Esophageal disorders in 61 horses. Results of nonsurgical and surgical management

Obstructive esophageal disorders in 61 horses included feed or foreign body impaction (27 horses), strictures (18 horses), perforations (11 horses), and diverticula (5 horses). Horses with feed impaction were treated nonsurgically (25 horses) or by esophagotomy (2 horses). Survival to discharge was 78%, and 37% of these had persistent chronic obstruction at home. Long-term survival was 52%. Long-term survival of nine horses treated nonsurgically for esophageal strictures was 22%; for nine horses treated surgically it was 44%. Long-term survival of horses treated nonsurgically was significantly better in acute than chronic strictures. Surgical repair of esophageal mural strictures was more successful than repair of annular or mucosal strictures. One third of the horses with strictures were foals. Long-term survival for horses with strictures was 33%. Long-term survival was higher for the horses with perforations managed surgically (2 of 4) than nonsurgically (0 of 7). Long-term survival for this group was 18%. One esophageal diverticulum was managed nonsurgically, and four were treated surgically; all horses survived long term. Complications of obstructive esophageal disorders included aspiration pneumonia, chronic obstruction, esophageal mucosal ulceration, postoperative infection, pleuritis, laminitis, laryngeal paralysis, and Horner's syndrome.     

Esophageal Disorders in 61 Horses: Results of Nonsurgical and Surgical Management

Obstructive esophageal disorders in 61 horses included feed or foreign body impaction (27 horses), strictures (18 horses), perforations (11 horses), and diverticula (5 horses). Horses with feed impaction were treated nonsurgically (25 horses) or by esophagotomy (2 horses). Survival to discharge was 78%, and 37% of these had persistent chronic obstruction at home. Long-term survival was 52%. Long-term survival of nine horses treated nonsurgically for esophageal strictures was 22%; for nine horses treated surgically it was 44%. Long-term survival of horses treated nonsurgically was significantly better in acute than chronic strictures. Surgical repair of esophageal mural strictures was more successful than repair of annular or mucosal strictures. One third of the horses with strictures were foals. Long-term survival for horses with strictures was 33%. Long-term survival was higher for the horses with perforations managed surgically (2 of 4) than nonsurgically (0 of 7). Long-term survival for this group was 18%. One esophageal diverticulum was managed nonsurgically, and four were treated surgically; all horses survived long term. Complications of obstructive esophageal disorders included aspiration pneumonia, chronic obstruction, esophageal mucosal ulceration, postoperative infection, pleuritis, laminitis, laryngeal paralysis, and Horner's syndrome.     

Fragments of nasogastric tubes as esophageal foreign bodies in two horses

Two horses were referred with fragments of nasogastric tubes as esophageal foreign bodies. Radiography and endoscopy were used to identify the location of the fragments. Portions of the tubes were retrieved by esophagotomy in 1 horse and by manual examination of the oral cavity in the other. Both tubes were friable in focal areas, but were quite pliable over most of the length of the tube.     

Esophageal foreign body obstruction caused by a dental chew treat in 31 dogs (2000-2006)

OBJECTIVE: To evaluate the signalment, clinical signs, diagnosis, treatment, and outcome associated with esophageal obstruction caused by a dental chew treat in dogs. DESIGN: Retrospective case series. ANIMALS: 31 dogs. PROCEDURES: Medical records were contributed from 19 hospitals via responses to a questionnaire that was developed for veterinarians who managed the cases. RESULTS: Esophageal obstructions with the dental chew treat occurred primarily in small dogs (26/31 [83.9%]). The most common clinical signs were gagging, regurgitation, vomiting, anorexia, and lethargy. Diagnosis was usually made via survey thoracic radiography. Obstructions were most commonly located in the distal portion of the esophagus (23/31; 74.2%). Esophageal lesions were moderate or severe in 86.7% (26/30) of the dogs. Orad endoscopic removal of the foreign bodies was uncommon (8/31 [25.8%]); most were pushed into the stomach. Thoracotomy was necessary in 6 dogs. Esophageal strictures developed in 6 of 25 (24%) dogs that survived initial hospitalization. Overall mortality rate was 25.8%. CONCLUSIONS AND CLINICAL RELEVANCE: Esophageal obstructions with a dental chew treat were difficult to remove orally via endoscopy, resulted in moderate or severe esophageal damage, frequently were associated with stricture formation, and were associated with a high mortality rate.     

