When I saw Michelle Prager and “Bob” listed in the appointment book, I assumed that Bob was having another flare-up of the Bartonella infection involving his eye. Bob’s eye, however, was fine.
“He’s been vomiting”, said Ms. Prager, “and his appetite is off, and I caught him eating my hair bands again.” Bob, it seems, has a well-known penchant for hair bands. No, not the heavy metal musicians from the 80’s, but rather, the thin elastic rubber-band type that Ms. Prager uses to keep her hair pulled back. “He’s eaten them before”, she informed me, “and he usually either vomits it back up, or passes them in the litter box, and then he’s fine.” This time was different. Bob was clearly not feeling well. I warmed up the x-ray processor, and prepared Bob for an abdominal x-ray.
Intestinal foreign bodies are a common cause of intestinal obstruction in dogs and cats. “Linear” foreign bodies – thread, string, ribbon, cord, rubber bands, etc. – are particularly common in cats. These can cause serious and extensive damage to the intestinal tract. In one study, 90.6% of feline linear foreign bodies were thread, and 9.4% were thread with the sewing needle. The most common linear foreign bodies reported in cats are string, carpet, and plastic.
The reason why linear foreign bodies can cause so much damage is the way they create an intestinal obstruction. Usually, one end of the string becomes anchored, either by wrapping around the base of the tongue, or by getting lodged in the pylorus (the part of the stomach that leads to the small intestine). The peristaltic waves generated by the intestines try to propel the free end of the string along the intestinal tract. But the leading end is lodged, so the string can’t be pulled along. Instead, the intestines “climb” up the string, causing the intestines to become pleated. This pleating or “accordion” pattern, if identified on an x-ray is an almost sure indication of a linear foreign body.
Bob’s x-rays were unambiguous. Not only could I see a stomach full of hair bands, I could also discern that a few of them had passed into the small intestine. Further scrutiny of the x-ray revealed the classic pleating pattern.
Cats with linear foreign bodies tend to be fairly young; the average age is 2.7 years. (Bob must be reading the text book, because that’s exactly how old he is.) Vomiting and poor appetite are the most common clinical signs. Cats often continue to drink small amounts of water. On physical examination, cats are often depressed, dehydrated, and may show signs of abdominal pain. A thorough oral examination is critical, to identify a string that may be looped around the base of the tongue. Sometimes a string will be seen protruding from the mouth, or protruding from the anus.
Armed with our certain diagnosis, Bob was taken to surgery. I could feel a firm clump of material lodged in the very end portion of the stomach. Right beyond that was the classic finding: the pleated intestines.
When a linear foreign body is lodged in the pylorus, as in Bob’s case, a gastrotomy (cutting into the stomach) is necessary to release it. When I performed the gastrotomy, I encountered a clump of thin black rubber hair bands, most of which were removed easily. One portion of the clump however, extended beyond the stomach and into the small intestine. Gentle traction failed to dislodge it. When that happens, it is imperative that the surgeon cut the string and make a new incision further down the intestinal tract. Pulling on the string can cause it to saw through the intestinal wall, resulting in multiple perforations. Leakage of intestinal contents through these perforations can result in peritonitis and death.
The next incision was in the pleated part of the intestine. There I encountered the remaining hair bands. I pulled the leading end of the hair band out of the incision, and then the trailing end. It came out easily, and the intestines quickly unraveled and assumed their normal configuration. I closed the intestinal incision, and then closed up the abdominal wall and the skin.
While Bob was recovering from his surgery, I untangled the foul-smelling clump of material I had just removed from Bob’s gastrointestinal tract. The final tally: 19 hair bands!