Correction of a Complication of the Use of a Nasoesophageal Feeding Tube in a Southern Tiger Cat (Leopardus guttulus)
Background: The southern tiger cat (Leopardus guttulus) is a vulnerable wild felid whose occurrence is restricted to the Atlantic Forest biome of Brazilian South and Southwest regions. Various strategies must be used to improve the conservation of species of felids, including preservation of forests and greater therapeutic support for animals in poor health condition. Enteral nutrition through a nasoesophageal tube is an option for patients in poor or critical condition; however, this procedure carries the risk of accidental ingestion of the tube. The objective of this work is to describe a conservative approach for the management of ingestion of a linear foreign body in a Leopardus guttulus patient.
Case: A young female southern tiger cat was taken for veterinary treatment. The patient had an estimated age of nine weeks, 0.846 kg of body weight, and exhibited cachexia, hypothermia, severe dehydration, and apathy. During the examination, blood samples were taken, and initial treatment commenced with fluid therapy, antibiotic therapy, and anti-inflammatory therapy along with administration of analgesics and a gastric protector. Since the patient did not want to eat, it received a nasoesophageal feeding tube under mild sedation. The patient was positioned in sternal recumbency, its head was tilted up, and a no. 6 nasoesophageal tube was ventromedially inserted through the right nostril. The tube was later confirmed to be correctly positioned at the ninth intercostal space by a radiographic study. The feeding tube allowed administration of drugs and microenteral nutrition with a hypercaloric diet; this minimized handling of the patient, which preserved its wild behavior. After the seventh day of treatment, a piece of the tube was found lying at the bottom of the cage. Since ingestion of the remainder of the tube by the patient was suspected, it was taken to the diagnostic imaging division. At the ultrasonographic exam, the stomach exhibited hypermotility and was filled with a moderate amount of mucous content. The stomach wall was thin, and its stratified structure was preserved. Ultrasound imaging did not reveal any alterations suggestive of obstruction or inflammation such as free liquid, thickened wall, or loss of the stratified structure of the layers of the stomach. A hyperechoic tubular structure compatible with the feeding tube used was detected in the fundus of the stomach. After verification of the presence of the tube-derived material in the digestive system, the medical team opted for a conservative therapy consisting of administration of fibers, to increase intestinal motility. The patient was followed up daily by means of imaging exams. The patient did not exhibit signs of intestinal obstruction during the follow-up period. Two days after commencement of the conservative therapy, the remnant of the feeding tube that had been ingested by the patient was expelled along with the feces.
Discussion: In spite of the accidental ingestion of the feeding tube by the patient, the use of this device was effective to provide nutritional and pharmacological support to the Leopardus guttulus cub, leading to its recovery. Managing malnutrition is fundamental for the recovery of any patient. Inappetence is alarming especially in felines, which quickly develop hepatic lipidosis during extended periods of anorexia. The conservative approach used, with the aid of serial imaging exams, was enough to treat ingestion of the linear foreign body by the patient.
Abood S.K. & Buffington C.A.T. 1992. Enteral feeding of dogs and cats: 51 cases (1989-1991). Journal of the American Veterinary Medical Association. 201(4): 619-622.
Armitage-Chan E.A., O’Toole T. & Chan D.L. 2006. Management of prolonged food deprivation, hypothermia and refeeding syndrome in a cat. Journal of Veterinary Emergency and Critical Care. 16: 34-41.
Basher A.W.P. & Fowler J.D. 1987. Conservative versus surgical management of gastrointestinal linear foreign bodies in the cat. Veterinary Surgery. 16: 135-138.
Boateng A.A., Sriram K., Meguid M.M. & Crook M. 2010. Refeeding syndrome: treatment considerations based on collective analysis of literature case reports. Nutrition. 26: 156-167.
Borges C.Q., Silva R.C., Assis A.M.O., Pinto E.J., Fiaccone R.L. & Pinheiro S.M.C. 2009. Fatores associados à anemia em crianças e adolescentes de escolas públicas de Salvador, Bahia, Brasil. Cadernos de Saúde Pública. 25(4): 877-888.
Brenner K., Kukanich K.S. & Smee N.M. 2011. Refeeding syndrome in cat with hepatic lipidosis. Case report. Journal of Feline Medicine and Surgery. 13: 614-617.
