Return of the Merrimac - three strikes and still not out
Merrimac a huge six year old Maine Coon was presented off his food, vomiting and had lost 1 kg since he had last been seen.
He had been in rude health. Only a month previously he had knocked the tooth out of another cat in the house in a fight!
Normally he was a healthy boy so as well as some symptomatic treatment to stop the vomiting, it was decided a blood test should be done immediately to help us diagnose his problem. This returned without any conclusive findings apart from a high white blood cell count. A few days later (a Friday of course) he looked no better and we decided that we had to take things further. He was placed on a drip, sedated and x-rays of his abdomen were taken. Things were very abnormal. His bowels were dilated with gas which is typical of an obstruction in the gut but nothing could be seen on the x-ray to be causing it. One urgent phone call later to the owners and it was decided we had no choice but to open Merrimac up and find out what had caused this catastrophic obstruction to intestines.
On opening his abdomen our hearts sank to find free purulent fluid seeping up from the depths which indicated a bacterial peritonitis which normally occurred when the bowel was ruptured. Sure enough there was a rupture in the wall of the intestines with a whole section of about 15cm looking very abnormal. We could nothing abnormal that could have caused this rupture apart from a whole load of plant material that was penetrating through the bowel rupture. Was this the cause or had Merrimac eaten a load of plant material to make himself sick when he was feeling unwell? Unfortunately this meant that we had remove 15cm of his intestines and suture the healthy bits back together. We then had to flush his whole abdomen with litres of sterile fluid knowing that if we left any infection behind this could be catastrophic to Merrimac's chance of survival. He was then sutured up. Before we allowed him to wake up, we placed a feeding tube down into his oesophagus and out through a hole in his neck so that we could feed him in the post-operative period. The prognosis remained very worrying as we now had to hope we could control the infection in his abdomen and that the sutures keeping the intestines together would hold so that we could get a complete recovery. Over the weekend he was kept on his intravenous drip so we could give him fluid and intravenous antibiotics. He was fed every 4 hours with a concentrated liquid food which he coped with very well apart from the occasional belch immediately afterwards. We got to Monday and he was looking happier, was not running a temperature and amazingly had passed a motion (a reason for huge celebration in the circumstances). Seventy two hours had passed and things were looking good when out of the blue, Merrimac suddenly became very wobbly on his legs and could not hold his head steady.
It seemed possible that Merrimac had suffered from a blood clot that had affected his brain function. He remained quite cheerful and was even starting to eat a little food. Two days later, we decided with the owners who had been visiting regularly, to get Merrimac home as he was getting stronger and we hoped he would be less stressed at home. The feeding tube was removed and he was sent home with antibiotics and strict instructions to rest. Despite a third set back when his feeding tube wound site got infected he has been going from strength to strength. He has improved neurologically so he only wobbles a little when he jumps down. Despite the poor odds he got rid of the infection in his abdomen and his intestines repaired and have started to work again. Slowly, slowly Merrimac is returning to his full Maine Coon glory and we hope that whatever caused the bowel rupture in the first place will not reappear in his life.
Simon Kent BVsc CertVC MRCVS, Vets on White Hart Lane, Barnes