Mallory-Weiss syndrome in a cat with an intestinal foreign body
Emily Brouwer
Animal Health Laboratory, University of Guelph, Guelph, ON.
AHL Newsletter 2025;29(3):20
An 18-month-old male Bengal cat was presented for postmortem examination after being found dead in a large pool of blood.
He was neutered three days prior, and by all accounts was clinically normal immediately following his surgery. He was given a 0.1 mg/kg dose of meloxicam subcutaneously, and discharged with oral meloxicam for four days. On the second day following his surgery when he was brought in for a recheck examination, the owners noted that he had vomited twice overnight, had stopped eating, and was 7% dehydrated. The veterinarian advised the client to discontinue the meloxicam, and the cat was brought home following some supportive care including subcutaneous fluids, maropitant injection, and mirtazipine. The following morning, the owners heard vomiting and a splashing sound, and when they investigated, they found him deceased.
On gross postmortem examination, the cat was found to have markedly pale oral mucus membranes and conjunctiva. There was hemorrhagic fluid in the oral cavity and dried blood at the nares, around the mouth, on the ventral chest, and on the forelimbs.
On internal examination, the stomach contained scant dark brown, granular fluid, consistent with digested blood. There was a linear tear in the gastric mucosa, approximately 3 cm long and 1 cm wide, extending from the cardia of the stomach up into the distal esophagus (Fig. 1). The trachea and esophagus both contained granular dark brown fluid, similar to that noted in the stomach. The small intestine was markedly dilated, thin walled, and contained abundant dark brown fluid. Tightly lodged in the distal jejunum/proximal ileum was a 3.6 cm x 1.5 cm diameter piece of dense, green foam (Fig. 2). Apart from visceral pallor, no other significant internal abnormalities were noted.
The cause of death was determined to be the combined effects of acute blood loss and obstructive asphyxia due to the fluid in the trachea.
Figure 1. Linear tear in the gastric mucosa (arrows).
Figure 2. Obstructive foreign body (green foam) in the lumen of the distal small intestine
The cause of sudden, intractable vomiting was interpreted to be the obstructive foreign body identified in the distal small intestine. The gastroesophageal tear was a spontaneous, non-penetrating mucosal laceration interpreted to be the result of forceful vomiting. The location of the lesion was not grossly compatible with (or in the proper location for) NSAID-related ulceration, which was the main differential diagnosis based on the history of post-surgical meloxicam treatment.
Spontaneous linear gastric tears in humans, known as Mallory-Weiss syndrome, result from increased intragastric pressure. This increased pressure can be endogenous, such as with forceful retching or vomiting, or exogenous (e.g., endoscopic insufflation, transesophageal echocardiography). These mucosal tears are characteristically longitudinal, and tend to occur at the gastroesophageal junction. The precise mechanism is not well understood, but the prevailing theory is that excess pressure in the abdomen causes gastric contents to rush into the esophagus, resulting in increased intragastric pressure, and mucosal tears that reach the submucosal vasculature. Hematemesis is the typical presenting sign, but other clinical signs can include melena, dizziness, syncope, and epigastric pain. In cats, the literature is sparse, but this syndrome has been reported in a cat with chronic vomiting related to atrophic gastritis and Helicobacter pylori infection.
References
1.Gualthieri M, et al. Spontaneous linear gastric tears in a cat. Journal of Small Animal Practice 2015;56:581-584.
2.Rawla P, Devasahayam J. Mallory-Weiss Syndrome. [Updated 2023 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538190/.