Thursday, October 13, 2005

Exploratory

Last Tuesday I saw a young cat that had not eaten for 2 days and was vomiting. This 1 year old had a history of playing with strings, too. She had a low grade fever. I recommended Xrays, and there was a bunching pattern to the small intestines.

Cats that ingest strings get into severe trouble with their gastrointestinal tract. As their guts work on passing the string, the intestines end up bunched up on the string like a gathered skirt. The string then works as a saw on the intestines. The only cure is surgery.

Based on her signs, and in agreement with the other doctors in my practice, I recommended surgery. The owners gulped when they saw the estimate, but agreed to the exploratory.

I opened the cat's abdomen, but there was no string, no obstruction, no gross abnormality to be seen. The irritated intestines were actively bunching up, relaxing, and bunching up again, which explained their appearance on Xray.

I took a biopsy and quickly closed her up. The only good thing is that the shorter surgery cost a few hundred dollars less than the longer resection and anastomosis I thought I'd be doing.

The patient did well at the emergency clinic overnight, and is apparently eating small, bland meals and not vomiting, so she is doing well. The owners are understanding about the whole ordeal, but I can't help but feel guilty. Given the same set of presenting symptoms and signs, I'd probably recommend the surgery again (young otherwise healthy cat, sudden onset, string playing, clumpy intestines). Still, I wish I could've seen into my crystal ball and saved the patient the surgery and the owners the expense.

We say in veterinary medicine that there are no negative exploratories. You have to have some where you find nothing, in order not to miss the ones that really need surgery before intestines rupture and the patient gets peritonitis. Certainly, I have sat on other cases, and had to go in anyway, after a day or two of hospitalization and gastrointestinal misery.

Still, wish I had better divination skills...

7 comments:

EdamameMommy said...

Euw. That sounds gut-wrenching. hee hee, sorry couldn't resist. ;)

Sorry you couldn't see inside before you cut. At least you had willing and understanding pet owners to deal with this time.

Leigh-Ann said...

So, what was up with the cat, then? The "bunching and unbunching intestines" part doesn't sound very attractive.

Aunty Norma said...

I was about to ask the same question,Leigh-ann...Jennifer..I am no Vet. but I should think other Vets.all over the World would have agreed with you..I know I would rather you had made sure and operated on my Pet. xxx

paula said...

I totally agree with what you did as well Jenn, if one of my three hooligans (sorry, cats) had those symptons I would rather you open them up and take a look, I'd never forgive myself if something was missed. But, same question, what was with all the "bunching"?

Anonymous said...

The only way you could've know what was going on was to do the surgery..Especially if you saw something suspicious on the X-Ray.

So, don't give your self a hard time! At least you got a biopsy done....do you think that will prove to be anyting?

I'd love to get an update about this case- when its available!=)

Love-Bevie-

Julie said...

I know that if it were my pet who was in danger of dying in a most unpleasant and painful way, I'd be happy to let you do the exploratory to be safe. If the people begrudged you that, I'd really wonder about them...

So, really, what WAS wrong with the cat?

Emily said...

Looks like you've got us all hooked on the story, Jenn! Now we just need a follow-up! Can cats get IBS?

I remember watching you do surgery once on a dog that had been attacked by a pack of dogs. The peristaltic movement of the intestines was really fascinating.

I agree with Bevie: sounds like you made the right decision given the facts and tools you had available. Don't give yourself such a hard time.