Esophageal obstruction in horses: a retrospective study of 34 cases

The major purpose of this investigation was to describe the causes, possible complications, and prognoses of horses with esophageal obstruction. Of 34 cases presenting with esophageal obstruction, 28 cases were due to impaction of ingesta. Obstruction due to pre-existing esophageal disease occurred in 4 horses with megaesophagus, in 1 horse with stricture in the upper third of the esophagus, and in 1 horse with esophageal diverticulum. There was no significant difference in the contamination of the trachea between horses that subsequently developed aspiration pneumonia and those that did not. The duration of esophageal obstruction prior to admission was significantly longer in horses that developed aspiration pneumonia (median 18, range 2-48 h) than in those horses that did not (median 4, range 0.5-48 h). Although the obstruction was relieved in all 34 horses, 4 were euthanized because of recurring obstruction due to megaesophagus (n = 2), esophageal diverticulum (n = 1), and esophageal stricture (n = 1).     

Intrathoracic esophageal perforation of unknown cause in four horses

Three horses (age 17 - 23 years) were referred to the equine clinic of the University of Berne due to colic, fever, tachycardia and tachypnea. All horses showed pleural effusion. Clinical findings in 2 of the horses were highly suggestive of an intra-thoracic esophageal perforation. Severe septic pleuropneumonia without suspicion of an esophageal lesion was diagnosed in the 3rd horse. In addition, an 11 year old stallion was referred to the equine clinic for treatment of a presumptive large colon impaction. The horse was given laxatives after nasogastric intubation. Subsequent dramatic clinical deterioration and signs consistent with severe pleuropneumonia suggest that esophageal perforation had occurred when passing the nasogastric tube. All 4?horses were euthanized due to a poor prognosis. Esophageal perforation was diagnosed or confirmed post mortem in all cases. A hypertrophy of the tunica muscularis of the intra-thoracic esophagus was found in 3 of 4?horses.     

Correction of cervical esophageal stricture in a dog by creation of a traction diverticulum.

A cervical esophageal stricture was corrected in a dog by creation of a traction diverticulum. Although abnormal esophageal motility persisted in the portion of the esophagus cranial to the stricture, the clinical effects of the stricture were ameliorated by the simple surgical procedure.     

Comparison of three feeding techniques after esophageal mucosal resection and anastomosis in the horse

The effects of 3 feeding techniques on healing of a cervical esophageal mucosal resection and anastomosis were investigated in 16 horses. Horses were fed a moistened pelleted diet 1 of 3 ways: 1) per os (n = 5), 2) by nasogastric (n = 5) or 3) by esophagostomy tube (n = 6) until the 14th postoperative day. The pelleted diet was then fed orally in all horses until euthanasia on the 60th postoperative day. Immediate postoperative feeding per os was unsatisfactory, as only 2 of 5 horses survived in this group. Endoscopic evaluation revealed that mucosal dehiscence of varying degrees occurred, with subsequent stricture formation in all horses. Although the incidence of some complications (fistula, sinus tract and traction diverticulum) was higher in the nasogastric tube-fed horses, 2 of 6 horses in the esophagostomy tube-fed group did not survive to the end of the study. There was more cervical phlegmon in the esophagostomy tube-fed group, and this resulted in increased periesophageal fibrosis on histopathologic examination. Radiographic measurements showed that esophageal lumen diameter increased predominantly between 30 and 45 days postoperatively. The mucosal healing time was significantly faster (p = 0.05) in the esophagostomy tube-fed group.     

Severe esophageal injuries occurring after general anesthesia in two cats: case report and literature review

Two healthy cats underwent elective surgical procedures under general anesthesia. One developed severe esophagitis leading to esophageal rupture, mediastinitis, and pyothorax. The other cat developed esophageal stricture, diverticulum formation, and suspected iatrogenic perforation. Both cats had signs of dysphagia and regurgitation beginning a few days after anesthesia. The first cat also had severe dyspnea due to septic pleural effusion and pneumomediastinum. In the second cat, endoscopy revealed diffuse esophagitis, an esophageal stricture, and a large esophageal diverticulum. Rupture of the esophageal wall occurred while inflating the esophagus for inspection. Due to the poor prognosis, both cats were euthanized. Necropsy revealed severe esophageal changes. Postanesthetic esophagitis has been previously described in dogs and cats; however, severe life-threatening esophageal injuries rarely occur as a sequel to general anesthesia. To the authors' knowledge, esophageal rupture secondary to perianesthetic reflux has never been reported in cats.     

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.     

