loops eventually occurs as the FB
segment and peritoneal drainage are the recommended cuts through the intestinal wall at the mesenteric bor-
treatments.34 Dehiscence rates in small animals after FB der; local or generalized peritonitis ensues.4,7,36,38
removal in two studies ranged from 6% to 27.7%.31,33
FB entrapment in the intestinal lumen may compro- Diagnosis
mise blood supply, impair intestinal integrity, and result Clinical Signs and Physical Examination
in dehiscence.31,33 One study found that the mean time Findings
from surgery to dehiscence was 3.9 days, which corre- Cats with linear FBs (mean age of 64 cats, 2.7
lated well with the lag phase of intestinal healing.33 The years38; median age of 24 cats, 1 year 37) are younger
same study also found a significantly higher band neu- than dogs with linear FBs (mean age of 32 dogs, 4.5
trophil count during the first 4 to 6 postoperative days years; median age, 2 years39). Vomiting and anorexia are
and a higher incidence of peritonitis in the dehiscence common clinical signs37–39; bloody diarrhea may also be
group when compared with a group of animals without seen.4,20,38 Most affected cats may drink small amounts
dehiscence. Reasons that may contribute to dehiscence of water, and in many cats the frequency of vomiting
include excessive tension on the suture line, sutures decreased as the duration of intestinal obstruction
placed in nonviable tissue, poorly placed sutures, inap- increased. 38 Physical examination findings include
propriate suture material, traumatic tissue handling, depression, fever, dehydration, abdominal pain, a
and excessive mucosal eversion.26,31,33 Another study thread looped around the tongue, an FB hanging from
reported no difference in mortality for animals having the mouth, an FB protruding from the anus, and pal-
surgery on the small or large intestine: Both groups of pable intestinal plication.37–39 Thorough oral examina-
patients had the same risk for dehiscence or bacterial tion is mandatory for animals with a suspected linear
peritonitis.35 FB intestinal obstruction. An initial physical examina-
tion failed to detect the linear FB found at the base of
LINEAR FOREIGN BODIES the tongue in 6 of 13 cats that presented with the linear
Linear FBs produce a unique type of intestinal FB lodged sublingually.37 Nervous animals may need
obstruction in small animals because they may cause sedation to allow thorough oral inspection. A string
serious and extensive damage to the intestinal tract. was found around the base of the tongue in 50% of
Linear FBs are more commonly reported in cats36–38 affected cats in two reports,37,38 whereas only 6% of
than in dogs 36,39: String and thread were found in affected dogs had a string revealed by physical examina-
cats, 37,38 whereas string, elastic tape, carpet, nylon tion.39 Hematologic and biochemical findings in an
hosiery, cord, plastics, and fabrics were found in animal with a linear FB intestinal obstruction are not
dogs.36,39 In cats, 90.6% of FBs were thread and 9.4% different from those in an animal with a nonlinear FB
were thread and needle.38 Linear FBs initially cause a intestinal obstruction.
partial intestinal obstruction; a chronic problem will
result in large portions of the small intestine becoming Diagnostic Imaging
damaged and nonfunctional, which leads to signs simi- Survey abdominal radiographic findings in cats with
lar to those of complete intestinal obstruction. a linear FB intestinal obstruction include intestinal pli-

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840 Small Animal/Exotics Compendium November 2003

