Computed tomographic diagnosis and clinical outcomes of small intestinal obstruction caused by trichobezoars in client-owned rabbits.

Small intestinal obstruction in rabbits, although demonstrated to be common, is still poorly characterized. The objective of this study was to report features of small intestinal obstruction caused by trichobezoars in rabbits upon CT and their clinical outcomes. Rabbits with a diagnosis of intestinal obstruction that underwent CT scanning were included in this study. From each CT scan, obstruction location, appearance, Hounsfield units, size (mm), volume (mm3), distance from the stomach, and diameter of the small intestine proximal and distal to it, were extracted. Nine rabbits were included in the study. All rabbits presented for anorexia and had a distended or enlarged stomach (7) or abdomen (2). CT scan showed a non-contrast-enhancing, ovoid, smoothly marginated structure with a hyperattenuating rim, heterogeneous center, and variable amount of centrally located gas, in the duodenum (5), the jejunum (2), or the ileum (2). The density of the trichobezoars ranged from -156 to 58 HU (median, -44 HU) and volume ranged from 86.1 to 633.8 mm3 (median, 320.6 mm3). Three rabbits underwent medical management. Two of them survived, and one of them died. Six rabbits underwent surgery, of which three were successfully discharged from the hospital. CT proved to be a valuable imaging modality in rabbits with a suspected intestinal obstruction to provide the exact location of the obstruction and the characteristics of the obstructive material. The location and size of the trichobezoar may have relevant clinical implications.

Histopathologic diagnosis and patient characteristics in cats with small intestinal obstructions secondary to trichobezoars.

OBJECTIVES: The aim of the present study was to describe the distribution of gastrointestinal histopathology findings associated with gastrointestinal obstructions secondary to trichobezoar formation in cats. METHODS: A total of 100 surgical gastrointestinal biopsies were obtained from 44 cats with gastrointestinal obstructions secondary to a trichobezoar. Medical records, including signalment, type and duration of clinical signs, surgical reports and histopathologic analysis, were reviewed for each cat. RESULTS: Biopsies taken near the site of the trichobezoar were more likely to show neutrophilic inflammation and mucosal erosion/ulceration compared with biopsies taken elsewhere in the small intestine. Lymphoplasmacytic and mixed lymphocytic and eosinophilic populations were the most common histopathologic findings from all biopsies followed by alimentary small cell lymphoma. Biopsy samples were more likely to represent a diagnosis of alimentary lymphoma in cats older than 10 years. CONCLUSIONS AND RELEVANCE: Gastrointestinal biopsies taken at the time of surgery in cats with trichobezoar obstructions may represent an important diagnostic tool for further evaluation of potential feline chronic enteropathy. Biopsies taken at the site of the obstruction should be interpreted cautiously as the presence of a trichobezoar may induce an acute inflammatory reaction. The resultant histologic interpretation at this site may not represent the chronic state of the intestinal mucosa, supporting the utility of obtaining multiple biopsies orad and aborad to the obstruction.

Endoscopic administration of Coca-Cola for medical management of a wedged intestinal trichobezoar in a cat.

A 16-year-old, neutered male domestic longhair feline with gastroduodenal and jejunal trichobezoars was treated with administration of Coca-Cola through endoscopic injection catheter. Examination with a Karl Storz endoscope identified a trichobezoar causing suspected partial or early complete obstruction of the jejunum; however, the length of the scope was inadequate to retrieve the trichobezoar. Consequently, 55 mL of Coca-Cola and 5 mL of iohexol were instilled into an injection catheter to disrupt the trichobezoar. No peri- or postoperative complications were reported, and the cat recovered uneventfully. Key clinical message: This case report demonstrates a minimally invasive approach to treatment of a small intestinal trichobezoar in a cat with no intra- or postoperative complications. Coca-Cola infusion through an endoscopic injection catheter may be a viable treatment in cats when a surgical approach is not an option, although further cases are needed to determine whether these results can be generalized to the larger patient population.