Cerny J.H. 1996. Alternative method for retrieving fishhook in dogs and cats. Journal of the American Veterinary Medical Association. 208(2): 184.
Chan D. 2009. The inappetent hospitalized cat – Clinical approach to maximizing nutritional support. Journal of Feline Medicine and Surgery. 11: 925-933.
Chan D.L. & Freeman L.M. 2006. Nutrition in critical illness. Veterinary Clinics of North America Small Animal Practice. 36: 1225-1241.
Chan D.L. 2004. Nutritional requirements of the critically ill patient. Clinical Techniques in Small Animal Practice. 19(1): 1-5.
Eachempati S.R., Hydo L.J., Shou J. & Barie P.S. 2009. Does de-escalation of antibiotic therapy for ventilator-associated pneumonia affect the likelihood of recurrent pneumonia or mortality in critically ill surgical patients? The Journal of Trauma. 66(5): 1343-1348.
Evans K.L., Smeak D.D. & Biller D.S. 1994. Gastrointestinal linear foreign bodies in 32 dogs: A retrospective evaluation and feline comparison. Journal of the American Animal Hospital Association. 30: 445-450.
Fossum T.W. 2013. Nutritional management of the surgical patient. In: Fossum T.W., Dewey C.W., Horn C.V., Johnson A.I., MacPhail C.M., Radlinsky M.G., Schulz K.S. & Willard M.D. (Eds). Small animal surgery. 4th edn. St. Louis: Elsevier, pp.95-113.
Freeman L.M., Becvarova I, Cave N, Mackay C., Nguyen P., Rama B., Takashima G., Tiffin R., Tsjimoto H. & Beukelen P.V. 2011. WSAVA Nutritional Assessment Guidelines. Journal of Small Animal Practice. 52: 385-396.
Garvey M.S. 1989. Fluid and electrolyte balance in critical patients. Veterinary Clinics of North America: Small Animal Practice. 19(6): 1021-1057.
Grossi P. & Gasperina D.D. 2006. Antimicrobial treatment of sepsis. Surgical Infections. 7(2): 87-91.
Guilford W.G. & Strombeck D.R. 1996. Intestinal obstruction, pseudo-obstruction, and foreign bodies. In: Guilford W.G., Center S.A. & Strombeck D.R., Williams D.A. & Meyer D.J. (Eds). Strombeck’s Small Animal Gastroenterology. 3rd edn. Philadelphia: WB Saunders, pp.487-502.
Hedberg G. 2002. Exotic felids. In: Gage L.J. (Ed). Hand-rearing wild and domestic mammals. Ames: Blackwell Publishing, pp.207-220.
Hoffmann K.L. 2003. Sonographic signs of gastroduodenal linear foreign body in 3 dogs. Veterinary Radiology & Ultrasound. 44(4): 466-469.
Janosik E.H. & Davies J.L.1996. Adaptational variations and disruptions. In: Janosik E.H. & Davies J.L. (Eds). Mental Health and Psychiatric Nursing. 2nd edn. Boston: Little Brown, pp.333-367.
Klaus J.A., Rudloff E. & Kirby R. 2009. Nasogastric tube feeding in cats with suspected acute pancreatitis: 55 cases (2001–2006). Journal of Veterinary Emergency and Critical Care. 19: 337-346.
MacDonald M.L., Rogers Q.R. & Morris J.G. 1984. Nutrition of the domestic cat, a mammalian carnivore. Annual Review of Nutrition. 4: 521-562.
Marlett J.A. & Fischer M.H. 2003. The active fraction of psyllium seed husk. Proceedings of the Nutrition Society. 62: 207-209.
Michel K.E. 1993. Prognostic value of clinical nutritional assessment in canine patients. Journal of Veterinary Emergency and Critical Care. 3: 96-104.
Miller C & Bartges J. 2000. Refeeding syndrome. In: Bonagura J. (Ed). Kirk’s Current Veterinary Therapy. 13th edn. Philadelphia: WB Saunders, pp.87-89.
Mitchel K.E. 1998. Nitrogen metabolism in critical care patients. Veterinary Clinical Nutrition. (suppl): 20-22.
Nascimento F.O. & Feijó A. 2017. Taxonomic revision of the tigrine Leopardus tigrinus (Schreber, 1775) species group (Carnivora, Felidae). Papéis Avulsos de Zoologia. 57(19): 231-264.