cation, increased numbers of ec-

centrically located comma-shaped
or tapered luminal gas bubbles,
small intestinal shortening to the
right of the midline as viewed ven-
trodorsally, radiopaque FB visuali-
zation, intestinal obstruction, and
peritonitis 36,38 (Figure 5). These
findings led to a tentative diagnosis
of linear FB in 54% of cats in one
study.38 In this study, however, no
radiographic abnormalities were
seen in 14% of affected cats. It was
thought that tapered bubbles pos-
sibly resulted from gas-filled intes-
tine that was corrugated around
the linear FB.38 Figure 5—Lateral abdominal radiograph of a cat with intestinal plication and tapered gas
Radiographic signs of linear FBs bubbles resulting from thread and a needle in the small and large intestine, respectively.
in cats may be differentiated from
(1) hyperperistaltic activity result-
ing in symmetric convolutions and formation of cen-
trally located luminal bubbles in the affected intestinal
segment (linear FBs, in contrast, cause asymmetric con-
volutions and eccentrically located gas bubbles36); (2)
intestinal adhesions after previous intraabdominal sur-
gery4,36; and (3) intestinal ascarids, which appeared as
luminal linear filling defects but without intestinal
pleating.36 Findings obtained from radiography with
contrast enhancement include eccentric plication and
shortening of the small intestine, fixation of the duode-
num in pleated position, and occasional visualization of
eccentrically located gas bubbles36 (Figure 6).
Radiographic findings in dogs with a linear FB intes-
tinal obstruction were similar to those of cats. However,
on the basis of the same radiographic findings as men-
tioned above, diagnosis of a linear FB was more com-
mon in dogs (71%)39 than in cats (54%).38 In addition,
the presence of tapered gas bubbles is not a common
radiographic finding in dogs.39 Ultrasonographic exam-
ination may detect intestinal plication, which is consid-
ered diagnostic for linear FBs. However, linear FBs are
not always visualized during this examination.28

Treatment
Although most surgeons favor surgical treatment as
soon as the diagnosis of linear FB is established, conser-
vative therapy can be tried in selected feline cases.

Conservative
One study37 found that 38% of cats that have a linear
FB looped around the base of the tongue may be man-
Figure 6—Ventrodorsal radiograph of a cat after barium admin-
aged conservatively, provided certain criteria are met. istration showing intestinal plication secondary to a linear FB.
The cat must be presented soon after linear FB inges-

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Compendium November 2003 Intestinal Foreign Bodies in Dogs and Cats 841

Figure 7—Multiple enterotomies are required for removal of a Figure 8—Intestinal plication and intussusception secondary
linear FB in a dog. to a linear FB in a dog.

tion and the owner must be aware of the ingestion; if the linear FB is carried along with the catheter until an
the cat is showing no signs of peritonitis, the linear FB assistant retrieves it through the anus. However, failure
that is embedded sublingually should be cut, which of this technique in a cat was reported.41
may allow elimination of the linear FB in the feces The linear FB may compromise the intestinal wall at
within 1 to 3 days. Hospitalization of the cat is essen- several sites, which can result in multiple perforations
tial for clinical, radiologic, and laboratory monitoring. and subsequent peritonitis. If the linear FB has been
Immediate surgical intervention is warranted if the present for a long period, localized peritonitis and
patient’s clinical condition deteriorates or if peritonitis intestinal fibrosis may occur, leading to permanent pli-
or pyloric entrapment of the linear FB occurs.37 cation. Those cases may be best managed with intes-
tinal resection and anastomosis. Peritonitis should be
Surgical managed as described earlier.
A linear FB that is wrapped around the tongue Intussusception was reported to accompany linear
should be identified and released before a celiotomy. FBs in dogs, possibly because of increased irritation by
The linear FB may be localized by identifying intestinal the types of linear FBs ingested by dogs or because of
plication after a midline celiotomy. Usually, a gastrot- different reactions of the canine intestine to linear FBs39
omy is required to release a linear FB lodged in the (Figure 8). Enterotomies may be closed as described
pylorus, a common location in dogs, possibly because earlier or by using skin staples in dogs.42 The stapling
of the large size of ingested foreign material in canine technique reduces time at surgery and minimizes
species.39 An enterotomy is performed midway along spilling of intestinal contents during surgery.42 After
the site of obstruction. With the aid of a curved mos- closure, the entire intestinal tract should be examined
quito hemostat, a linear FB located in a mesenteric site for perforations in the mesenteric border. Fat and fibrin
can be pulled gently and gradually until the more distal deposition may mask intestinal leaks. Normal saline
point of fixation is reached. Another enterotomy is injection into the isolated intestinal segment may facili-
made at the distal position. Multiple enterotomies, tate detection of leakage. The abdominal cavity is thor-
spaced along the intestine, are required to minimize oughly lavaged and is then closed in a routine fashion.
excessive traction and avoid subsequent intestinal per-
foration and to remove the FB completely32 (Figure 7). Postoperative Care, Complications,
A single-incision technique has been described for and Prognosis
extraction of string in cats, provided no penetration of Postoperative care and complications are similar to
the mucosa has occurred.40 An enterotomy is made to those for animals with nonlinear FBs. Short-bowel syn-
the most proximal site of the duodenum, and the linear drome may result after resection of 90% of the small
FB is attached with suture to the end of a red rubber intestine.20,26 After ileocecal valve removal, overgrowth
catheter. The entire catheter is placed into the small of bacteria that ascend from the colon may contribute
intestine in a proximal direction, and the incision is to diarrhea.20 The small intestine that remains after
closed routinely. The catheter is then milked along the extensive resection may undergo adaptation associated
intestine, so that the plicated intestine is resolved and with increased diameter, enlarged microvilli, and

