Clinical Management of Esophageal Choke - A Clinical Study of 25 Cattle.
The study reports types, causes and clinical findings of esophageal choke, effectiveness of radiography in diagnosis and different methods of foreign body retrieval in twenty five (25) cows. Obstruction at cervical esophagus was found more frequent than pharynx and cardia. Manipulative method of retrieval of foreign body was successful in fifteen (15) cows (60%) and surgical intervention was undertaken in ten (10) cows (40%).
Keywords: Bovine; beet root; choke; tennis ball
Esophageal choke is the most frequently encountered clinical presentation in bovines and may be intraluminal or extraluminal in location (Smith 2008). An Intraluminal esophageal obstruction (choke) are more common in crossbred cows because of indiscriminate eating behaviour and occurs when foreign objects, large feed stuffs, trichobezoars and phytobezors lodge in esophageal lumen (Tyagi and Singh, 1999). Rare cases of extraluminal choke occur when pressure is exerted on esophagus by neighboring organs, tissues or space occupying lesions. Choke is an acute condition, because it prohibits the eructation of ruminal gases leading to severe free gas bloat which may be life threatening if not relieved in time (Prakash et al., 2014). Diagnosis of choke depends on history of eating habits and clinical signs as bloat, tenesmus, retching and salivation. External palpation may be used to confirm those located in cervical esophagus. The additional diagnostic tools that may help to determine the location of obstruction, include oral explorations, passing probangs or stomach tubes, esophageal endoscopy and radiography of esophagus (Marzok et al., 2015). Various conservative treatments have been described for management of esophageal foreign bodies in bovines. Treatments comprise of percutaneous external esophageal massage, passing a stomach tube, Thygesen's probang and endoscopic removal of foreign bodies. Surgical intervention is necessary if conservative treatment fails.
Materials and Methods
Over a period of one year (Jan- Dec.' 2015), twenty five (25) crossbred cows presented with history of choke are reviewed in the present paper. The animals presented were in the age from 9 months to 6 years (Median: 2.4 years) and all the animals were cows. The case history, etiology, clinical signs, diagnosis, treatment and prognosis were recorded.
Affected animals appeared anxious and restless. The head was held in extended position and over stretched. The presented animals showed acute ruminal tympany, respiratory distress, copious drooling of saliva, inability to swallow and coughing at regular intervals. In few animals which made attempt to drink, water was regurgitated through the mouth and nostrils immediately.
Six (6) animals were referred within 6 hrs, 15 animals between 6 hrs to 24 hrs and 4 animals between 24 hrs to 48 hrs from recognition of obstructive episode.
Clinical and Radiological Diagnostic Findings
Diagnosis was based on history, clinical signs, visual examination, palpation, probing and radiography. The presented animals had swelling at pharyngoesophageal junction and mid cervical region. On palpation, a hard mass was palpable at variable sites of esophagus. Upon probanging, obstruction was felt at variable regions of esophagus and confirmed (Fig.1). Even in some animals, survey and contrast radiograph of esophagus was used to confirm site of obstruction (Fig.2).
Out of 25 animals, 15 cases of esophageal obstruction were treated by conservative method. It comprised of 10 HF and 5 Jersey crossbred cows. The choke was relieved by various methods (Table 1).
The animals were properly restrained in trevis. Out of 15 cows in six cases, choke was at pharyngoesophageal junction. Choke was relieved through percutaneous external esophageal massage towards oral cavity and foreign body was expelled out while animal coughed. The foreign bodies found were beet root, potato and coconut shell (Fig.3).
In nine cases of cervical esophageal choke, gunthers mouth gag was applied to restrain oral cavity. One assistant was pushing the foreign body present in mid or caudal caudal cervical esophagus by percutaneous external esophageal massage towards pharynx and manually hand was inserted in to mouth and foreign body was grasped by fingers and removed. The foreign bodies found were beet root, potato, guava, mango and orange (Fig.4). To confirm relief of obstruction, probang was passed down the esophagus into rumen in all cases.
Surgical intervention was conducted when manipulative procedures to remove foreign body failed. Out of 25 cows, 10 cows subjected for surgery first using a sterile 16G needle ruminocentesis was performed to relieve acute bloat. In nine animals, left lateral cervical region was prepared aseptically. Local analgesia was achieved by local infiltration of 2% Lignocaine Hcl above the site of incision. A 6-8 inch long linear incision was made above the jugular vein just cranial to obstructive mass. Upon gentle dissection, esophagus having foreign body was identified. The foreign body was removed by esophagotomy by temporarily holding the cranial and caudal esophageal lumen. The esophageal area was flushed with normal saline. Esophagotomy wound was closed using chromic catgut No 2-0 by simple interrupted pattern and knots were placed inside lumen. Cervical muscles were opposed by using chromic catgut no 2 in simple continuous pattern. Skin was closed using monofilament polyamide (nylon) suture in horizontal mattress (Fig.5 and Fig.6). In one case, laparorumenotomy was performed through left paralumbar fossa under light sedation with Xylazine Hcl and paravertebral analgesia using 2% Lignocaine in standing position and removed jackfruit peel which was seated at cardia (Fig.7).