Esophageal phytobezoar in a horse

A 23-year-old Thoroughbred stallion was admitted to the hospital for treatment of acute esophageal obstruction. Clinical examination and contrast radiography confirmed the presence of an esophageal obstruction. The horse was euthanatized, and examination revealed a bolus of feed material occluding the esophageal lumen 6 cm caudal to the thoracic inlet, with underlying necrosis of the esophageal mucosa. A large pulsion diverticulum was identified in the caudocervical portion of the esophagus. Apparently, the phytobezoar was formed within the esophageal diverticulum and subsequently became dislodged, occluding the esophagus.     

Esophageal dysfunction in a weanling thoroughbred

A 6-month-old Thoroughbred colt was examined because of persistent dysphagia noted since birth. Moderately severe regurgitation occurred when the colt ate semi-solid food or drank. Complete esophageal impaction developed when the colt ate solid material. Endoscopic examination revealed ulceration, dilatation and lack of peristalsis in the area of the previous impaction. Barium esophagram demonstrated the dilatation in the area of the previous impaction. Esophageal manometry revealed prolonged simultaneous contractions throughout the esophagus suggesting the presence of a motor abnormality. The colt was maintained on a slurry of complete pelleted feed, but the esophageal dysfunction persisted until euthanasia at 17 months of age. Gross post mortem and histologic examinations showed no abnormalities in the muscularis mucosa, myenteric plexus, vagus nerve, or brain stem. The history, signs, and manometric findings suggested esophageal dysfunction in this colt. Motor disorders of the esophagus should be considered in horses with persistent dysphagia or recurrent episodes of choke and esophageal manometry can help characterize these disorders.     

Evaluation of Intestinal Staples for End-to-end Anastomosis of the Small Intestine in the Horse

Segments of jejunum that had been subjected to ischemia 1 month previously were resected en bloc in six horses. Everted end-to-end anastomoses were performed by application of double rows of stainless steel staples. The anastomotic sites were examined at 3 weeks, 3 months, 6 months, and 8 months postoperatively. All but one of the horses experienced colic at some point after the second postoperative week. At 3 weeks, there was extensive adhesion and stricture formation associated with the anastomoses. With increasing time postoperatively, there were progressively less severe adhesions and strictures. At 6 and 8 months, there was separation of the muscularis with noticeable thinning at the anastomotic site.     

Effects of acetylcysteine and migration of resident eosinophils in an in vitro model of mucosal injury and restitution in equine right dorsal colon

OBJECTIVES: To evaluate the in vitro protective effects of acetylcysteine and response of resident mucosal eosinophils in oxidant-induced injury to tissues of right dorsal colon of horses. ANIMALS: 9 adult horses. PROCEDURE: Gastrointestinal mucosa was damaged in vitro with 3 mM hypochlorous acid (HOCl), with and without prior exposure to 6mM acetylcysteine. Control tissues were not exposed to HOCl or acetylcysteine. Control and damaged tissues were incubated in Krebs-Ringer-bicarbonate solution and tissue resistance measured during 240 minutes. Tissue permeability to radiolabeled mannitol was also used to assess mucosal barrier integrity. Tissues were examined by light microscopy before and after HOCl exposure and during and after incubation. RESULTS: Exposure to HOCl caused tissue damage and decreased tissue resistance. Restitution did occur during the incubation period. Eosinophils were located near the muscularis mucosae in freshly harvested tissues and migrated towards the luminal surface in response to HOCl-induced injury. Compared with tissues treated with HOCl without acetylcysteine, pretreatment with acetylcysteine prevented HOCl-induced tissue damage, changes in resistance, and histologically detectable eosinophil migration. The permeability to mannitol increased to the same extent in tissues treated with HOCl alone or with acetylcysteine and HOCl. CONCLUSIONS AND CLINICAL RELEVANCE: Eosinophils migrated toward the mucosal surface in equine colon in response to oxidant-induced damage in vitro. This novel finding could be relevant to inflammation in equine colon and a pathophysiologic feature of many colonic diseases. Acetylcysteine protected the mucosa against oxidant-induced injury and may be useful as a treatment option for various gastrointestinal tract disorders in horses.     

Microvascular circulation of the small intestine in horses.