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842 Small Animal/Exotics Compendium November 2003

increased numbers of mucosal cells, the result being 13. Basson MD, Fielding LP, Bilchik AJ, et al: Does vasoactive intes-
increased absorption.20,26 tinal polypeptide mediate the pathophysiology of bowel obstruc-
tion? Am J Surg 157:109–114, 1989.
Mortality rates after surgical removal of linear FBs
were higher in dogs (22%) 39 than in cats (16%) 38 14. Shikata JI, Shida T, Amino K, Ishioka K: Experimental studies
on the hemodynamics of the small intestine following increased
because frequencies of perforations and peritonitis were intraluminal pressure. Surg Gynecol Obstet 156:155–160, 1983.
higher in dogs (31%)39 than in cats (16%).38 Moreover,
15. Summers RW, Yanda R, Prihoda M, Flatt A: Acute intestinal
a significant prognostic indicator associated with an
obstruction: An electromyographic study in dogs. Gastroenterol-
increased probability of peritonitis in dogs is the pres- ogy 85:1301–1306, 1983.
ence of fabric and plastic linear FBs. 39 One study
16. Prihoda M, Flatt A, Summers RW: Mechanisms of motility
reported decreased survival of dogs and cats that under- changes during acute intestinal obstruction in the dog. Am J
went more than one intestinal procedure in the same Physiol 247:G37–G42, 1984.
operation. 35 In addition, dogs require an increased 17. Capak D, Simpraga M, Maticic D, et al: Incidence of foreign-
number of intestinal resections for linear FB manage- body–induced ileus in dogs. Berl Munch Tierarztl Wochenschr
ment compared with cats, possibly because of the 114:290–296, 2001.
increased severity of intestinal trauma in dogs.39 18. Clark WT: Foreign bodies in the small intestine of the dog. Vet
Rec 83:115–119, 1968.
REFERENCES 19. Barrs VR, Beatty JA, Tisdall PLC, et al: Intestinal obstruction by
1. Lantz GC: The pathophysiology of acute mechanical small bowel trichobezoars in five cats. J Feline Med Surg 1:199–207, 1999.
obstruction. Compend Contin Educ Pract Vet 3:910–918, 1981.
20. Orsher RJ, Rosin E: Small intestine, in Slatter DH (ed): Text-
2. Ellison GW: Intestinal obstruction, in Bojrab MJ (ed): Disease book of Small Animal Surgery, ed 2. Philadelphia, WB Saunders,
Mechanisms in Small Animal Surgery, ed 2. Philadelphia, Lea & 1993, pp 593–612.
Febiger, 1993, pp 252–257.
21. Shields R: The absorption and secretion of fluid and electrolytes
3. Walshaw R: The small intestine, in Gourley IM, Vasseur PB by the obstructed bowel. Br J Surg 52:774–779, 1965.
(eds): General Small Animal Surgery. Philadelphia, JB Lippin-
cott, 1985, pp 343–384. 22. Lamb CR, Hansson K: Radiological identification of nono-
paque intestinal foreign bodies. Vet Radiol Ultrasound 35:87–
4. Guilford WG, Strombeck DR: Intestinal obstruction, pseudo- 88, 1994.
obstruction, and foreign bodies, in Guilford WG, Center SA,
Strombeck DR, et al (eds): Strombeck’s Small Animal Gastroen- 23. McNeel SV: The small bowel, in Thrall DE (ed): Textbook of
terology, ed 3. Philadelphia, WB Saunders, 1996, pp 487–502. Veterinary Diagnostic Radiology, ed 2. Philadelphia, WB Saun-
ders, 1994, pp 524–543.
5. Jones S, Blivslager A: Role of the enteric nervous system in the
pathophysiology of secretory diarrhea. J Vet Intern Med 16:222– 24. Graham JB, Lord PF, Harrison JM: Quantitative estimation of
228, 2002. intestinal dilation as a predictor of obstruction in the dog.
J Small Anim Pract 39:521–523, 1998.
6. Pass MA: Small intestines—physiology, in Slatter DH (ed):
Textbook of Small Animal Surgery, ed 1. Philadelphia, WB Saun- 25. Gomez JA: The gastrointestinal contrast study. Vet Clin North
ders, 1985, pp 738–752. Am 4:805–842, 1974.

