What is telescoping of the intestines?
The cat’s digestive system is a long, hollow tube that starts in the mouth and ends at the anus. A series of wave-like contractions known as peristalsis pushes food along the GI tract.
Telescoping or intussusception (in-tuh-suh-sep-shun) of the intestines is a severe and life-threatening emergency that occurs when one segment of the intestine folds or slides into the section immediately ahead of it (like a telescope). Blood vessels become trapped between the layers, which compromises blood flow and leads to edema (swelling). Strangulation of the blood vessels leads to (necrosis) death of the affected tissue and disruption of the mucosal barrier which allows bacteria to enter the bloodstream (sepsis).
Intussusceptions can occur anywhere along the gastrointestinal tract but develop most often in the small intestine.
The inner (invaginated) portion is known as the intussusceptum, while intussuscipiens is the portion of the intestine that contains the intussusception.
There is no sex predilection, and intussusception can affect cats of any age; however, 75% of cases involve cats under 12 months, and there is a higher incidence in Siamese cats.
Causes
Intussusception occurs when there is a change in normal peristalsis and is most often associated with enteritis (inflammation of the intestine). Most cases develop when an upper section telescopes on the proceeding section.
- Parasitic worms
- Ingestion of a linear foreign body (tinsel, piece of string or cotton, hair tie)
- Tumours
- Recent gastrointestinal surgery
- Viral, bacterial or protozoal infection
- Pancreatitis (inflammation of the pancreas)
- A sudden change to the diet
Symptoms
Symptoms can vary depending on the location within the gastrointestinal tract as well as complications such as necrosis, perforation, and sepsis. One review found the most common site is the ileocolic junction which is formed by the junction of the ileum into the ascending colon. Intussusceptions high in the GI tract causes more severe symptoms than those in the lower GI tract.
Initially, intussusception may only cause a partial obstruction, but will quickly develop into a full blockage.
High intussusception
- Vomiting, which may contain blood
- Regurgitation
- Bloody, mucoid diarrhea
- Lethargy
- Loss of appetite
- Abdominal pain
- Difficulty breathing
Low intussusception
- Sporadic vomiting
- Bloody diarrhea
- Infrequent or absent defecation
Diagnosis
Always seek veterinary attention for cats with vomiting or diarrhea which has lasted longer than 24 hours.
The veterinarian will obtain a medical history from you and perform a complete physical examination. A tentative diagnosis can be made based on history, symptoms as well as a cylindrical palpable mass.
Diagnostic workup:
Baseline tests: Biochemical profile, complete blood count (CBC) and urinalysis.
- CBC may reveal low or high white blood cell count depending on the underlying cause as well as anemia.
- A biochemical profile is useful to evaluate for electrolyte imbalances and check kidney and liver function.
Imaging studies: Ultrasound, x-ray or barium studies can confirm intussusception as well as evaluate the GI tract for evidence of foreign bodies or tumours.
Fecal studies: To check for worm eggs.
Treatment
The goal of treatment is to correct the intussusception and treat the underlying cause. Before surgery, it may be necessary to provide hydration and manage electrolyte imbalances.
Surgery: Conservative treatment may involve the veterinarian manually unfolding the intussusception (manual reduction). However, there is an increased risk of recurrence. Most cases will require surgical resection, in which the affected tissue is removed, and the cut areas are re-connected (intestinal anastomosis).
Aftercare
The cat will remain in hospital after surgery and be administered analgesics to relieve pain, fluids to maintain hydration and electrolytes and antibiotics to prevent secondary infection.
Most cats will be discharged between 2-3 days post-surgery and the cat will go home with a care sheet, always follow instructions and administer medications as prescribed. Notify the veterinarian if you notice complications such as redness or discharge, vomiting, diarrhea or loss of appetite.
Keep the cat indoors and restrict activity during the recovery period.
Prognosis
The prognosis will depend on the underlying cause, the severity of the intussusception as well as the overall health of the cat.
Prevention
- Regular parasite control and routine vaccination are essential for all cats regardless of or indoor or outdoor status
- Avoid sudden changes to the cat’s diet by making changes gradual by increasing the amount of new food while decreasing the old type
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