The microvascular anatomic features of the small intestine was described by correlating results of microangiography, light microscopy, gross studies, and scanning electron microscopy of vascular replicas in 14 horses. After heparinization, the horses were euthanatized, a length of jejunum was transected, and blood was flushed free of the circulation, using isotonic NaCl solution. In six horses, the circulatory system was perfused with a modified radiopaque medium and evaluated radiographically. These sections were then evaluated by standard histologic methods. Sections from 8 horses were perfused with 1 of 2 types of plastics and studied grossly or by scanning electron microscopy. The marginal arterial arcade gives rise to vessels that enter the jejunum at the mesenteric angle. These vessels penetrated either directly, by branching and entering on both sides of the mesenteric angle, or supplying only 1 side of the mesenteric angle. All these vessels continued in the submucosa branching extensively, forming a submucosal plexus. This submucosal plexus supplied the tunica muscularis, tunica serosa, and the mucosa. Vessels within the 2 muscle layers ran parallel to the muscle fibers and, consequently, perpendicular to each other. The arterial supply to the mucosa penetrated the muscularis mucosae and branched to supply 2 mucosal capillary networks. An eccentrically placed arteriole penetrated the base of the villus and spiralled to the tip where it "fountained" into a mesh-like capillary network, which descended peripherally in the villus to drain via 1 to 3, but most commonly 2 venules. Venules from adjacent villi united and drained via the submucosal veins.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effect of topical anesthesia of the laryngeal mucosa on upper airway mechanics in exercising horses.

OBJECTIVE: To determine the effect of desensitization of the laryngeal mucosal mechanoreceptors on upper airway mechanics in exercising horses. ANIMALS: 6 Standardbreds. PROCEDURE: In study 1, videoendoscopic examinations were performed while horses ran on a treadmill with and without topical anesthesia of the laryngeal mucosa. In study 2, peak tracheal and nasopharyngeal pressures and airflows were obtained from horses during incremental treadmill exercise tests, with and without topical anesthesia of the laryngeal mucosa. A nasal occlusion test was performed on each horse while standing during an endoscopic examination for both trials. RESULTS: In study 1, horses had nasopharyngeal collapse while running on the treadmill when the laryngeal mucosa was anesthetized. In study 2, inspiratory upper airway and nasopharyngeal impedance were significantly higher, and peak tracheal inspiratory pressure, respiratory frequency, and minute ventilation were significantly lower in horses when the laryngeal mucosa was anesthetized, compared with values obtained when horses exercised without topical anesthesia. Peak inspiratory and expiratory airflows were lower in horses when the laryngeal mucosa was anesthetized, although differences did not quite reach significance (P = 0.06 and 0.09, respectively). During a nasal occlusion test, horses had episodes of nasopharyngeal collapse and dorsal displacement of the soft palate when the laryngeal mucosa was anesthetized. Upper airway function was normal in these horses without laryngeal mucosal anesthesia. CONCLUSIONS AND CLINICAL RELEVANCE: Receptors within the laryngeal mucosa may be important in maintaining upper airway patency in exercising horses.     

Vascular Injury Associated with Naturally Occurring Strangulating Obstructions of the Equine Large Colon

Ten horses were euthanatized before, during, or after surgery to correct severe volvulus of the large colon. At surgery, the colonic serosa changed from blue-gray, blue or purple toward a more normal pink in seven horses after the volvulus was corrected. The mucosa consistently remained black or dark red. Results of postmortem colonic microangiography revealed perfusion of the serosa and the circular and longitudinal muscle layers, but mucosal perfusion was limited by thrombosis in the muscularis mucosae and submucosa. There was evidence of thrombosis of the mesenteric colic vessels in six horses. Damage to the colonic vascular system, especially thromboembolism in the submucosa, may be an important limitation to colonic viability after surgical correction of volvulus of the large colon.     

IMAGING DIAGNOSIS—MUSCULAR HYPERTROPHY OF THE SMALL INTESTINE AND PSEUDODIVERTICULA IN A HORSE

A 14‐year‐old Thoroughbred gelding was presented for chronic colic and weight loss. Transcutaneous and transrectal abdominal ultrasonography revealed distended, thickened small intestine with primary thickening of the muscularis and a focally more thickened loop with an echoic structure crossing the wall from the mucosa to the serosa. Visualization of diffuse thickening of the muscularis (muscular hypertrophy of the small intestine) and a focal lesion (pseudodiverticulum) helped clinicians make informed decisions. This case illustrates the importance of transabdominal and transrectal ultrasonography in horses with chronic colic and the relevance of considering the abnormalities in layering pattern of the intestinal wall.     

Surgical Treatment of Intramural Esophageal Inclusion Cysts in Three Horses

Three horses were diagnosed as having esophageal inclusion cysts. Clinical signs included dysphagia, swelling of the cervical esophagus, and salivation. Surgical removal of the cyst was attempted in two horses. Both horses survived, but multiple complications occurred, including esophageal fistulation and neurovascular damage. Marsupialization of the cyst was performed in the third horse. The stoma closed 3 weeks after surgery without complications, and endoscopic examination revealed a grossly normal esophagus. Marsupialization may be preferable to surgical removal for treatment of selected esophageal inclusion cysts in horses.     