7. O’ Brien TR: Small intestine, in O’Brien TR (ed): Radiographic 26. Bauer MS, Matthiesen DT: Complications and decision making
Diagnosis of Abdominal Disorders in the Dog and Cat: Radi- associated with small intestine surgery. Probl Vet Med 1:316–
ographic Interpretation, Clinical Signs, Pathophysiology. Philadel- 332, 1989.
phia, WB Saunders, 1978, pp 259–351. 27. Robertson ID, Burbidge HM: Pros and cons of barium-impreg-
8. Mishra NK, Appert HE, Howard JM: The effects of distention nated polyethylene spheres in gastrointestinal disease. Vet Clin
and obstruction on the accumulation of fluid in the lumen of North Am Small Anim Pract 30:449–465, 2000.
small bowel of dogs. Ann Surg 180:791–795, 1974. 28. Tidwell AS, Penninck DG: Ultrasonography of gastrointestinal
9. Guilford WG, Strombeck DR: Classification, pathophysiology foreign bodies. Vet Radiol Ultrasound 33:160–169, 1992.
and symptomatic treatment of diarrheal diseases, in Guilford 29. Bright RM: Preoperative antibiotics: Do I or don’t I? Proc ACVS
WG, Center SA, Strombeck DR, et al (eds): Strombeck’s Small Symp:260–263, 2001.
Animal Gastroenterology, ed 3. Philadelphia, WB Saunders,
30. Allen D, Kvietys PR, Granger DN: Crystalloids versus colloids:
1996, pp 351–366.
Implications in fluid therapy of dogs with intestinal obstruction.
10. Enochsson L, Nylander G, Ohman U: Effects of intraluminal Am J Vet Res 47:1751–1755, 1986.
pressure on regional blood flow in obstructed and unobstructed
31. Weisman DL, Smeak DD, Birchard SJ, Zweigart SL: Compari-
small intestines in the rat. Am J Surg 144:558–561, 1982.
son of a continuous suture pattern with a simple interrupted
11. Cooke HJ, Reddix RA: Neural regulation of intestinal elec- pattern for enteric closure in dogs and cats: 83 cases (1991–
trolyte transport, in Johson LR (ed): Physiology of the Gastroin- 1997). JAVMA 214:1507–1510, 1999.
testinal Tract. New York, Raven, 1994, pp 2083–2132.
32. Ellison GW: Enterotomy, in Bojrab MJ (ed): Current Techniques
12. Cullen JJ, Caropreso DK, Hemman LL, et al: Pathophysiology in Small Animal Surgery, ed 4. Baltimore, Williams & Wilkins,
of adynamic ileus. Dig Dis Sci 42:731–737, 1997. 1998, pp 245–248.

