Folding of the Intestines

Intussusception in Cats

A change in the shape of the intestine can cause the affected portion of the intestine to slip out of its normal place (prolapse) into an adjoining cavity or duct in the body. Intussusception, the medical term used to describe this condition, can also be used to describe a folded portion of the intestine (invagination), causing that section of the intestinal tract to be blocked. Either of these conditions can result in inflammation of the intestines.

While intussusception can occur in animals of all ages, it is more common in younger animals that have weaker immune systems, generally between the ages of one week to nine years of age. In affected animals, around 80 percent are younger than one year of age. Although any breed may be affected, the Siamese breed has been found to have a higher frequency. The exact mechanism behind this medical condition is unknown. This obstruction can be either partial or complete, but the occurrence of an intussusception eventually leads to a mechanical obstruction of the gastrointestinal tract.

Symptoms and Types

The clinical signs associated with the intussusception will depend on the anatomic region of the intussusception. If the intussusceptions occur in the gastroesophageal regions -- where the stomach and esophagus are located (gastroesophageal intussusception, or GEI) -- the signs are typically much more severe than if they occur in other regions.

In addition, if there is a total obstruction, the cat will have severe complications potentially and symptoms that are more severe. Whether partial or complete, obstruction of the gastrointestinal (GI) tract can lead to hypovolemia, dehydration, and compromise of the venous and/or lymphatic systems. Prolonged obstruction can lead to necrosis (death of the tissue) and disruption of the normal capacity of the mucosal barrier that protects the GI tract, allowing bacteria and toxins to be absorbed into the GI tract.

Other common symptoms can include:

Intussusception high in the intestinal tract

• Difficulty breathing (dyspnea)
• Vomiting
• Bloody vomit (hematemesis)
• Regurgitation (inability to swallow food)
• Abdominal pain
• Abdominal distention

Intussusception low in the intestinal tract

• Bloody diarrhea (melena)
• Occasional vomiting
• Loss of appetite (anorexia)
• Weight loss
• Straining to defecate (tenesmus)

Causes

It can be challenging to isolate the exact cause, as any disease that can alter gastrointestinal motility can lead to an intussusception. Some of the most common causes include: enteritis, recent abdominal surgery, intestinal mural disease, intestinal parasites, a foreign object in the tract, and intense contractions of the bowel portion of the intestine.

Diagnosis

Your veterinarian will perform a thorough physical exam on your cat, taking into account the background history of symptoms and possible incidents that might have led to this condition. Because there are several possible causes for this condition, your veterinarian will most likely use differential diagnosis. This process is guided by deeper inspection of the apparent outward symptoms, ruling out each of the more common causes until the correct disorder is settled upon and can be treated appropriately.

While some intussusceptions can be chronic in nature, a chronic history of vomiting and/or diarrhea does not necessarily confirm an intussusception. Imaging is often used to properly view the intestines for any possible other causes. This may show an object in the intestinal tract, or a mass of tissue. Your veterinarian may also choose to use a contrasting agent -- a solution that is highlighted in X-ray -- that is either injected or fed to your cat, so that it can be tracked as it  progresses through the intestinal tract, allowing your doctor to view any abnormal turns of obstructions.

A fecal sample will be taken to check for intestinal parasites, and the electrolyte balances will be checked. In the case of intussusception that are high in the gastrointestinal tract, electrolyte imbalances, such as hypokalemia, hypochloremia, and hyponatremia are not uncommon.

Treatment

Immediate and aggressive intravenous fluid treatment will need to be given if your cat is dehydrated, and your cat's electrolyte imbalances will need to be treated as well. Your veterinarian will initially work on stabilizing your cat and addressing any signs of electrolyte imbalances. A sodium solution may also be given if your cat is found to have hyponatremia. Following any surgical procedure, it is recommended that you limit your cat's daily activity until a complete recovery has taken place. Antibiotics are often administered to reduce the likelihood of a potential infection developing.

In the case where a foreign object is found to be causing the obstruction, or a complete block is present, surgery will need to be initiated to correct the issue. If your veterinarian believes the intestinal tissue is ulcerated as a result of the irritation, medications can be prescribed to encourage healing and prevent infection.

Living and Management

It is important to maintain fluids following the surgical procedure to prevent dehydration. Most recurrence issues occur within the first several weeks of the animal's surgery, so this is the time for more careful observation. Your doctor will advise you on an appropriate diet for the days following surgery or treatment. Generally, they will be small, easily digestible meals for the first several days, and depending on your cat's recovery, the diet can return to normal once the issue has resolved.