Administration endoscopique de Coca-Cola pour la prise en charge médicale d'un trichobézoard intestinal coincé chez un chat. Un félin domestique à poil long mâle castré de 16 ans atteint de trichobézoards gastroduodénaux et jéjunaux a été traité par l'administration de Coca-Cola via un cathéter d'injection endoscopique. L'examen avec un endoscope Karl Storz a identifié un trichobézoard suspecté d'obstruction partielle ou complète précoce du jéjunum; cependant, la longueur de l'endoscope était insuffisante pour récupérer le trichobézoard. Par conséquent, 55 ml de Coca-Cola et 5 ml d'iohexol ont été instillés dans un cathéter d'injection pour défaire le trichobézoard. Aucune complication péri- ou postopératoire n'a été signalée et le chat s'est rétabli sans incident.Message clinique clé :Ce rapport de cas démontre une approche peu invasive du traitement d'un trichobézoard de l'intestin grêle chez un chat sans complications per- ou postopératoires. L'infusion de Coca-Cola via un cathéter d'injection endoscopique peut être un traitement viable chez les chats lorsqu'une approche chirurgicale n'est pas une option, bien que d'autres cas soient nécessaires pour déterminer si ces résultats peuvent être généralisés à une population de patients plus large.(Traduit par Dr Serge Messier).

Esophageal obstruction due to trichobezoar in a she-camel (Camelus dromedarius).

Background: Occurrences of esophageal foreign bodies are common in camels. Esophageal obstruction in camels due to bezoars is rare. Case Description: This report describes esophageal obstruction in camel due to trichobezoar. A 2-year-old she-camel presented with a history of inability to swallow and there was food and water regurgitation for one day before. Radiography and endoscopic examination revealed an oval-shaped foreign body embedded in the esophageal lumen in the level distal third of the neck. The foreign body was successfully removed using cervical esophagotomy under general anesthesia. Successful esophagostomy revealed trichobezoar weighing 45 g and measuring 85 mm × 75 mm × 42 mm. The trichobezoar removed from the esophagus was the cause of esophageal obstruction. Conclusion: Esophageal obstruction in camel could be due to trichobezoar. Radiography and endoscopy are valuable diagnostic methods to determine the position and nature of an obstructive object.

The effects of diets varying in fibre sources on nutrient utilization, stool quality and hairball management in cats.

Pet food companies use fibrous ingredients in cat foods to aid weight and hairball management. Miscanthus grass could be an alternative novel fibre source for cat foods. The objectives of this work were to determine the effects of Miscanthus grass as a fibre source on nutrient utilization, stool quality and hairball management in cats. Dry extruded cat foods (average chemical composition; digestibility trial: 94.54% dry matter-DM, 34.47% crude protein-CP, 11.67% crude fat, 7.06% ash and 13.04% total dietary fibre-TDF; and hairball trial: 94.88% DM, 34.60% CP, 11.30% crude fat, 7.02% ash and 9.77% TDF) were fed to 12 cats for a 9-day (digestibility trial) or 16-day (hairball trial) adaptation period followed by a 5-day total faecal collection period. Digestibility trial was performed as a replicated Latin square design, and the hairball trial was performed as a switchback design. In general, the cats fed the beet pulp diet (BPD) had higher DM, organic matter, gross energy and TDF digestibility than cats fed Miscanthus grass (MGD) or cellulose (CED) diet (p < .05). However, CP digestibility was lower for cats fed BPD (82.1 vs. 84.7 and 85.1%, respectively, for BPD, MGD and CED). These differences could be due to the differences in dietary fibre content and(or) composition. Faecal scores were lower for cats fed BPD (2.84) compared with MGD (3.32) and CED (3.21; p < .05). No effects due to fibre were reported on the faecal hairball variables, with the exception of less total hair weight and hair clumps per gram of dry faeces for cats fed Miscanthus grass (MGH) compared with control diet (COH; p < .05). In conclusion, Miscanthus grass could be used as an alternative ingredient to cellulose in cat diets.

Massive Bezoar in a Free-Ranging South African Oryx (Oryx gazella gazella) in South-Central New Mexico, USA.

We documented a 23 kg bezoar that filled >60% of the rumen of an adult oryx (Oryx gazella gazella) harvested in New Mexico, US. The nidus of the bezoar was comprised of nylon cords and parachute cloth, constituents of parachutes. Although slightly thin, the oryx was otherwise healthy at harvest.

Catastrophic gastric rupture in a horse secondary to psyllium pharmacobezoars.

A mare was euthanized because of gastric rupture secondary to complete duodenal obstruction by 2 bezoars located in the pylorus and proximal duodenum. Infrared spectroscopy showed that the bezoars were composed of psyllium. The mare had been receiving treatment with a pelleted psyllium product at 4 times the recommended dosage. Veterinarians should be aware that treatment of colic in horses with pelleted psyllium products could be associated with gastric impaction.

