Visiting Vet: Tori was lucky

But small, pointy items are to be guarded with care.

Cat is waking up from anesthesia after I removed this needle and thread from the roof of her mouth and esophagus. — Michelle Jansy

“I don’t know what to do,” the caller said urgently. “I can’t catch her. I don’t know if she swallowed it.” The “her” in question was a 14-month-old cat named Tori. The “it” was a needle and thread swiped from a sewing table. Who knows why cats are so attracted to yarn, dental floss, tinsel, ribbons, strings, needles and thread? They just are. As a result, “linear foreign body” ingestion is a common kitty problem. Sometimes Kitty is lucky — the item goes in one end and out the other. Sometimes Kitty is unlucky — one end of string gets stuck, while the other end keeps moving down the gut. The intestines bunch up in pleats like an accordion. The string pulls tighter and tighter, eventually cutting through the gut like a saw. Intestinal contents leak into the abdomen, leading to potentially fatal infection. 

In Tori’s case, I was worried about both needle and thread, each posing somewhat different concerns. “There was a lot of bloody drool,” her mom reported, “but now she’s just sitting grooming herself. She seems fine, but won’t let me look at her closely.” Hmmm. Perhaps when the needle jabbed Tori, she dropped it. Or perhaps she swallowed it.

Thirty-odd years ago I was filling in for a veterinarian north of Boston while he spent the winter golfing in Florida. There was this cat he had been treating for an infection on her shoulder. Being an outdoor kitty, my employer had assumed the cause was an abscessed cat fight wound — a reasonable assumption — but when I inherited the case after he flew south, I couldn’t get it to heal. Every time I prescribed antibiotics, things would improve, but it would never completely resolve. As soon as we stopped medicating, the area would fill with fluid and pus again. Clearly it was bothering the cat, who was intermittently lame.

“I don’t know why this won’t heal,” I told the owners, and suggested exploring surgically to look for a foreign body, then biopsy and take a culture. Maybe it was some weird cancer, fungal infection, or resistant organism. They agreed reluctantly. With Kitty anesthetized, I poked around inside the oozing wound. Nada. I took the culture and biopsy, then flushed the gaping pocket with sterile saline. Still nothing. After debriding the necrotic tissue, I was preparing to place a drain and suture the lesion closed when I spied a tiny black dot peeking into my surgical field. Reaching into the depths, I snagged the dot with the tip of my hemostat and pulled gently. The dot became a line. I pulled a little harder, eventually extracting a two-inch length of black thread … attached to a sewing needle. Ouch. At least six weeks previously, my patient must have swallowed this needle and thread. The needle perforated the esophagus, then migrated through the muscles behind his shoulder blade, trying to work its way out of the body. Now I had removed it, all I had to do was stitch him up and he was good as new. Problem solved. 

What if Tori had swallowed her needle? It was Saturday night. She was not showing any signs of distress. I suggested her owner look around the house carefully to see if Tori had dropped the needle and thread. If not, I advised an x-ray to determine if the needle was inside her somewhere. When she didn’t call back, I assumed she had found the needle and thread. As a young veterinarian, I once received a call from a client who had seen his cat swallow a needle a few days previously. Since this had happened on a weekend when another practice was covering emergencies for me, the owner had consulted them by telephone. The doctor on call had not seen the cat, but simply advised feeding bulky foods until the patient could see her regular veterinarian (me) on Monday. The doc had said not to worry, that the needle would likely pass. 

 At first I was outraged. I hadn’t been in practice all that long, but I knew if a needle perforated the gut, it could lead to fatal infection. “I don’t think we can risk that,” I said dramatically, recommending immediate surgery. When the cat arrived, we took a radiograph to confirm the location of the needle before surgery. I was shocked to see it had moved harmlessly almost the entire length of the gut, and was now encased in a fecal wad, on its way to the litter box. No surgery required. Nor any outrage. The weekend veterinarian had been correct, at least this time. The veterinary lore is full of tales about needles that passed uneventfully. But there are also plenty of stories of needles perforating, migrating, and sometimes causing serious, even lethal, damage. Since that time I have seen several cats and one small dog succumb to overwhelming infections caused by intestinal perforation after ingesting sharp items.

So when Tori’s mom called again on Monday to say the cat was eating and acting normally, but she had not located the needle and thread, I encouraged her to come right down for an x-ray, which she did. “Let me take a quick peek before we x-ray,” I said, popping her on the exam table and opening her mouth. There, on the roof of her mouth: a shining silver stripe. The needle. One end stuck deeply in the middle of her palate, the other end lodged firmly in the back of her throat. Ouch.

We sedated Tori. With a bit of manipulation, I managed to dislodge the needle, and pulled it out, along with a foot of attached thread which had snaked down her esophagus. Amazing, she had been eating and grooming as though she didn’t have a care in the world. My parting advice — always keep needles and thread safely stowed away. Pins, too. I once saw a boxer puppy who swallowed an entire box of straight pins … but that’s a tale for another day.