Post-operatively, Ceftriaxone and Tazobactum 3370 mg (Intacef Tazo (a)) intramuscularly and Meloxicam (Melonex (a)) at 0.3mg/kg b.wt intramuscularly were administrated for 5 days. Chlorpheniramine maleate (0.5mg/kg IM) was administered in all animals for three days. Cows subjected to surgery were discharged on 3rd post-operative day. Feed was withheld for 48 hour post-operatively. During this period, animals were maintained with 0.9% Saline, Ringers lactate and 5% Dextrose solution intravenously. After that, soft diet was advised and then roughages were introduced gradually from 7th day post-operatively. Antiseptic dressing of suture site was done by Povidone iodine solution. Sutures were removed on 12th post-operative day.
Treatment and Outcome
Careful removal of choke by manipulative trials was successful so that it could be withdrawn from the mouth. Surgical treatment of cervical esophageal choke was successfully carried out through cervical esophagatomy or surgical drainage and removal of deeply situated foreign objects causing periesophageal cellulitis and all cows recovered without any post-operative complications. Treatment of caudal thoracic esophageal obstruction was carried out by laparorumenotomy and showed complete recovery.
Choke of oesophagus occurs mostly in cervical region and choke of thoracic oesophagus is rare in ruminants (Singh et al., 1993) and in our study, out of 24 cows presented only one was found having obstruction in thoracic esophagus. Survey and contrast radiographs have a value in diagnosis of various esophageal disorders in cattle as reported by Haven (1990). In our study, most cases of cervical and thoracic esophageal choke were diagnosed easily by physical palpation, passage of probang and radiography.
Passing the probang to push the choke in to rumen with vigorous efforts may lead to dislodgment of choke and usually result in rupture of esophagus, which may cause esophageal perforations or fistula and even deaths as recorded by some authors. Some of the obstructive masses were removed by percutaneous external massage technique and in some cases animals were gulping back the obstructive mass after bringing the foreign body to oropharynx region from cervical region through percutaneous external massage. In such animals, foreign body is retrieved manually using mouthgag after bringing the foreign body to oropharynx by conservative massaging technique. Probang can be passed to ascertain the patency of esophagus after removal of choke. Conservative technique is also advantageous over surgical removal of obstructive mass as there is no risk of post-operative complications such as wound dehiscence and fistula formation. If conservative treatment failed, esophagotomy is indicated as reported by Sreenu and Sureshkumar (2001). In bovine practice, esophagotomy is indicated if foreign object is embedded within cervical esophagus (Meagher and Mayhew, 1978). In the present study out of 25 cases, in nine cases a standard esophagotomy procedure was followed and relieved choke. A laparorumenotomy is recommended approach to foreign body located at caudal thoracic esophagus as reported by Hari krishna et al. (2011). Although esophagotomy is a well established technique, the risk of post-operative complications associated with esophagotomy incisional dehiscence and fistula formation must be considered.
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V. Mahesh, J.K. Pramodh, L. Ranganath (1), N.G. Amith and K.M. Srinivasa Murthy
Department of Surgery and Radiology Veterinary College Karnataka Veterinary, Animal and Fisheries Sciences University (KVAFSU) Hebbal Bengaluru - 560024 (Karnataka)
(1.) Professor and Head/Corresponding author. E-mail: firstname.lastname@example.org
a - Brand of Intas Animal Health, Ahmedabad
Table 1: Retrieval of foreign bodies in esophageal choke Treatment Conservative methods Surgery Foreign Animals Percutaneous Per oral Esophagotomy Rumenotomy bodies External removal massage by hand Beet root 6 3 2 1 Potato 2 1 1 Phytobezors 2 2 Jackfruit peel 2 1 1 Mango 3 3 Coconut shell 2 2 Tennis ball 1 1 Orange 2 2 Guava 1 1 Trichobezors 4 4 Total 25 6 9 9 1
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|Title Annotation:||Clinical Article|
|Author:||Mahesh, V.; Pramodh, J.K.; Ranganath, L.; Amith, N.G.; Murthy, K.M. Srinivasa|
|Date:||Jul 1, 2016|
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