Welcome to September/October's Case of the Month! This month we have a problem with one of our own "children."

IF AT FIRST YOU DON'T SUCCEED...

HISTORY

Harry was our very own office cat. The day after Labor Day, our technician noticed that he was acting strangely. He was moping around, looked bleary-eyed, and was actually trying to sleep in the sink. Not normal for Harry! We also found several places where someone had thrown up over the weekend (He shares a room with his "sister" Skyler, so we weren't sure who was responsible.)

PHYSICAL FINDINGS

On examination, Harry seemed pretty normal, except for being a little bit dehydrated. His breath also smelled like bile, so we believed he was the one who had been vomiting. Unfortunately, Harry had a habit of stealing toys from other cats' carriers, so he would get his own little collection after a while. His other bad habit is to destroy toy fur mice and, although he'd never eaten part of one before, we were worried he'd swallowed something he shouldn't have.

Because we had so many patients after Labor Day, we weren't able to do a lot with him the first day, so gave him some fluids to rehydrate him, and added some antibiotics in case he was fighting an infection. The next day, he felt better, but was still vomiting, so we took some x-rays.

X-RAY RESULTS

Harry's stomach looked a little strange. I've outlined it below in purple. Usually there's much less of the white color, which indicates some kind of material in the stomach.

So, what now? In order to get a better idea of what might be going on, we gave Harry some barium, a chalky material that shows up white on x-rays and can outline any foreign objects in the digestive tract. By watching how it moves, we can also see how food and other materials are passing through the stomach and intestines. Here's a picture of Harry right after the barium was given. The long section of barium on the right is his esophagus, and the round blob to the left is his stomach:

Next, we have a picture of barium moving over time. It should show up on most browsers as a progression of images. The first is 15 minutes after barium was given, the second is 30 minutes after, the third is after 1 hour, and the fourth is a few hours later, after the testing we'll discuss below.

What this shows us is that things weren't moving through Harry's stomach the way they should. Normally the stomach should be completely empty after an hour or so. We saw very little barium moving past the stomach at all, so suspected a blockage or motility problem in the stomach.
To get a better idea of what was happening, we used our endoscope to take a look in Harry's stomach. We didn't find anything stuck in there, but parts of the stomach lining were very irritated. Any kind of stomach upset (viral and bacterial infections, poisons, eating something rotten) can cause irritation like this, and can sometimes cause ileus, which is a (usually temporary) loss of normal function. Here's a picture of an irritated area, with barium sticking to it:

TREATMENT

An x-ray after the procedure (last picture in the animated group above) showed air moving from his stomach into his intestines. Seeing this and finding nothing stuck in the stomach, we suspected Harry had a case of severe stomach upset, and started to treat him with antibiotics, fluids to correct dehydration, and a drug called Reglan, which can restore normal stomach motility.

I'M STILL SICK!

Harry did well for a couple of days, but, much to our dismay, started vomiting again and acted like he felt awful. This time when we examined him we felt an unusual knot in his abdomen, just behind his stomach. Another x-ray showed that he still had barium in his system.

Since we knew for sure that he didn't have anything trapped in his stomach, we knew we'd have to look at his intestines, which required an exploratory surgery. Right away, we found the culprit, a toy mouse head that he'd chewed up and swallowed. We figured it probably lodged in his stomach first (causing all of the irritation there), then may have slipped out as we dilated the stomach during his endoscopy. A few days after surgery he was back to his normal self!

DISCUSSION

Obstructions caused by swallowed objects (we call them "foreign bodies") are fairly common in pet animals, and have to be considered any time we see repeated vomiting, weight loss, or abdominal pain. Unlike Harry's, in most cases a foreign body can be detected (or strongly suspected) either with a physical exam or with x-rays and barium. In some cases, a foreign body can remain in an animal's system for a long time. Just this year we had a dog who was with her owners at camp when she vomited up the tip of a spatula. She'd swallowed it almost a year earlier!

back to stuff

see other cases