Upper gastrointestinal endoscopy

Upper GI endoscopy is a frequently performed endoscopic procedure that is particularly suited for the diagnosis of upper GI diseases with a luminal or mucosal location. Contraindications are few and complications are rare. Procedures that can be performed during upper GI endoscopy include mucosal biopsy, brush cytology, aspiration of duodenal fluid for culture and cytology, foreign body retrieval, bougienage of strictures, and endoscopic placement of gastrostomy tubes. Unresolved issues that face veterinary endoscopists include the interrelationship between contrast radiology and endoscopy, the advisability of routine combination of upper and lower GI endoscopy, the reasons for discordance among clinical signs, endoscopic appearance, and biopsy findings, and the role of post-treatment biopsies.     

Endoscopic evaluation of the esophagus and stomach in three loggerhead sea turtles (Caretta caretta) and a Malaysian giant turtle (Orlitia borneensis).

Three loggerhead sea turtles (Caretta caretta) and a Malaysian giant turtle (Orlitia borneensis) were presented with suspected or confirmed esophageal foreign bodies. Esophagoscopy was performed on all turtles, and gastroscopy was performed on three turtles. In all cases, endoscopy was easy to perform, and allowed visualization of most upper gastrointestinal features. The papillated esophagus was easy to navigate, but mucosal papillae in the loggerhead sea turtles prevented examination of the underlying mucosa. The stomach was easily entered and examined in both species, but the working endoscope length (100 cm) prevented inspection of the pyloric antrum and the duodenum in all turtles. The turtles in this report may serve as references for future endoscopic examinations of these species.     

Surgical diseases of the esophagus

The diagnosis and management of surgical diseases of the esophagus are discussed. Esophageal foreign bodies, strictures, esophagobronchial fistulas, diverticula, gastroesophageal intussusception, hiatal hernias, and megaesophagus are included in the discussion.     

Esophagitis and esophageal strictures.

Esophagitis and esophageal strictures are important causes of esophageal disease in dogs and cats. Clinical suspicion is created when the clinician recognizes the clinical signs suggestive of esophageal disease and accounts for historical information and physical examination findings. Once suspected, the diagnosis of esophagitis and esophageal strictures is a fairly simple one in most cases. Although the benefit of diminishing secretion of gastric acid in patients with esophagitis is unquestioned, other questions regarding adjunctive medical treatments, such as sucralfate and glucocorticoids for dogs and cats with esophagitis, have not been answered through appropriate clinical studies. Esophageal strictures are readily treated with balloon dilation or esophageal bougienage, and clients can expect most patients to become functional, although dietary change may be necessary.     

Polyurethane Adhesive Ingestion

Polyurethane adhesives are found in a large number of household products in the United States and are used for a variety of purposes. Several brands of these expanding wood glues (those containing diphenylmethane diisocyanate [MDI]) have the potential to form gastrointestinal (GI) foreign bodies if ingested. The ingested adhesive forms an expanding ball of glue in the esophagus and gastric lumen. This expansion is caused by a polymerization reaction using the heat, water, and gastric acids of the stomach. A firm mass is created that can be 4-8 times its original volume. As little as 2 oz of glue have been reported to develop gastric foreign bodies. The obstructive mass is reported to form within minutes of ingestion of the adhesive. The foreign body can lead to esophageal impaction and obstruction, airway obstruction, gastric outflow obstruction, mucosal hemorrhage, ulceration, laceration, perforation of the esophageal and gastric linings, and death. Clinical signs following ingestion include anorexia, lethargy, vomiting, tachypnea, and abdominal distention and pain, and typically develop within 12 hours. Clinical signs may depend upon the size of the mass. If left untreated, perforation and rupture of the esophagus or stomach can occur. The glue mass does not stick to the GI mucosa and is not always detectable on abdominal palpation. Radiographs are recommended to confirm the presence of the “glue-ball” foreign body, and radiographic evidence of the obstruction may be seen as early as 4-6 hours following ingestion. Emesis is contraindicated owing to the risk of aspiration of the glue into the respiratory tree or the subsequent lodging of the expanding glue mass in the esophagus. Likewise, efforts to dilute the glue and prevent the formation of the foreign body through administration of liquids, activated charcoal, or bulk-forming products to push the foreign body through the GI tract have proven ineffective. Even endoscopy performed to remove the foreign body has been shown to be unreliable. The safest, most effective, and successful therapy is surgical intervention to remove the GI foreign body. If performed early enough, complete recovery of the animal can be expected. Differential diagnoses for polyurethane adhesive ingestion include any potential cause of GI obstruction. The public is largely unaware of the hazards that ingestion of this product may produce. Public education efforts are needed to inform pet owners about the hazards of these glues and the overall importance of providing our companion animals with safe, poison-free environments.     

