G I Stasis/ Carpet Fiber Blockage

Question
QUESTION: Hi
Four weeks ago our female rabbit ate some of our carpet. Since then she stpooed eating, drinking and pooing. After taking her to the vet some improvement was made and she did start to eat alittle and drink and to pass small pellets. That was until this weekend when she stopped eating again.
As yet she is still passing some pellets which are softer. The vet though can feel a mass fairly high up in her abdomen which she feels could be a tumor but i think it is more likely to be carpet fibres. At the moment she is being hydrated at the vets and being treated with gut motility medicine and pain relief. Do you think there is any chance of dispersing this mass ? I realise that surgery is not a good idea but dont want to put her to sleep if there is anything else we can try.

Thank you
Gail

ANSWER: Dear Gail,

Was this synthetic carpet?  And are you absolutely sure she actually ingested it?  And if so, how much?

Does she have any intestinal sounds at all?  If her guts are quiet, she may be suffering from ileus:

www.bio.miami.edu/hare/ileus.html

but in some cases, ileus of the lower GI can be elicited by the presence of a blockage, and it will resolve once the blockage is gone.  (Administration of intestinal motility drugs is not advised in the case of a true blockage, until the blocking mass can be hydrated and broken up with medical treatments.)

This is not a good situation, as--from your description--it sounds as if the fibers have, indeed, caused a mass to form.  Has the vet done any barium radiographs of her stomach to see if there is a mass in the stomach or in the lower GI?  The location of the blockage can be important, as it's easier to move an intestinal mass than one in the stomach.

If she didn't eat a LOT of carpet, it's possible that, like the fur she constantly ingests in small amounts daily, the fibers have wound up with food and fur and other things in her intestines, making a large mass.  It's more problematic that the mass contains synthetic fibers (which I'll assume they are for now), but it might be helpful to do the following:

1.  Hydrate bunny *well* with subQ Lactated Ringer Solution anbd continue hydration support throughout treatment.

2.  Administer proteolytic enzyme (this must be done with caution, as it can burn the oral and esophageal mucosa; we give a little bit of simethicone suspension first, to coat the surface of the mouth and esophagus a bit.  But even a little bit of mouth/esophagus soreness will go away in a day or two.)

3.  Administer lactulose at a dose of 0.5cc per kg of body mass every 8 hours.  This is an osmotic laxative, and will draw liquid into the gut.  As the proteolytic enzyme dissolves mucus (and possibly some fur, depending on which supplement you use--pancreatic enzymes will blast fur, too.) holding the mass together, the hydration drawn in by the lactulose will help hydrate it, making it easier to pass through the gut.  

(NOTE:  I do NOT recommend using mineral oil *at all* in a case like this.  It can coat the mass, making it nearly impossible to re-hydrate, and can make matters worse if the mass is too big to pass, even with lubricant.  The best way to do this is to break up the mass as much as possible, and then it will pass more easily, with or without lubricant.)

If she's eating anything at all, keep up with *wet* fresh greens.  Fragrant ones sometimes will entice an inappetent bunny to eat, but it's important to get even a *little* bit into her now and then.

If the mass has moved into her intestines, it may be possible to gently massage it, once it's hydrated, and knead it into a smaller, more passable mass.  This must be done carefully, to avoid injuring the intestine, but I've done this myself with good success.

Hydration of the *intestinal contents* is paramount for a problem like this:  subQ hydration is not sufficient, as a lot of that will simply pass out via the kidneys without entering the intestine.  Lactulose (or super-saturated epsom salts, which tastes nasty) is great for ensuring hydration of intestinal contents.  

If this situation is not improving, then a careful enema of saturated epsom salts and warm water will help hydrate the lower GI tract, sort of "lubing" things up and helping them come down the chute.  The enema also seems to stimulate lower GI muscle contractions, which can only help in a situation like this.

In short, this *can* be treated, depending on how much synthetic fiber there is inside the mass she's created in her intestines.  It's always best to try medical treatment (such as those described above) before resorting to surgery.   

Gastrotomy (stomach surgery) seems to be tolerated far less well in rabbits than enterotomy (intestinal surgery).  We've had good survival in bunnies who've had to undergo an intestinal resection, but not so great with stomach surgery.

If you *do* resort to stomach surgery, one vet up in NJ who has an incredibly high survival rate ascribes his success to his filling the surgically emptied stomach with well-hydrated Critical Care (www.oxbowhay.com) before closing it up.  This seems to "jump start" the system.  A rabbit is an herbivore whose stomach and intestine is normally *always* containing some food, and it does seem that a completely empty stomach somehow contributes to the shutdown of the entire intestine.  If you can stimulate it to move with a bit of food inside, the survival rate is better, at least from the few data points we have!

I hope this helps with some ideas.  If your vets would like the name of that NJ vet, I can get it for you (I can't remember, and want to get this to you ASAP).  But I hope the hydration, pancreatic enzymes, and lactulose will do the trick.

Hang in there, and please let me know how it goes.

Dana

---------- FOLLOW-UP ----------

QUESTION: Dear Dana
I can hardly believe what has happened but instead of a carpet blockage it turned out to be much worse - a tumour as large as a tennis ball and wrapped around "Lily's" intestines. The only option we had was chemo-therapy which we were told could give her 6-12 months if the tumr were treatable or to not wake her up from surgery. Regrettably I had to choose to let her go and hope I made the best choice for her though at the moment we are missing her terribly.
However from reading your articles and from your very helpful reply to my e-mail I have learned so much and want to thank you for being a part of this service and for showing such interest, I only wish the outcome could have been happier.
Many thanks
Gail

Answer
Dear Gail,

Oh, no.  I can't tell you how sorry I am.  

I was actually starting to wonder if the carpet fibers were a "red herring," and something else was actually going on.

I think you made absolutely the right decision for her, though it's much harder on you.  There are much worse ways to pass from this world than under anesthesia, and one of those is suffering chemotherapy (I've never heard of its successful use in rabbits) and pain in the last days.  You spared her that, and are an unselfish, wonderful bunny mom for that, and for all the love and care you gave her.

She was very lucky to have you, and she will always live in your hearts.  I will light a candle for her tonight.

Take care,

Dana