Nascimento F.O. 2010. Revisão taxonômica do gênero Leopardus Gray, 1842 (Carnivora, Felidae). 357f. São Paulo, SP. Tese (Doutorado em Ciências) - Departamento de Zoologia. Instituto de Biociências da Universidade de São Paulo.
Oliveira T., Tortato M.A., de Almeida L.B., Campos C.B. & Beisiegel B.M. 2013. Avaliação do risco de extinção do gato-do-mato Leopardus tigrinus (Schreber, 1775) no Brasil. Biodiversidade Brasileira. 3(1): 56-65.
Oliveira T., Trigo T.C, Tortato M., Paviolo A., Bianchi R. & Leite-Pitman M.R.P. 2016. Leopardus guttulus. The IUCN Red List of Threatened Species. Fonte: < http://dx.doi.org/10.2305/IUCN.UK.2016-2.RLTS.T54010476A54010576.en > [Accessed online in April 2018].
Oliveira T.G & Cassaro K. 2005. Guia de campo dos felinos do Brasil. São Paulo: Instituto Pró Carnívoros/ Fundação Parque Zoológico de São Paulo/ Sociedade de Zoológicos do Brasil/ Pró-Vida Brasil. 80 p.
Papazoglou L.G., Patsikas M.N. & Rallis T. 2003. Intestinal foreign bodies in dogs and cats. Small Animal/ Exotics Compendium. 25(11): 830-844.
Penninck D.G. 2002. Gastrintestinal tract. In: Nyland T.G. & Mattoon J.S. (Eds). Small Animal Diagnostic Ultrasound. 2nd edn. Philadelphia: Saunders, pp.207-230.
Perea S.C. 2008. Critical care nutrition for feline patients. Top Companion Animal Medicine. 23(4): 207-15.
Riedesel E.A. 2014. Intestino delgado. In: Thrall D.E. (Ed). Diagnóstico de Radiologia Veterinária. 6.ed. Rio de Janeiro: Elsevier, pp.789-811.
Rocha B.D. & Rabelo R.C. 2005. Fluidoterapia microenteral. In: Rabelo R.C. & Crowe D.T. (Eds). Fundamentos de Terapia Intensiva Veterinária. Rio de Janeiro: L.F. Livros, pp.617-622.
Santos A.E. & Trouillet A.V.P. 2003. Emergência Gastrintestinal: Corpo Estranho Linear. In: Souza H.J. (Ed). Coletâneas em Medicina e Cirurgia Felina. Rio de Janeiro: L.F. Livros, pp.173-180.
Trigo T.C., Schneider A., de Oliveira T.G., Lehugeur L.M., Silveira L., Freitas, T.R.O. & Eizirik E. 2013. Molecular data reveal complex hybridization and a cryptic species of neotropical wild cat. Current Biology. 23(24): 2528-2533.
Valtolina C. & Favier R.P. 2017. Feline hepatic lipidosis. Veterinary Clinics of North America Small Animal Practice. 47: 683-702.
Watson P.J. 2015. Doenças hepatobiliares no gato. In: Nelson R.W. & Couto C.G. (Eds). Medicina interna de pequenos animais. 5.ed. Rio de Janeiro: Elsevier, pp.536-558.
Zippi M., Febbraro I., De Felici I., Mattei E., Pica R., Traversa G. & Occhigrossi G. 2007. Foreign bodies in the upper gastrointestinal tract. Personal experience. La Clinica Terapeutica. 158(4): 291-295.
How to Cite
This journal provides open access to all of its content on the principle that making research freely available to the public supports a greater global exchange of knowledge. Such access is associated with increased readership and increased citation of an author's work. For more information on this approach, see the Public Knowledge Project and Directory of Open Access Journals.
We define open access journals as journals that use a funding model that does not charge readers or their institutions for access. From the BOAI definition of "open access" we take the right of users to "read, download, copy, distribute, print, search, or link to the full texts of these articles" as mandatory for a journal to be included in the directory.
La Red y Portal Iberoamericano de Revistas Científicas de Veterinaria de Libre Acceso reúne a las principales publicaciones científicas editadas en España, Portugal, Latino América y otros países del ámbito latino