Linear Foreign String Body In A Cat. What happens when your cat swallows a piece of string and it gets stuck in their intestines.

This is Bella. She is a 3 year old indoor only long haired spayed cat. She was brought to the local ER about 1 week before I saw her. At that time she had not been eating for about 1 week and had been vomiting.

At the ER she was given an examination. They found a string stuck under her tongue. In vet med, especially with cats, checking under the tongue is a super important place to look for the culprit of a sick cat of unknown origin. All ER vets know this, and, I hope every other vet, and cat parent also knows this now. If your cat isn't eating get a really (really!!, and not always easy to do) good look under their tongue. About once in every 500 cats (my guess) we find the problem hiding here. The biggest fear we have with cats and linear foreign bodies, (like a piece of string or ribbon), is that the start playing with it and the little barbs on their tongues that allow them to be such successful groomers,  causes them to start swallowing the string. It is not uncommon for the linear foreign body to get stuck under their tongue as the esophagus keeps trying to swallow.

The ER vets advice was to run some blood work, take an x-ray and possibly even do an exploratory surgery to see if the string was able to be removed and how much damage it had done to her internally. It was a good and thorough plan, but it was also an expensive plan. Bellas parents could not afford any of this. The emergency exploratory surgery that was recommended included an estimate of $1500 to $4000 plus. Without any funds to do any of the recommended services the only thing anyone could do was cut the string under the tongue, which would at least relieve it from further cutting into and strangulating the tongue, and, hope (really, really hoping here) that if it was freed it would pass through the gi tract on its own.

Can you tell that she is in pain? Cats hide it very well.

So, that's what was done. Bella went home.

A week after the ER visit she came to see me.

She was laying on her side, very reluctant to move, and very painful. I took an x-ray and saw the classic "string of pearls" plication pattern. Plication is the gathering  of the intestines when something inside of it is pulling it together which is an indication that there is intestinal bunching.

After I saw Bellas x-ray, how painful she was when I touched her abdomen, and how sweet she was even though I knew she was beyond miserable, I just felt compelled to help her. Her mom told me that she had recently been homeless and that Bella had been the reason she got through all of the rough spots her life had recently given her. "Bella was everything, and, she just didn't know what she would do without her?" I understood exactly what she meant. I had been in just her shoes many years ago, before I went to vet school. It wasn't just Bella who spoke to me, who moved me to take pause and want to help, it was her mom too. They both needed me, and, I was pretty sure I could help. I could at least help to see what was going on inside. Whether I was too late to save Bella had yet to be determined, but, I knew that if I didn't help Bella she would die.

I told Bellas mom I thought that it would be best if she left Bella with us at the clinic. It was a Sunday,, and although we weren't going to be at the clinic late that day Bella needed fluids, antibiotics and pain medications. I also wanted her to be with us first thing in the morning on Monday so I could get her started on all the things she would need the day of her surgery.

I can't explain it to those who don't understand. I have almost given up trying. I knew that I could help Bella and I wanted to try. When I talk about finding and living your purpose I am talking about cases like Bellas. She is the reason I went to vet school. She is also the reason I still love being a vet. I can help her, it won't cost me a fortune to do so, and if I don't no one else is likely to intervene. Some people would think me unlucky to have cases like this. I think just the opposite. I think I learn my value here.

I told Bella's mom that I would keep her in the clinic overnight to do surgery the next day. She needed fluids, antibiotics and pain medication immediately.

The is what "bunched up" plication of the intestines looks like.

This is the string that I could see tearing its way through the intestines. It popped and poked out of about a hundred places along the whole intestines.

I spent about an hour gently removing the string from her very unhappy intestines. It was a slow, tedious process. Although we never want to see anything tearing through any organ, especially the intestines, it was actually fairly easy to remove the string. It had been in there long enough that where it was lodged it was cutting through. The holes it was making as it lanced its way through were pinpoint sized. Too small to suture. And there were far too many to even try to close. The point of the needle was going to do just as much damage as the thread had, and make her even more susceptible to leaking fluid that was supposed to stay inside her muscular tube of intestines into her open abdomen which will lead to sepsis, and probable death. 