Rupture gastrique catastrophique secondaire à des pharmacobézoards de psyllium en boulettes chez un cheval. Une jument a été euthanasiée en raison d'une rupture gastrique secondaire à une obstruction duodénale complète par deux bézoards situés dans le pylore et le duodénum proximal. La spectroscopie infrarouge a montré que les bézoards se composaient de psyllium. La jument avait reçu un traitement composé d'un produit de psyllium en boulettes à quatre fois la dose recommandée. Les vétérinaires devraient être au courant que le traitement des coliques chez les chevaux avec des produits de psyllium en boulettes pourrait être associé à une impaction gastrique.(Traduit par Isabelle Vallières).

Beet pulp intake and hairball faecal excretion in mixed-breed shorthaired cats.

Hairball formation may induce vomiting and intestinal obstruction in predisposed cats. Some insoluble fibres as sugarcane fibre and cellulose can prevent hairball formation. The aim of this study was to evaluate the effect of beet pulp consumption, a moderate soluble and fermentable fibre source, on faecal trichobezoars excretion in adult shorthaired cats fed kibble diets. Eighteen mixed-breed shorthaired cats and three extruded diets were used as follows: a basal diet without added fibre source (PB0-8.8% dietary fibre); BP8-8% inclusion of beet pulp (17.5% of dietary fibre); BP16-16% inclusion of beet pulp (23.8% of dietary fibre). The cats were fed during 31 days and faeces quantitatively collected during three periods of 3 days each (from days 3-5; 15-17; 26-28). Gastrointestinal transit time was determined in the last 3 days of study (from days 29-31). The trichobezoars were separated from faeces, collected, dried and washed in ether for complete removal of all faecal material. The results were submitted to repeated-measure analysis of variance and means evaluated by polynomial contrast (p < 0.05). Beet pulp increased faecal production (p < 0.001) and reduced gastrointestinal transit time (p = 0.003). No alterations were found on trichobezoar faecal excretion, both as considered in number per cat per day of mg per cat per day (p > 0.05). Beet pulp intake did not reduce the number or the size of hairballs eliminated via faeces of shorthaired cats.

Compactação ruminal e obstrução intestinal em bovinos, associadas ao consumo de Agave sisalana Perrine (Agavaceae) / Ruminal indigestion and intestinal obstruction in cattle associated with consumption of Agave sisalana Perrine

A compactação dos pré-estômagos é um transtorno digestivo resultante da ingestão de forragem de baixa qualidade, rico em lignina e com baixos níveis de energia e proteína digerível, associada ou não a restrição hídrica. O acúmulo de vegetais ricos em fibras indigeríveis pode levar também a formação de fitobezoares, causando transtornos digestivos e obstruções intestinais. Objetivou-se com este trabalho descrever os aspectos epidemiológicos e as alterações clínico-patológicas de um surto de alterações digestórias em bovinos alimentados com Agave sisalana. O rebanho acometido era formado por 22 animais adultos, criados de forma semiextensiva, que, devido a escassez de forragem, receberam no cocho, quase que exclusivamente, durante dois meses, o caule do A. sisalana cortado manualmente. Seis vacas apresentaram diminuição do apetite, distensão abdominal, redução dos períodos de ruminação e da produção de fezes. Um animal foi encaminhado ao Hospital Veterinário da Universidade Federal de Campina Grande. O diagnóstico presuntivo de compactação ruminal e obstrução intestinal foi dado pela epidemiologia, sinais clínicos e análise de fluido ruminal. Na necropsia observou-se rúmen, retículo e omaso repletos, com conteúdo fibroso e ressecado constituído por fibras de A. sisalana. No abomaso observou-se a presença de conteúdo pastoso e esverdeado a acastanhado. Em todos os pré-estômagos e no abomaso havia fitobezoares, que mediam entre 4 e 12 cm de diâmetro. No duodeno um fitobezoar obstruía parcialmente a luz do órgão, com a porção anterior repleta de conteúdo e a posterior vazia. Conclui-se que a alimentação com caules de A. sisalana por longos períodos causa compactação de pre-estômagos e formação de fitobezoares.(AU)