Endoscopic removal of esophageal and ruminal foreign bodies in 5 Holstein calves

Endoscopic removal of esophageal and ruminal foreign bodies was successfully performed in 5 Holstein-Friesian calves under sedation or general anesthesia by using an electrocautery snare or a wire-guided Dormi basket. This report describes the endoscopic manipulations, treatment, and outcomes of esophageal foreign body removal in these calves.     

Incidence and characterization of esophagitis following esophageal foreign body removal in dogs: 60 cases (1999–2003)

Objective: To characterize the presence of esophagitis in dogs after esophagoscopy for diagnosis and treatment of esophageal foreign body and to relate the degree of esophageal injury to clinical signs and outcome. Design: Retrospective study. Animals, intervention, and measurements: Medical records of 60 dogs with esophageal foreign bodies diagnosed between January 1999 and December 2003 were reviewed. Information obtained from the medical records included age, breed, and sex; type and duration of clinical signs; physical examination, radiographic, and esophagoscopy findings; type and location of foreign body; surgical intervention; morbidity, and outcome. Animals were divided into 2 cohorts based upon the degree of esophageal injury detected during esophagoscopy: mild esophagitis or moderate‐to‐severe esophagitis. Data were then compared between the groups. Results: Dogs with moderate‐to‐severe esophagitis had a longer duration of clinical signs, were more likely to present for lethargy and regurgitation/vomiting, and had a longer time to recovery. This cohort had significantly greater morbidity including esophageal stricture, perforation, necrosis, and diverticulum formation, as well as aspiration pneumonia, pneumothorax, severe tracheal compression, and death. Dogs with mild esophagitis were more likely to present to the hospital for gagging. Conclusions: This study demonstrated a wide range of injury associated with esophageal foreign bodies. The degree of esophagitis appears to relate to the duration and severity of some of the clinical signs.     

Medical and surgical management of esophageal foreign body in a ferret

A ferret was examined because of anorexia, repeated episodes of regurgitation, and subsequent dehydration. Radiography had revealed a radiodense midesophageal foreign body. Results of endoscopy of the esophagus, however, could not confirm the diagnosis. Contrast radiography revealed esophageal perforation, with subsequent penetration of the foreign body into the right pleural space, causing pleural effusion. Surgical repair of the esophagus was performed, and a gastrostomy feeding tube was inserted to provide adequate nutrition during esophageal healing. Nine days after surgery, radiography revealed a severe stricture at the esophageal surgical site. Surgery was repeated; the esophagus was transected, the stricture was removed, and esophageal tissues were closed in 2 layers. Systemically administered antibiotics and gastrostomy tube feedings were continued throughout the post-operative healing period. The esophagus healed with a mild stricture that diminished over time in response to corticosteroid administration.     

Esophageal laceration and obstruction caused by a foreign body in 2 young foals

This report describes 2 foals with esophageal laceration due to ingestion of foreign bodies. Endoscopic examination of the esophagus revealed full thickness esophageal laceration in 1 colt and partial thickness laceration of the esophagus in the other. The esophageal obstruction was relieved by repetitive esophageal lavages and flush under general anesthesia in both foals.     

