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Intestinal intussusception is uncommon in adult cats and is usually associated with an underlying causative condition such as inflammatory bowel disease, foreign body or neoplasia. This case describes an intussusception in an adult Maine Coon cat in which both ultrasound and cytology raised genuine concern for neoplasia, and illustrates the diagnostic trap of a partial obstruction and the value of adjacent-bowel histology when referral is not an option.
Case presentation
Mr Springfield, a four-year-old male neutered Maine Coon cat weighing 6.7 kg, presented with a two-day history of vomiting and inappetence, having vomited approximately two hours after eating. He was bright and alert, with a temperature of 39.2°C. Importantly, the abdomen was soft and comfortable on palpation, with no palpable mass.
Blood tests and imaging were offered, but the pet’s owner initially elected symptomatic treatment with maropitant, a gastrointestinal prescription diet and probiotics.
Over the following fortnight the pattern proved intermittent; he would settle, then vomit again. Blood tests revealed a profound neutrophilia, an elevated GGT and hypokalaemia. This was initially treated as a suspected gastrointestinal infection, with antibiotics and antiemetics producing partial, temporary improvement. Such a relapsing course, in a bright cat with a consistently soft, non-painful abdomen, is more consistent with a partial than a complete obstruction, where intestinal contents can still pass intermittently.
Imaging and cytology
When signs failed to resolve, abdominal ultrasonography was performed under sedation. A jejunal lesion was identified with complete loss of normal wall layering—a feature strongly concerning for neoplasia. No foreign body was seen. The pancreas was mildly thickened with hyperechoic nodular change.
Because the necrotic, mass-like lesion could not be confidently distinguished from neoplasia, a fine-needle aspirate was taken at the time of ultrasound.
Cytology showed necrosis and spindle cells. Reactive fibroblasts, myofibroblasts and granulation tissue can, however, mimic mesenchymal neoplasia cytologically, and an abscess or partial foreign body with secondary bowel necrosis could not be excluded.
The pet’s owner was counselled honestly—neoplasia could not be ruled out, the lesion might equally be benign, and an intussusception remained possible despite the non-classic appearance. With specialist referral not financially viable, the realistic options were exploratory surgery or euthanasia. Surgery was elected.
Surgery and histopathology
Potassium supplementation was commenced before anaesthesia. Multimodal analgesia included ketamine and fentanyl infusions, with intraoperative cefazolin and metronidazole, and an intraperitoneal lignocaine splash block over the enterectomy site.
Exploratory laparotomy confirmed a jejunal intussusception with no foreign body—an unusual finding in an adult cat, and one that could not be assumed free of an underlying inflammatory or neoplastic lead point. An enterectomy was performed back to grossly healthy bowel, with the resection deliberately extended a short distance so that histopathology could assess apparently healthy intestine for inflammatory bowel disease not visible on ultrasound. The anastomosis was closed with 4/0 PDS, leak-tested, and an omental patch sutured over the site. The mildly inflamed pancreas was biopsied.
Histopathology was decisive. The small intestine showed an unreduced intussusception with extensive fibrinosuppurative and necrotising enteritis and transmural haemorrhage. There was mild lymphoplasmacytic inflammation at the margins but no villous atrophy to suggest chronic enteropathy, and the margins were clear. Crucially, there was no neoplasia and no foreign body.
Recovery and complications
Persistent hypokalaemia impaired gastrointestinal smooth muscle function, promoting gastric stasis and ileus and perpetuating nausea and weakness. Hospitalisation with intravenous fluids and potassium supplementation was required.
A week after surgery the cat escaped his recovery suit and Elizabethan collar, groomed the incision and removed a suture. The superficial incision dehisced with purulent discharge, while the body wall remained intact. The wound was debrided, flushed and closed in layers, and a swab cultured Escherichia coli resistant to amoxicillin-clavulanate but sensitive to marbofloxacin. Antibiotics were rationalised accordingly.
Mr Springfield made a full recovery, and at the final recheck one month after surgery was bright, gaining weight and eating well.
Discussion
In cats, intussusception is far more common in young animals, where a substantial proportion are idiopathic1. In adult cats it is uncommon and more often associated with an identifiable lead point, most concerningly neoplasia. Affected cats tend to be older and are more likely to have underlying neoplasia than dogs1, 2. The jejuno-jejunal location seen here is the most commonly reported site in cats1, and Maine Coons and male or castrated males have been reported as over-represented in at least one feline retrospective series3.
A partial obstruction is a diagnostic trap. This cat was repeatedly bright, with a soft, non-painful abdomen and no palpable mass, and even responded transiently to symptomatic treatment. Vomiting that recurs with attempts to eat, particularly alongside weight loss, warrants imaging even when the abdomen feels unremarkable.
Neither ultrasound nor cytology could reliably distinguish this lesion from neoplasia. A chronically telescoped, necrotic intussusceptum can mimic a tumour on imaging, and aspirates of necrotic, inflamed bowel are frequently equivocal. Submitting both the lesion and adjacent intestine substantially increases the histological diagnostic yield—a diagnosis was reached in 85 per cent of cases where additional biopsies were submitted, compared with 47 per cent where only the intussusception was examined2—and this was decisive here.
Key messages
Consider intussusception in any adult cat with intermittent vomiting and weight loss, even when the abdomen is soft and non-painful. Both ultrasound and cytology may suggest neoplasia in a necrotic intussusceptum. Histopathology of the resected bowel with adjacent margins is required for definitive diagnosis. When referral is unaffordable, exploratory laparotomy with enterectomy is an achievable general-practice procedure, provided electrolyte derangements are addressed and wound protection is rigorous.
References
1. Burkitt JM, Drobatz KJ, Saunders HM, Washabau RJ. Signalment, history, and outcome of cats with gastrointestinal tract intussusception: 20 cases (1986-2000). J Am Vet Med Assoc. 2009;234(6):771-776.
2. Levien AS, Baines SJ. Histological examination of the intestine from dogs and cats with intussusception. J Small Anim Pract. 2011;52(11):599-606.
3. Haider G, Leschnik K, Katic N, Dupre G. Enteroplication in cats with intussusception: a retrospective study (2001-2016). J Feline Med Surg. 2018;21(6):488-494.
Dr Daniel Richmond BSc BVMS
Vet Detective
Dr Daniel Richmond graduated from Murdoch University in 1995 and has practised across the UK and Australia for three decades.
A previous practice owner, Dr Richmond was a lead veterinarian at Willunga and Aldinga Veterinary Services in South Australia when he treated this patient Mr Springfield.
Observing the impact of communication on veterinary burnout, Dr Richmond co-founded Vet Detective, a training consultancy teaching veterinarians how to navigate difficult client conversations, and he also provides a mobile veterinary ultrasound service in Adelaide.
