Intussusception in Cats

Cats

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An intussusception is the telescoping of one part of the intestinal tract into an adjoining segment of intestinal tract. It commonly involves the small intestines. Intussusception can cause narrowing or obstruction of the lumen (inside diameter) of the intestines, resulting in an acute emergency. Intussusception can also cause waxing and waning signs if the intussusception is periodically relieved by the affected segment of intestine moving back and forth from a telescoped position into a normal position.

Intussusceptions are seen in both dogs and cats. Although intussusceptions can occur in all ages of animals, it is most common in young cats. Intussusceptions secondary to tumors are more common in older pets.

Causes

  • Idiopathic (unknown cause)
  • Secondary to enteritis (inflammation or infection of the intestinal tract)
  • Intestinal parasites
  • Previous intestinal surgery
  • Intestinal mass

    What to Watch For

    Clinical signs and disease progression vary markedly depending on the location and degree of blockage associated with the intussusception. Some signs may include:

  • Vomiting
  • Vomiting blood
  • Anorexia (loss of appetite)
  • Depression
  • Diarrhea
  • Weight loss
  • Abdominal pain
  • Signs of shock, collapse, and sudden death within several hours with complete obstruction of the intestinal track

    Diagnosis

    The clinical signs associated with intussusception can be vague and nonspecific, so several tests are often necessary to confirm the diagnosis. Such tests include:

  • Complete history and thorough physical examination. Careful palpation of the abdomen may reveal a firm, sausage-shaped mass.
  • A complete blood count (CBC), biochemical profile, urinalysis and fecal examination
  • Thoracic (chest) and abdominal radiographs (X-rays) to eliminate a foreign body of the gastrointestinal tract or other disease process
  • Abdominal ultrasound
  • Barium study of the upper gastrointestinal tract
  • Endoscopy of the gastrointestinal tract
  • Possibly surgical exploration of the abdomen

    Treatment

    Patients with an intussusception require hospitalization and aggressive treatment, as clinical deterioration may be rapid and can be fatal. Most of these cases are surgical emergencies.

    Aggressive intravenous fluid and electrolyte therapy is also extremely important. Antibiotics are usually prescribed and your veterinarian may also recommend a specific post-operative diet.

    Home Care

    The prognosis for patients with an intussusception is variable, depending on the severity and degree of the intussusception and the associated clinical signs. Most cases of intussusception cannot be prevented.

    Administer all medication and recommended diets as directed by your veterinarian. If your pet has a recurrence of signs, which is most likely within the first week of surgery, contact your veterinarian at once.

  • An intussusception is a telescoping of one part of the intestinal tract into an adjoining segment of intestinal tract. Intussusceptions can occur anywhere throughout the gastrointestinal tract, but are most common in the small intestines. Partial or intermittent intussusceptions are often associated with chronic, or waxing and waning signs. A complete intussusception with a total blockage of the intestine may cause acute onset of severe clinical signs, with even shock and death. In general, when the blockage is high in the gastrointestinal tract, the signs are more severe and life threatening.

    Many problems can cause intussusceptions, and many other diseases/disorders have the same symptoms. These include:

  • Viral enteritis, especially panleukopenia (feline distemper), which is a contagious virus that affects unvaccinated kittens

  • Bacterial enteritis, an inflammation/infection of the intestinal tract with agents such as Salmonella, Clostridia

  • Intestinal parasites such as roundworms, hookworms and whipworms

  • Ingestion of foreign bodies

  • Mesenteric volvulus or twisting of the tissue that suspends the intestines in the abdomen (extremely rare in the cat)

  • Gastrointestinal masses (tumors)

  • Pancreatitis or an inflammation of the pancreas

  • Diagnosis

    Certain diagnostic tests are performed to diagnose an intussusception, and to exclude other disease processes that may cause similar symptoms. Obtaining a complete description of clinical signs and a thorough physical examination are an important part of obtaining a diagnosis. In addition, the following tests may be recommended to confirm the diagnosis:

  • A complete blood count may be within normal limits. It may also reveal a low white blood cell count in cases of viral infections, or a high white blood cell count in cases associated with bacterial or inflammatory processes. The red blood cell count may be low if there is associated bleeding into the intestinal tract. The red blood cell count may be high in cases of severe dehydration.

  • A biochemical profile may show electrolyte abnormalities (changes in sodium, potassium, chloride), altered kidney function tests, and abnormalities associated with concurrent disease processes.

  • A urinalysis is useful to assess kidney function and the presence of any dehydration of the patient.

  • Fecal tests are performed to check for certain intestinal parasites that can cause or be associated with intussusceptions .

  • Abdominal radiographs (X-rays) may reveal the classic appearance of a tubular mass in the intestinal tract associated with distended loops of bowel. Additionally, abdominal X-rays may rule out other disorders that cause similar clinical signs such as tumors, foreign bodies.

  • Thoracic (chest) radiographsmay be performed, especially in older patients in which cancer may be a factor, in order to rule out metastatic (spread of cancer) disease. Chest X-rays may also be indicated prior to anesthesia and surgery.

  • Abdominal ultrasonography is helpful in evaluating many of the abdominal organs, including the liver, kidneys, lymph nodes and spleen. It is equally important to rule out other disorders or diseases that may initially be difficult to differentiate from an intussusception. In many cases, it helps identify a cylindrical, sausage-like intestinal mass, very characteristic of an intussusception. Abdominal ultrasonography is a noninvasive test that utilizes specialized instrumentation. It may require that your cat be referred to a veterinary internal medicine specialist or a radiologist to perform the procedure.

  • An upper gastrointestinal (GI) barium series may be considered, especially in those patients with chronic vomiting. It may help diagnose foreign objects or tumors that are not apparent on radiographs, confirm a diagnosis of GI ulceration, or directly outline an intussusception. A safe dye is given to the patient by mouth, and is then watched as it travels through the GI tract. It is a non-invasive test that can often be performed by your regular veterinarian, although in some cases it may necessitate transfer to a specialty hospital.

  • Some cases of intussusception are only confirmed via surgical exploration of the abdomen.

    Treatment

    Patients with life-threatening clinical signs are hospitalized and treated aggressively. Clinical deterioration is often rapid and can be fatal. Successful treatment depends on medical stabilization of the patient with correction of fluid, electrolyte, and acid-base abnormalities. Once the animal is stabilized surgical correction is instituted as soon as possible. It is important to address each patient individually, as different underlying processes may warrant different recommendations regarding therapy and prognosis. Therapies that may be administered include the following:

  • Rapid intravenous fluid therapy is imperative in severely ill animals.

  • Surgical correction involves relieving the telescoping of the bowel, or resection (removal) of the affected segment of intestine. If the bowel is not resected, it may be folded and tacked upon itself, so the telescoping does not recur.

  • Water and food is withheld from most patients until 24 hours after surgery, or after all vomiting has stopped. The animal is then introduced to small amounts of water, followed eventually by small, frequent meals of an easily digestible food.

  • Injectable antibiotics are often given around the time of surgery to help prevent infection.

    Follow-up

    Optimal treatment for your pet requires a combination of home and professional veterinary care. Follow-up can be critical, especially if your pet does not rapidly improve.

  • Administer all prescribed medications and diets as directed. Alert your veterinarian if you are experiencing problems treating your pet.

  • Watch your pet closely for recurrence or worsening of signs post-operatively and contact your veterinarian at once.

  • The prognosis for these patients varies, depending on the severity of the blockage, the length of time the animal has been affected, and the underlying cause. Many patients have a full recovery, while others do not. Recurrence is seen in some cases, even with corrective surgery.

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