Outcomes of esophageal and gastric bone foreign bodies in dogs

BackgroundBone foreign bodies are commonly encountered in small animal practice. Esophageal bone foreign bodies (E‐bFBs) warrant removal, whereas gastric bone foreign bodies might not.ObjectivesDescribe management and outcomes for dogs with esophageal or gastric bone foreign bodies.AnimalsOne hundred twenty‐nine dogs with esophageal (n = 45) or gastric (n = 84) bone foreign bodies.MethodsRetrospective review of medical records.ResultsDogs with E‐bFBs were younger than dogs with gastric bone foreign bodies (median age esophageal, 4 years [IQR 2‐8]; median age gastric, 6 years [IQR 3‐10]; P = .03), and had a higher bone cross‐sectional area relative to body weight (median esophageal, 98.21 mm²/kg [IQR 48.25‐142.6]; median gastric, 28.6 mm²/kg [IQR 17.25‐64.28]; P < .001). Forty‐two of 45 esophageal foreign bodies were resolved non‐surgically and 3 by esophagotomy. Esophageal erosions were more likely with distal entrapment (OR 12.88, [95% CI 31.95‐129.29], P = .01) and longer duration (OR 18.82 [95% CI 2.22‐273.97], P = .01). Sixty‐two of 84 bone gastric foreign bodies were left in situ. Endoscopic removal was successful in 20 of 22 (91%; 95% CI 70‐99) attempts.Conclusions and Clinical ImportanceWhile all E‐bFBs were dislodged either by advancement into the stomach, endoscopic removal, or esophagotomy, the majority of gastric bone foreign bodies were left in situ for dissolution, with no reported complications. Gastric advancement of E‐bFBs should be considered when oral removal is not feasible, and dissolution can be considered even with large bones.     

Rectal strictures in 19 dogs: 1997-2005

The etiologies for nonneoplastic rectal strictures in dogs included foreign bodies, postoperative formation, inflammatory disease, and congenital malformation. Sixteen of 19 dogs underwent balloon dilatation therapy, and 14 of these 16 dogs received intralesional triamcinolone injections. Following dilatation, clinical signs persisted in one dog, improved with continued medical therapy in five dogs, and resolved in nine dogs for the duration of their follow-up period (mean 18 months; median 12 months); one dog was lost to follow-up. Balloon dilatation and triamcinolone were parts of a treatment regimen that improved clinical signs in the majority of dogs diagnosed with nonneoplastic rectal strictures.     

Aetiology and diagnosis of persistent nasal disease in the dog: a retrospective study of 42 cases

Forty-two dogs with a history of persistent nasal disease were evaluated by a combination of clinical examination, thoracic and nasal radiography, retroflexed endoscopy and biopsy, and anterograde rhinoscopy and blind nasal biopsy. A definitive diagnosis was made in 91 per cent of cases. Neoplasia was the most common diagnosis (33 per cent of cases), followed by inflammatory rhinitis (24 per cent). Other diagnoses included periodontal disease (10 per cent), aspergillosis (7 per cent) and foreign bodies (7 per cent). Adenocarcinoma was the most common tumour diagnosed. The clinical findings were found to be too variable to be used as specific diagnostic criteria. Anterograde rhinoscopy and retroflexed endoscopy had higher specificity and sensitivity than radiology for the diagnosis of neoplasia, inflammatory rhinitis, aspergillosis and foreign bodies. With a systematic approach to the investigation of persistent nasal disease, a definitive diagnosis can be successfully obtained in the vast majority of cases.     

Risk Factors for Death in Dogs Treated for Esophageal Foreign Body Obstruction: A Retrospective Cohort Study of 222 Cases (1998–2017)

Background

Limited data exist describing risk factors for death, and long‐term outcomes in dogs with esophageal foreign body (EFB) obstruction.

Hypothesis/Objectives

To evaluate short‐ and long‐term outcomes, and analyze risk factors for death in dogs with EFB obstruction. We hypothesized duration of entrapment and treatment type would affect outcome.