Indigestion due to compaction of the ruminal content is a digestive disorder resulting from low-quality forage intake, rich in lignin and with low levels of energy and digestible protein, with or without water restriction. The accumulation of plant residues rich in indigestible fibers can also lead to formation of phytobezoars, causing digestive disorders and intestinal obstructions. The objective of this paper was to describe the epidemiology and the clinical and pathological changes of an outbreak of indigestion and other digestive disorders in cattle fed Agave sisalana. The affected herd consisted of 22 adult cattle reared in a semi-extensive system, which ingested almost exclusively stalks of A. sisalana manually cut for two months. Six cows showed decreased appetite and rumination, abdominal distension, and reduced production of dried feces. One animal was referred to the Veterinary Hospital. The presumptive diagnosis of indigestion was made by the epidemiologic data, clinical signs, and laboratory evaluation. At necropsy, the rumen, reticulum and omasum were filled with fibrous and dried A. sisalana content. A viscous, greenish brownish content was present in the abomasum. Numerous phytobezoars were found in the pre-stomachs and abomasum measuring 4-12cm in diameter. One phytobezoar was partially obstructing the duodenum, with the cranial part of the organ filled with intestinal content, and the caudal portion was empty. It is concluded that the administration of A. sisalana stalks for long periods may cause indigestion due to ruminal compaction and formation of phytobezoars.(AU)

Gastrolithiasis in prehensile-tailed porcupines (Coendou prehensilis): nine cases and pathogenesis of stone formation.

Gastrolithiasis was diagnosed in nine prehensile-tailed (PT) porcupines (Coendou prehensilis) housed at six zoologic institutions in the United States and Canada. Affected animals were either asymptomatic or had clinical signs, including weight loss, diarrhea, and depression. Abdominal palpation was adequate for diagnosis in all six antemortem cases, and radiographs confirmed a soft tissue density mass effect produced by the concretion. These gastroliths were all successfully surgically removed. Recurrence of gastrolith formation was common and occurred in four of the cases. Three cases were diagnosed postmortem, with the gastrolith causing gastric perforation in one case. Gastroliths from four cases were identified by mass spectrometry as bile acid precipitates consisting of the insoluble acid form of endogenous glycine-conjugated bile acids.

Persimmon phytobezoars in meerkats (Suricata suricatta).

Two meerkats (Suricata suricatta) died acutely and gastric bezoars were found at necropsy. Four of the eight remaining meerkats had bezoars identified radiographically. Surgical gastrotomies were performed and bezoars containing orange fibrous material were removed. Histologic examination of the bezoars and persimmon fruit from a tree in the exhibit revealed that the materials were identical. Tannins found in ripe persimmons are known to coagulate in the presence of gastric acid, and the resultant phytobezoars can lead to gastrointestinal obstructions. All four meerkats recovered uneventfully. The combination of interspecies aggression and a diet change may have led to consumption of persimmons produced by a tree in the exhibit. Persimmon phytobezoars are also seen in humans and horses.

Hair balls in cats: a normal nuisance or a sign that something is wrong?

PRACTICAL RELEVANCE: Vomiting of hair balls is a common problem in domestic cats, to the extent that it is considered by many owners and veterinarians to be a normal feline behaviour. Whether this is ever the case remains unclear but in most shorthaired cats the frequent elimination of hair balls is an indicator of an underlying chronic disease that is causing increased ingestion of fur or altered gastrointestinal motility. Pruritic skin disease, flea infestation and/or an underlying dietary intolerance are common contributing factors that should not be overlooked. EVIDENCE BASE: Studies concerning this common problem are lacking and there are no previously published data regarding the incidence of hair balls in pet cats or potential predisposing causes. Although a range of commercial hair ball control diets are available there is no objective information in the public domain regarding their efficacy. Similarly, no studies have evaluated the success of other commonly recommended preventive strategies. CLINICAL CHALLENGES: Despite the lack of evidence-based information, veterinarians are faced with the day-to-day challenge of helping owners to limit the extent to which their cats produce hair balls. The problem is at best an unpleasant nuisance for both cat and owner, and at worst may be a cause of significant morbidity and even, in rare cases, mortality.

Pyloric trichobezoar in a Canadian lynx (Lynx canadensis).

An adult female Canadian lynx (Lynx canadensis) was presented with a 3-wk history of anorexia and lethargy. Initial examination and diagnostics did not provide a diagnosis. The lynx continued to demonstrate vague clinical signs, including anorexia and an abnormal gait. During follow-up immobilizations 2 wk later, a barium gastrointestinal study revealed a pyloric obstruction. Abdominal exploratory surgery was elected, and a gastrotomy and an enterotomy of the proximal duodenum were performed to remove the pyloric obstruction. The obstruction was determined to be a trichobezoar. Fleas, a likely cause of hair ingestion through grooming, were noted during surgical preparation. The lynx made a full recovery from surgery. Reoccurrence of the trichobezoar was prevented after surgery with the use of monthly flea control and three times a week hairball laxative.