The Story of Bimp and the Broom Bristles

Bimp, a handsome 10-year-old brown tabby cat, was brought in to the clinic by his owner, Victoria, after several days of not wanting to eat. Normally a cat who would eat just about anything—“including broom bristles!” Victoria says—his poor appetite was of serious concern. She described how nine months prior, a mass had been felt in his abdomen. He had X-rays taken, but the mass was not visible on the films. Because he had been doing well at the time and not showing any signs of illness, Victoria had put it out of her mind. Now she was worried that the mass may have come back—and so was I.

The Exam

She set his hot pink carrier on the exam table and gently lifted him out. Instead of kicking up a fuss like he normally would, Bimp crouched quietly on the table while I listened to his heart and lungs; checked his eyes, ears, and nose; and felt his belly. Soon enough, I confirmed Victoria’s fears: There was a firm, fist-sized lump in the left front part of his abdomen.

Most masses in the abdomen arise from one or more organs. A number of important organs occupy the left front past of the abdomen, including the stomach, parts of the small intestine, the liver, the spleen, and the pancreas. It is usually almost impossible to tell which organ the mass is on just by feel.

Victoria and I discussed different ways to image the abdomen in more detail. We could take X-rays again, and compare them to the X-rays from nine months ago. X-rays are a very important diagnostic tool, since they allow the veterinarian to get a visual look at structures inside the body as well as provide important information on the size, shape, and alignment of both normal and abnormal structures. Many veterinary practices come equipped with in-house X-ray machines, which means the X-rays can be performed and reviewed within hours of a sick animal’s visit.

For all of their benefits, however, X-rays can still leave us with unanswered questions. Often times, an abnormal structure will be identified on an X-ray, but we still might have difficulty pinpointing where it is coming from, exactly how large it is, or if it is solid or filled with fluid. In these cases, veterinarians have another important diagnostic tool: ultrasound.

Ultrasound is a specialized form of imaging that uses sound waves to form images of internal structures. A bat uses echolocation to bounce sound waves off of its surroundings to form a mental map of obstacles in its path. Similarly, the ultrasound probe bounces sound waves off of the internal organ, and then forms an image that we can view on a screen. Because the ultrasound is a specialized piece of equipment, it requires specialized training both to use the instrument and to interpret the images. Most large specialty hospitals employ an ultrasonography specialist on staff, and many ultrasonographers are happy to travel to smaller clinics to provide their services.

After discussing these options with Victoria, we decided together that doing an ultrasound would be the best option for Bimp. Luckily, our traveling ultrasonographer, Jeremy, was in the area that day, and he was willing to make a special stop for Bimp.

The Ultrasound

For the ultrasound, Bimp needed to lay on his back on a cushion and remain still while his belly was shaved, cool blue ultrasound gel was applied, and the ultrasound probe slid gently over his skin. Normally, he would be too energetic and squirmy to hold still for the required 20 minutes, but that day, he lied calmly and gazed at us with tired eyes. Everyone held their breath while Jeremy set to work.

Regardless of the reason for doing an ultrasound, an ultrasonographer always does a thorough scan of every part of an abdomen, to make sure nothing is missed. Sometimes the cause of the problem is immediately apparent; other times, it’s less obvious.

Fortunately in Bimp’s case, Jeremy found the problem right away: Bimp’s stomach was very large and full of abnormal material that was blocking the passage of food and water. The material was either a large tumor—“Or could it be those broom bristles?” Victoria wondered. It was hard to say just by looking; after scanning the rest of his organs to make sure there were no other abnormalities, Jeremy recommended surgery to remove the mass of whatever-it-was, relieve Bimp’s discomfort, and allow his system to start digesting food again.

With no time to lose, the team began prepping Bimp for surgery. An intravenous (IV) catheter was placed to allow administration of anesthetic drugs and IV fluids. Bimp was sedated, and a breathing tube was passed down his windpipe to allow delivery of anesthetic gas and oxygen. His skin was scrubbed with antiseptic solution, and he was brought to the operating room, ready for surgery.

As Bimp’s primary doctor, I was on deck for performing his potentially life-saving surgery. I knew the procedure was going to require cutting into his stomach, a technique I had learned about in school, had seen performed by other surgeons, and had even assisted on a few times. But I had never done it myself.

While Bimp was being readied by the rest of the team, I took a moment for some deep breathing and a quick read-through of my surgery textbook to refresh myself on the details of the procedure. I sent a quick text message to one of my old mentors, looking for confirmation of my plan—and maybe a little encouragement, too. Her reply was swift, yes my plan was solid, and I was gonna do great! Bolstered by my moment of quiet and my mentor’s confidence, I began my own preparations for surgery: scrubbing my hands and arms, and dressing in cap, mask, sterile gown, and gloves.

Bimp was ready. I was ready.

The Abdominal Surgery

Surgery of the abdomen is, by nature, an invasive procedure, but the surgeon must take to care to handle tissues and organs gently so as not to cause trauma or bruising. Making the incision into Bimp’s abdomen, I was careful not to cut into any of the organs just below the surface. Before looking at his stomach, I did a thorough visual inspection of the rest of his organs, confirming what Jeremy has seen on the ultrasound: no other abnormalities, just the stomach.

I set to work, placing holding sutures into the stomach wall. These would allow me to keep the stomach elevated and keep the area I was working on clear of the other organs. Anna, one of our technicians, had also donned sterile gown and gloves; it was her job to hold the sutures and the stomach while I worked. Sarah, our other technician, and the rest of the team were in charge of keeping Bimp’s vitals stable during the procedure. Sarah periodically read out numbers: heart rate, breathing rate, oxygen level. Bimp was holding steady.

Taking a deep breath, I made the cut into his stomach wall, starting with a surgical blade and then switching to scissors. Once the incision was long enough, I was able to insert blunt-ended forceps to grab a piece of the mass and pull out … broom bristles! Each bristle was about 2 inches long and formed a solid mat in the stomach. After a few minutes of pulling small clumps of the bristles out, I finally got a good grip on the mass of them, and was able to gently work the mass out.

Victoria took a picture from a distance. “Mom is the one who lets him chew on the broom!” she laughed. Sounded like Mom was in for a talking to. But my job wasn’t finished. After checking to make sure every bristle was out, Anna and I flushed out the stomach with warm sterile saline, and then I carefully stitched up Bimp’s stomach. Closing the stomach requires precision stitching, to ensure that there are no leaks afterward. Once the stomach was closed, we gave the whole abdomen a warm saline rinse and then stitched up his muscles and skin.

The Recovery

Anna, Sarah, and the team helped Bimp wake up from the anesthesia safely, while I discussed his aftercare with Victoria. He would be going home with pain medications to keep him comfortable during recovery, antibiotics to prevent infection of the surgical site, and an Elizabethan collar (the dreaded “cone of shame”) to prevent him licking or chewing his incision and opening it back up.

Bimp went home later that evening with Victoria, who sent us frequent updates on his recovery. By the next morning, he already was eating better than he had been, and some of his usual energy was returning. After two weeks, his incision was healed, his E-collar came off, and he was back to normal. Victoria’s family has made sure to keep all brooms locked away out of his reach.

All’s well that ends well.