Recognizing and treating esophageal disorders in dogs and cats - Veterinary Medicine
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Recognizing and treating esophageal disorders in dogs and cats
Esophageal disease is not as rare as you might think, but the signs are often subtle and the clues are often misconstrued.


VETERINARY MEDICINE


Esophageal foreign bodies

Esophageal foreign bodies are not common but are seen frequently enough that practitioners must be adept at diagnosing them, otherwise the consequences can be catastrophic (e.g. pyothorax). The key to suspecting esophageal foreign bodies is to recognize that the acute vomiting reported by a client is actually acute regurgitation. In such cases, immediately obtain thoracic radiographs. Most esophageal foreign bodies do not show up as obvious esophageal lesions on plain radiographs. Instead, they often appear as ill-defined, soft tissue opacities that look as if they could be in the pulmonary parenchyma.

Whenever a suspected pulmonary mass is detected radiographically, consider whether it could be an esophageal mass. If there is any possibility the mass is esophageal, your next step should be to perform contrast radiography or endoscopy (which is usually preferred). In general, endoscopic manipulation is the best way to resolve most cases of esophageal foreign objects.4 Surgical removal is necessary when the object cannot be removed endoscopically. If endoscopy is anticipated, avoid contrast esophagograms, because barium tends to obscure the visual field and makes endoscopic removal more difficult. Contrast films are rarely needed to detect esophageal perforation. Discovering a pneumothorax or pleural fluid on plain radiographs should make you strongly suspect an esophageal perforation. Obtain pleural fluid for cytologic examination to diagnose sepsis.

Rigid endoscopy is often more effective than flexible endoscopy for removing esophageal foreign bodies. Rigid endoscopes allow the use of rigid forceps, which permit a much stronger grip on the object and more delicate and precise manipulation of the object to free it from any ulcers or craters it has created. Carefully placing the edge of the rigid endoscope against a lodged bone may allow the rigid forceps to break off pieces of the bone or even to break it in two, without further injuring the esophagus. This maneuver is especially helpful when the bone has eroded deep ulcers into the esophagus and cannot be removed otherwise. A foreign body can be partially drawn into the rigid endoscope, facilitating its removal from the esophagus. This is especially valuable if you are attempting to remove sharp-edged objects or trying to pull objects through the cricopharyngeal area. Likewise, most fishhooks, even treble hooks, can be removed endoscopically.5 Again, rigid endoscopic equipment is preferred and can usually be used successfully, even if the hook and barb have penetrated the esophageal mucosa. The limiting factors in removing such hooks are the size of the barb (i.e. large barbs will not tear out of the mucosa) and whether the hook and barb have penetrated the esophagus and could lacerate the great vessels of the heart if they are pulled back into the esophagus. In these cases, surgical removal is warranted.

After removing a foreign object, immediately reexamine the esophagus endoscopically to assess the degree of esophagitis. Also obtain a thoracic radiograph to check for evidence of pneumothorax, which would indicate perforation has occurred. While perforation generally requires referral for surgery, a small perforation might heal spontaneously if pleural contamination is avoided. If a minor perforation has occurred, placing a gastrostomy tube endoscopically may allow the perforation to heal. (The gastrostomy tube prevents food, water, and medications from traversing the esophagus.) Depending on the amount of esophageal damage, it may be advisable to treat the patient for esophagitis (i.e. placing a gastrostomy tube and providing aggressive antacid therapy and gastric prokinetic therapy).


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Source: VETERINARY MEDICINE,
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