Case Study of the Month: March 2014
Kitty cats sometimes feel like a nut!! 

History: A 1-year-old male neutered cat was presented for evaluation of vomiting for a duration of 3 days. The patient has a known history of frequently eating inappropriate things around the house (strings, foreign objects, etc…). The owner reported no urination or bowel movement for 2 days. No vomiting, coughing, sneezing, or diarrhea was noted. The physical examination was unremarkable. Blood work was performed with the following findings: elevated hematocrit (the volume percentage of red blood cells in the blood) of 52.7%, eosinopenia (decreased numbers of a type of white blood cell), thrombocytopenia (low number of platelets), mild hyperglycemia (elevated blood sugar), elevated BUN (kidney enzyme), elevated calcium, low albumin (a common protein), and slightly elevated ALT (liver enzyme). (Non-veterinarians see Patient Information for links to more detailed information about blood values).

Ultrasound Findings: The stomach was dilated in this patient with anechoic (dark black) fluid. The fluid dilation continued into the pylorus (stomach outlet). Gas artifact was noted in the upper gastrointestinal and stomach. This obscured some visibility. The small intestine was dilated and was followed by empty small intestine. The midabdomen revealed echogenic (visibly white) material in what appeared to be the small intestine. The descending colon presented some stool.

Ultrasound Differential Diagnoses: Upper gastrointestinal obstructive pattern. Suspect foreign body.

Actual Diagnosis: Foriegn body obstruction; a pistachio.

Outcome: The patient underwent an abdominal exploratory in which a pistachio was removed from the jejunum via uncomplicated enterotomy (surgical opening and closing of the intestines). The patient recovered uneventfully.
Anechoic fluid dilation is noted in the stomach that is uniform to the level of the pylorus (arrow) without and evidence of pyloric obstruction.
A distinctly shadowing 1.5 cm structure (large arrow) is evident in the duodenum followed by empty small intestine after the obstruction (small arrow). The dilated small intestine before the shadowing foreign body was present but not in view in this image.
Pistachio obstruction is the 1.5 cm shadowing structure at the end of the clip.
Patient Information

Age 1 Year
Gender Male, Neutered
Species Feline

Blood Chemistry
CBC
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