The string ran the  entire length of her intestines. At the top of the intestines is the stomach. The stomach is a big pouch. Stuff only gets stuck here if it cannot be dissolved or digested in the acidic juices it produces, or if it wedges at the outlet, called the pylorus. In the top section of the intestines I grabbed the first place the string was tearing through. Very gently I pulled it out of the  stomach. Having one end is helpful. But, having it running through the whole rest of the gut was not. I could see and feel it running all the way down to the colon. It literally ran the whole gut. Not good!

I carefully pulled it out all the way down to (almost) the colon. We never, ever want to open the colon. So, I did what we all (vets) have done about a ba-zillion times. We glove up and go rectal fishing. I actually employed my smallest fingered person to help. As I tried to push the tiny amount of poop I could feel in the colon to her awaiting inside the rectum finger I hoped she could find the other end and then I could cut my end as she pulled it out. 

After a few minutes and a few fecal balls we had no luck. I cut the string as close to the large intestine as I could. I expected that there was only a few inches outside of the colon that had to advance and she would easily pass the rest. It was a little leap of faith, but, based on everything we had going against us I was hopeful.

I said a little prayer to her red, angry, yet peristalsis moving intestines. Peristalsis means the muscular tube is moving, and therefore still functional and the best indication it can recover that there is.

I carefully replaced all of her intestines back in her abdominal cavity and started to close her up.

As a veterinarian this is the place we all stop, breathe and hope. There is nothing more I can do.

There were still things to worry about. Because she is such a small cat and she has been unable to eat for so long and it had been so long with the string in her, she wasn't the best candidate for surgery. I had also spent a long period of time trying to remove the string with her whole belly open. This causes severe hypothermia pretty fast.. I know had to worry if she was going to wake up.

She came off the table at 95 degrees. Normal is about 101F. She had to warm up. We cuddled her in a big wrapped burrito blanket and heating pads. The techs stayed with her for about an hour. Pain meds were given and she actually looked happier from the moment she opened her eyes, despite the incision on her belly that ran sternum to pubis. She was awake and she was relieved of the excruciating pain I cannot even imagine how horrible it was. Veterinarians take an oath for this. How many of us forget pain is part of suffering? Relieving pain requires relieving the cause.

Here is her culprit. The string measured about 16 inches long.

Here she is the next day. Can you see the difference in her from day one? She is laying on her side. Stretched out and looking for attention. A different pose than curled up in the back of her cage and not wanting to engage, or say hello. She is inherently a social calm girl, but guarded, hiding, retreating and reluctant to move are all key signs that there is a problem.. Her parents saw not eating, I saw misery. It's why we ask all pet parents to call us the moment your pet isn't acting normally.

Here is her abdominal incision a few days later.

If anyone ever has the chance to give back, for just the simple pleasure of seeing a smiling face of gratitude back, take it. Paychecks come and go,, gratitude and all the joy it brigs last far longer.

I am sure people will think I am crazy for this, but, I donated my time for her. I felt really good about doing it.

This is Bella about 10 days post op. She is up, walking, comfortable and eating!!

I still love this cat. I am so glad she did so well.

Here is the cost breakdown of Bellas procedure;

walk in non-client Sunday exam $75

NSAID for pain $18

Day of surgery;

propoflo induction $60

exploratory surgery $350

surgical package (i.v. catheter, i.v. fluids, i.v. fluid pump, instrument pack) $250

anesthesia $125

additional suture packs $30

e-collar $15

overnight boarding 2 nights $40

Total for procedure; $950

I donated my time and $500 towards her surgery. I do so because I have the help of our internal Good Samaritan Fund. I have found that as much as I take from it our friends and supporters refill it.. I never let cost be a reason to deny care. I give more than I have to and in return I get more than I expect. It keeps me feeling whole and purposeful. It keeps me feeling grateful to be able to work, to help, and to be a part of someone else's story. Isn't that we all want?

Related Blogs;

What Gets Swallowed Must Go Through.... or else. Foreign Body Obstruction Surgery. Levi's blog.

For those of you interested in learning more about pet care please visit my YouTube channel. 

If you have any questions about your pets health you can ask me for free at Pawbly.com.

For more information on our clinic, Jarrettsville Veterinary Center please find us on our website JarrettsvilleVet.com, or our Facebook page, Jarrettsville Vet.

Please be safe everyone.