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More about spontaneous gastrointestinal perforations

Jan 22, 2016

Benardin F, Martinez L, et al. Spontaneous gastrointestinal perforation in cats: a retrospective study of 13 cases. J Feline Med Surg. 2015 Oct; 17(10):873-879.

Gastrointestinal perforation is considered a life-threatening situation in veterinary medicine due to the potential development of septic peritonitis and  eventually death if the condition is untreated.  What is a spontaneous perforation? This is a perforation that occurs in the absence of foreign body ingestion, gastric dilatation and volvulus, external trauma, leakage at previous gastrointestinal surgical sites, or iatrogenic trauma. The most common form of perforation in humans is a peptic ulcer. In cats, the condition is uncommonly reported and in previously reported cases no cause was found in a significant proportion of the cases.

The purpose of this study was to describe the clinical details and frequency of malignant versus nonmalignant causes for spontaneous gastrointestinal perforation in cats. The medical records of cats diagnosed with gastrointestinal perforation for a three-year period between 2010 and 2013 were evaluated. Exploratory surgery was the diagnostic method used for confirmation. Thirteen cats were included in the study. Additional information included five of the cats had concurrent illnesses, including viral upper respiratory tract disease, pancreatitis, and chronic kidney disease. Cats receiving previous medications included two receiving non-steroidal anti-inflammatory drugs and four that received corticosteroids (both types of medications are considered potential causes of gastrointestinal perforations).

In evaluating the thirteen cats, the most common clinical presentations were non-specific signs of gastrointestinal or systemic illness (anorexia, vomiting, lethargy, weight loss, abdominal distension, dehydration, hyperthermia, abdominal pain, pallor, dyspnea and icterus). Any signs related to intestinal bleeding (vomiting blood, melena or blood in the stool) were found in only 1 of the 13 cats, none of the cats exhibited decompensated shock.  The location of the perforations were 6 of 13 had gastric perforations, four had duodenal perforations and three had jejunal perforations. Lymphoma was diagnosed in 6 of the 13 patients and was equally associated with the three locations.

From the final results, lymphoma needs to be considered a possible frequent cause of gastrointestinal perforations. Therefore, histological examination of any ulceration is essential in such cases. This study did not find a direct implication of anti-inflammatory therapeutic administration as an established cause in a gastrointestinal perforation. Surprisingly, signs of shock and collapse were rare in these cases. Since the presentation of clinical signs in these cats was not specific enough to determine a perforation was present, clinicians should use multimodality diagnostic procedures to avoid delay in reaching a diagnosis.  (VT)

See also:
Freiche V, Faucher MR, German AJ. Can clinical signs, clinicopathological findings and abdominal ultrasonography predict the site of histopathological abnormalities of the alimentary tract in cats? J Feline Med Surg. 2015 Feb 26.

 

 

 

ulcers lymphoma gastrointestinal perforations melena

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