Animals

A total of 222 dogs were treated for EFB obstruction at an emergency and referral hospital between March 1998 and March 2017.

Methods

Medical records for dogs with EFB were retrospectively evaluated.

Results

Foreign material most frequently was osseous (180/222 [81%]), with distal esophagus the most common location (110/222 [49.5%]). Duration of clinical signs was not associated with risk of death (OR = 1.08, 95% CI 0.99–1.17; P = 0.2). Entrapment was treated by endoscopy (204/222 [91.8%]), surgery after endoscopic attempt (13/222 [5.9%]), and repeat endoscopy after surgery was recommended but declined (5/222 [2.3%]). In‐hospital case fatality rate was 11/222 (5%). Risk of death was significantly higher with surgery (OR = 20.1, 95% CI 3.59–112.44; P = 0.001), and 5/5 (100%) of dogs died if undergoing endoscopy after surgery was recommended but declined. Increasing numbers of postprocedural complications (OR = 3.44, CI 2.01–5.91; P < 0.001), esophageal perforation (OR = 65.47, CI 4.27–1004.15; P = 0.003), and postprocedure esophageal hemorrhage (OR = 11.81, CI 1.19–116.77; P = 0.04) increased in‐hospital risk of death. Esophageal strictures were reported in 4/189 (2.1%) of survivors available for follow‐up.

Conclusions and Clinical Importance

Death is uncommon in canine EFB; however, treatment type affects outcome, and these data should be used to guide decision‐making in dogs with EFB.     

FATAL VENOUS AIR EMBOLISM IN A CAT WITH A RETROPHARYNGEAL DIVERTICULUM

A cat with a 1-year history of oropharyngeal foreign bodies was diagnosed with a pharyngeal diverticulum. The cat experienced fatal cardiac arrest during endoscopy, and postmortem radiographs and ultrasound revealed venous air embolism. Venous air embolism is uncommonly reported in veterinary medicine, but is a risk during any procedure that introduces air into a body cavity. Precautions should be taken during these procedures to help minimize the risk of adverse events.     

Balloon dilation of oesophageal strictures in two horses

Oesophageal strictures in 2 horses with chronic recurrent oesophageal obstruction or choke was diagnosed by endoscopy and contrast radiography. Balloon dilation of the strictures was performed under endoscopic and fluoroscopic guidance. Follow‐up endoscopic and radiological examinations performed 6 weeks after the procedure showed clear dilation of the strictures. Both horses did not have any recurrence during follow‐up periods of 10 and 12 months.     

Endoscopically Guided Balloon Dilatation of Benign Esophageal Strictures in 6 Cats and 7 Dogs

Benign esophageal strictures in 6 cats and 7 dogs were treated with endoscopically guided balloon dilatation. Six of 13 had a history of anesthesia within 3 weeks prior to the onset of signs; 8 animals had a single stricture, and 5 had multiple strictures, for a total of 19 strictures. Four of the 19 strictures were in the upper esophagus, 11 were in the middle esophagus, and 4 were in the lower esophagus. The luminal diameters ranged from 1 to 18 mm, with a mean of 5.1 mm. Twelve animals survived the immediate postprocedure period and had a total of 50 dilatation procedures performed; the mean number of procedures per animal was 4.2 (range, 2 to 8). Complications included mild bleeding and tearing (11 of 13), moderate bleeding (1 of 13), and esophageal perforation (1 of 13). The cat with the perforation was subsequently euthanized. Follow-up information was available on the 12 remaining animals; 9 were known to be alive 6 to 59 months (mean, 28.2 months) after dilatation. Two were euthanized, 1 for persistence of signs and the other for unrelated causes. One animal died of possible aspiration pneumonia. Three of 13 animals had complete and 9 had partial resolution of signs. Of the 9 animals with partial resolution, 7 were substantially better with dietary modification, 1 was moderately better, and 1 had minimal improvement. Eleven of 13 animals (85%) had a successful outcome with moderate to complete resolution of signs. Thus, it is concluded that endoscopically guided balloon dilatation is an effective and relatively safe treatment for benign esophageal strictures in dogs and cats.