The Little Hairball that Could

Jeff Johansson, DVM
The Little Hairball that Could - R.E.A.C.H.
This is an x-ray of "Wallace" lying on his side,
taken as we were passing the stomach tube to nudge
the hairball into his stomach

“Wallace” is a 4 year old, neutered male domestic shorthair cat that presented to R.E.A.C.H. of Asheville with a two day history of vomiting.  He’d had problems with hairballs in the past, but was usually able to “cough it up” and quickly return to normal.  This time, his owner said that he had not been himself for the past few days, and in addition to his vomiting, he was showing signs of elevated respiratory rate, loss of appetite, and increased salivation.  

When he got to R.E.A.C.H., Wallace’s temperature and pulse were normal, but he was panting and seemed painful in his abdomen. Bloodwork showed that Wallace’s internal organs were working normally, but that he was mildly dehydrated.  Radiographs (x-rays) of his abdomen showed a gas-filled stomach, and several loops of intestine that contained air, probably from his panting and inhaling air.  Although no foreign object was seen, there was still a strong suspicion that Wallace had swallowed something that was causing a gastrointestinal blockage.  While some foreign objects, such as a rocks or pieces of bone will show up readily on an x-ray, others such as cloth, rubber, or matted hair may not be visible.  We placed Wallace on IV fluids and would recheck x-rays several hours later, once his body was rehydrated and his intestinal tract was working better.

The repeat x-rays did show improvement in terms of the amount of gas that was present, however, there appeared to be an object lodged in his esophagus that had not been evident earlier.  To confirm this suspicion, we administered a small amount of barium, which is a white, chalky liquid that shows up readily on a radiograph.  By giving barium, then taking a radiograph, we can watch the passage of materials through the entire intestinal tract.  However, when we gave Wallace this small amount of barium, some of it came right back up before he had a chance to fully swallow it.  When we took the x-ray, our suspicions were confirmed- the barium was only going a short distance in, and was then blocked from entering the stomach.  The object in the x-ray had all the characteristics of a hairball (or trichobezoar).

Options for removal of a foreign body in the esophagus include surgery, which can be very risky and expensive as this often involves opening the chest; endoscopy, which involves specialized equipment and training and is not widely available; or passing a stomach tube in the hopes that the object can be pushed into the stomach where it can be broken down by the body’s digestive processes, or removed surgically (abdominal surgery is far less risky than thoracic surgery).  After consulting with the owner, we decided to attempt to pass a stomach tube to push the object into his stomach.  

Wallace was placed under general anesthesia and a stomach tube was passed.  When we checked the placement of the tube radiographically, it turned out that the hairball was lodged so firmly in the esophagus that the tube had gone underneath it.  We then used a larger diameter tube and with a little finesse and the help of our digital radiography equipment monitoring the position of the tube, we were able to pass the object safely into Wallace’s stomach. Wallace’s owner did not want to put him through a surgery after this procedure and elected to wait and see if the hairball would pass, which it eventually did.  

Prevention of hairballs in cats can be difficult.  Laxatives, high fiber diets, and in some cases medications may help prevent problems with intestinal hairballs.  But esophageal or intestinal obstruction, either from a hairball or some other foreign object can quickly become a serious cause of illness if untreated.  Luckily for Wallace, his owner recognized that this was not typical for him and brought him in quickly so that he could be successfully treated.