GI Perforation in Cats
GI perforation is a life-threatening event that can lead to septic peritonitis and death. Perforation can occur if the digestive mucosal circulation, bicarbonate buffer, and mucous layer secretion are disrupted, which allows for autodigestion of the GI mucosal lining. Spontaneous perforation arises in the absence of foreign body ingestion, gastric dilatation and volvulus, external trauma, leakage at previous surgical sites, or iatrogenic trauma. Mechanisms of spontaneous perforation include gastric hyperacidity, ischemia, mucosal trauma or infiltrative disease, drug administration, and mastocytosis causing increased histamine release and gastric acid production. In cats, little is known about the presentation of and predisposing factors for spontaneous GI perforation.
In cats, little is known about the presentation of and predisposing factors for spontaneous GI perforation.
Medical records were searched for cats diagnosed with spontaneous GI perforation via exploratory surgery. Thirteen cats of various breeds ranging in age from 9 months to 17 years were included in this study. Clinical signs were generally nonspecific, and multimodal diagnostics were used. The most common histological finding was lymphoma in 6/11 cats. Other findings included chronic hyperplasic gastritis, chronic suppurative ulcerative enteritis, and chronic lymphocytic-plasmacytic ulcerative enteritis. FeLV/FIV status was negative in the 7/13 cats tested. Two of the 13 cats were previously administered nonsteroidal anti-inflammatory drugs (NSAIDs), and 4 received corticosteroids. Three of these cats were treated with corticosteroids for chronic vomiting and weight loss; 2 of these were later diagnosed with lymphoma. The direct implication of corticosteroid or NSAID administration and spontaneous perforation was not clearly established in this study.
Global Commentary
Although based on a small number of cases and therefore of limited reliability, this study suggests that the signs of septic peritonitis in cats, as in dogs, are nonspecific.
A high index of suspicion is required for an early diagnosis, which is best made using a combination of imaging and clinical pathology. Unlike in dogs, a large proportion of spontaneous GI perforations seems to result from alimentary lymphoma, whether low- or high-grade. Surgery is not riskier in cases of lymphoma,1 but the prognosis associated with these perforations appears guarded, regardless of the malignancy of their cause. Adjuvant chemotherapy is indicated in cases of lymphoma.—Laurent Findji, DMV, MS, MRCVS, DECVS