Functional suture-holding layer of the esophagus in the dog

Several investigators have stated that the suture-holding layer of the esophagus is the mucosa. In this study, the component layers of the esophagus were separated. Segments of the cervical esophageal wall, muscularis, submucosa, and submucosa-mucosa were each sutured, and the suture lines were subjected to tensile forces. When subjected to tensile force, all suture lines failed when sutures pulled through the tissue. The data were subjected to statistical analysis. Based on this analysis, it was concluded that the full esophageal wall had the greatest ability, and the muscularis the least ability, to hold sutures against tension. Therefore, when no significant difference in suture-holding ability between the submucosa alone and the submucosa-mucosa together was demonstrated, it was concluded that the submucosa was the suture-holding layer of the esophagus.     

DUODENAL ULTRASONOGRAPHY IN THE NORMAL ADULT HORSE

Ultrasonography was used to evaluate the duodenum of 6 clinically normal horses. Examinations were performed in horses which each, alternatively, received diets of; 1) concentrates and hay, 2) hay only, or 3) after 36 hours of starvation. The duodenum was constantly visualized just ventral to the right kidney at the 16th and 17th intercostal spaces on a line joining the olecranon and tuber sacrale. Cranial to the 16th intercostal space visibility depended on thickness of interposing liver and lung field interference. Duodenal distensions, contractions and content are described. Starved horses had fewer contractions and distensions than horses on hay, or hay and concentrate diets but the difference was not significant. Duodenal wall thickness ranged from 3–4 mm. Ultrasonographically five layers, corresponding to the mucosal surface, mucosa, submucosa, muscularis propria and serosa, could be identified. A necropsy specimen of the duodenum was evaluated histologically and Ultrasonographically in a water bath for comparison.     

Idiopathic muscular hypertrophy of the oesophagus in the horse: a retrospective study of 31 cases

REASONS FOR PERFORMING STUDY: To present the first report of a case series concerning equine idiopathic muscular hypertrophy of the oesophagus (IMHO). OBJECTIVES: To investigate the clinical and pathological features of the disorder. METHODS: The medical records of 31 horses suffering from the disorder were reviewed retrospectively. In all these animals the diagnosis was confirmed at post mortem examination. RESULTS: The median age of the affected horses was 12.5 +/- 5.6 years (range 1-26) without sex or breed predilection. Only 2 out of 31 horses showed clinical signs associated with oesophageal dysfunction, indicating that the muscular hypertrophy was rather a coincidental post mortem finding. Histology revealed thickening of the distal portion of the oesophagus mainly involving the circular layer of the tunica muscularis without fibrosis or inflammation. In 8 cases, the disorder was seen in concurrence with idiopathic hypertrophy of the tunica muscularis of various other parts of the gastrointestinal tract. CONCLUSIONS: In the majority of patients, IMHO was a coincidental finding at post mortem examination usually confined to the smooth, circular muscle layer of the tunica muscularis externa. POTENTIAL RELEVANCE: Further research is necessary to study the precise effect of IMHO on oesophageal function.     

Microvascular circulation of the descending colon in horses.

The microvascular circulation of the descending colon was studied in 5 adult horses, using microangiography and light microscopy combined with gross studies and scanning electron microscopy of vascular replicas. After heparinization, horses were euthanatized, and 3 segments of the descending colon and its mesentery containing 1 vascular arcade were removed from each horse. The fecal balls were gently massaged from the lumen, and the blood was flushed free of the circulation with isotonic NaCl. In 5 segments, the vascular system was injected with a modified radiopaque medium and evaluated radiographically. Specimens examined radiographically also were prepared for histologic examination, using standard methods. Ten segments were injected with 1 of 2 types of plastics and studied grossly or by scanning electron microscopy. Arcuate arteries gave rise to a descending colonic rete that surrounded the vein and supplied numerous descending colonic lymph nodes. The rete also supplied the mesocolon and the descending colonic tissue. Short filamentous vessels arising from the rete directly penetrated the mesenteric tenia to supply an intermuscular plexus between the longitudinal and circular muscle layers of the muscularis externa. Larger vessels arising from either side of the rete divided into the long- and short-terminal arteries that supplied an extensive submucosal plexus, which was continuous around the circumference. The submucosal plexus supplied the mucosa, the tunica muscularis, and the serosa. Vessels running centrifugally from the submucosal plexus formed an intermuscular plexus between the longitudinal and circular muscle layers of the muscularis externa. The intermuscular plexus at the mesenteric angle also was supplied by vessels branching from the short-terminal arteries as they penetrated the muscularis externa.(ABSTRACT TRUNCATED AT 250 WORDS)