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Compendium November 2003 Intestinal Foreign Bodies in Dogs and Cats 843

33. Allen DA, Smeak DD, Schertel ER: Prevalence of small intes-
ARTICLE #2 CE TEST

CE
tinal dehiscence and associated clinical factors: A retrospective
study of 121 dogs. JAAHA 28:70–76, 1992. The article you have read qualifies for 1.5 con-
34. Papazoglou LG, Rallis T: Diagnosis and surgical management of tact hours of Continuing Education Credit from
septic peritonitis in the dog and cat. Waltham Focus 11:9–14, the Auburn University College of Veterinary Med-
2001. icine. Choose the best answer to each of the follow-
35. Wyllie KB, Hosgood G: Mortality and morbidity of small and ing questions; then mark your answers on the
large intestinal surgery in dogs and cats: 74 cases (1980–1992). postage-paid envelope inserted in Compendium.
JAAHA 30:469–474, 1994.
36. Root CR, Lord PF: Linear radiolucent gastrointestinal foreign
bodies in cats and dogs: Their radiographic appearance. J Am 1. Which factors contribute to luminal distention in
Vet Radiol Soc 12:45–53, 1971. complete intestinal obstruction?
37. Basher AWP, Fowler JD: Conservative versus surgical manage- a. gas accumulation
ment of gastrointestinal linear foreign bodies in the cat. Vet Surg b. fluid accumulation related to hypersecretion in the
16:135–138, 1987. gastrointestinal tract
38. Felts JF, Fox PR, Burk RL: Thread and sewing needles as gas- c. fluid accumulation related to reduced absorption in
trointestinal foreign bodies in the cat: A review of 64 cases. the gastrointestinal tract
JAVMA 184:56–59, 1984. d. all of the above
39. Evans KL, Smeak DD, Biller DS: Gastrointestinal linear foreign
bodies in 32 dogs: A retrospective evaluation and feline compar-
2. Experimental studies of dogs with intestinal obstruc-
ison. JAAHA 30:445–450, 1994. tion showed selective intestinal mucosal ischemia
when intraluminal pressure was
40. Anderson S, Lippincott CL, Gill PJ: Single enterotomy removal a. 10 mm Hg. c. higher than 40 mm Hg.
of gastrointestinal linear foreign bodies. JAAHA 28:487–490,
b. 30 mm Hg. d. 80 mm Hg.
1992.
41. Muir P, Rosin E: Failure of the single enterotomy technique to 3. Fluid and electrolyte losses in intestinal obstruction
remove a linear intestinal foreign body from a cat. Vet Rec 136: may be the result of
75, 1995. a. vomiting.
42. Coolman BR, Ehrhart N, Marretta SM: Use of skin staples for b. diarrhea.
rapid closure of gastrointestinal incisions in the treatment of c. fluid sequestration in the intestinal lumen.
canine linear foreign bodies. JAAHA 36:542–547, 2000. d. all of the above
844 Small Animal/Exotics Compendium November 2003

4. Vomiting in a dog with distal intestinal obstruction c. Atraumatic tissue handling

may result in d. Lack of tension on the suture line
a. metabolic alkalosis.
b. metabolic acidosis. 8. Cats with linear FB ingestion may be managed conser-
c. hypokalemic metabolic alkalosis. vatively if they
d. hypochloremic metabolic alkalosis. a. present soon after ingestion and have no signs of
peritonitis.
5. Which antibiotic is recommended for prophylactic use b. show signs of acute abdomen.
in surgery on the large intestine? c. show signs of pyloric obstruction.
a. cefalexin c. cefazolin d. have chronic hemorrhagic diarrhea.
b. cefoxitin d. cefadroxil
9. Which approach is not recommended for enterotomy
closure?
6. Which characteristic is not used for assessment of
a. simple continuous approximating suture pattern
intestinal viability? b. simple interrupted approximating suture pattern
a. wall thickness c. skin staples
b. wall color d. wound glue
c. appearance with IV fluorescein dye
d. arterial pulsations 10. In patients with linear FBs, intestinal resection and
anastomosis are recommended for treatment of
7. ________ may increase the possibility of dehiscence a. multiple perforations and subsequent peritonitis.
after enterotomy closure. b. intestinal fibrosis and permanent plication.
a. Minimal mucosal eversion c. extensive intestinal wall compromise.
b. Excessive mucosal eversion d. all of the above

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