Surgical Management of Oesophageal Foreign Body Obstruction in a Cat.
A Persian tom cat was presented with history of reluctance to take feed and occasional regurgitation since last two days. Gagging and coughing were elicited on palpation of upper third of neck region. Radiograph of lateral cervical region revealed presence of bone like opacity occluding the cervical oesophagus at level of [C.sub.2] to [C.sub.4] vertebrae. History confirmed consuming chicken two days back oesophagotomy was performed through ventral mid line incision on neck and obstruction was relieved by removing piece of chicken bone. The cat was supplemented with intravenous fluids, antibiotics and proton pump inhibitors, post-operatively for seven days. The tom cat recovered uneventfully.
Keywords: Cat; foreign body; oesophageal
Oesophageal foreign body is a common problems in dogs but comparatively occassional in cats due to their more fastidious eating habits. A variety of foreign bodies had been described in oesophagus of cats which are commonly acquired during hunting or playing (Hobbs, 2014). String, bone, trichobezoars, needles and fish hooks are the common oesophageal foreign bodies reported in cat (Hayes 2009). The presenting signs associated commonly included pawing at mouth, cervical pain, gagging, hypersalivation, dysphagia, retching, regurgitation, restlessness, lethargy, dehydration and respiratory distress that may be associated with aspiration pneumonia. Plain radiography can be used for diagnosing radio-opaque foreign body (Chiang and Chou, 2005).
An eight month old Persian tom cat weighing 1.8 kg was presented with history of ingestion of raw chicken meat two days earlier. Since then animal was showing reluctance to eat, salivation and regurgitation of food. On physical examination, animal was dull and depressed, dehydrated and rectal temperature was 39.2 (0)C. Palpation of neck region elicited pain and cough when approached at upper third of neck region. A survey radiograph of lateral cervical region revealed bone like opacity occluding the lumen of oesophagus. The condition was diagnosed as foreign body obstruction of cervical oesophagus and decided for surgical removal.
Pre-operatively animal was stabilized with intravenous Ringers lactate and Dextrose normal saline and ventral cervical region was prepared for aseptic surgery. Anaesthesia was induced by Ketamine hydrochloride @ 25mg/kg b. wt. administered intramuscularly. Animal was intubated with 2mm cuffed endotracheal tube and anaesthesia was maintained with 2% Isoflurane and oxygen. Animal was positioned in dorsal recumbancy and 3 cm long skin incision was made on ventral midline of neck over the obstruction, subcutaneous and platysma muscle were bluntly dissected and retracted. The underlying trachea was exposed by separating sternohyoid and sternocephalicus muscle. Trachea was retreated to the right and identified oesophagus with foreign body, the oesophagus was incised longitudinally just anterior to foreign body and a chicken bone obstructing the lumen was removed. Oesophageal incision was closed in one layer with suture passing through all layer of oesophagus, in a series of simple interrupted suture using polyglactin 910 no. 3/0. Sternohyoid and sternocephalicus muscle was sutured in simple continous pattern with polyglactin 910 no. 2/0. The skin incision was apposed in horizontal mattress pattern using monofilament nylon. Post-operatively, food was with held for 72 hrs and cat was maintained with intravenous fluids. It was medicated with Ceftriaxone @ 50mg/kg b. wt. and Pantaprazole @ 1mg/kg b. wt. all given intravenously for three days. Semisolid diet were fed afterwards. Antibiotic and other supplementing therapy was given orally for two days. Sutures was removed on tenth day postoperative. The cat was fed with regular diet afterwards and had an uneventful recovery.
Oesophageal foreign bodies are most commonly lodged at the thoracic inlet, base of heart and caudal oesophagus, where extraoesophageal stricture restrict oesophageal dilatation. Persistence of foreign body in oesophagus stimulates peristalsis, causing pressure necrosis and oesophageal perforation. It may interfere with oesophageal motility, obstruct food passage, proximal oesophageal distention and causes oesophagitis (Augusto, 2004). Sharp foreign bodies occasionally causes perforation of oesophageal wall, great vessels at base of heart, causing severe haemorrhage and can establish fistula with trachea, bronchi, pulmonary parenchyma and skin (Fossum, 2012). In present case, obstruction of oesophagus with chicken bone was found at pharyngeal oesophagus and no signs of perforation was observed. Timely diagnosis and surgical retrieval of foregin body releaved the animal from pain and suffering for successful recovery.
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Chiang, K.H. and Chou, A.S. (2005). Imaging of a gastrointestinal foreign body in a feline-A Case Report. Tzu Chi Med. J. 17:187-89.
Fossum.T.W. (2012). Surgery of the esophagus. In: Small Animal Surgery, 4th Edn., Publ Mosby Elsevier. pp. 436-40.
Hayes, G. (2009). Gastrointestinal foreign bodies in dogs and cat - A retrospective study of 208 cases. J Small Anim Pract. 50: 576-83.
Hobbs, S.L.J. (2014). The Abdomen. In: Feline Soft Tissue and General Surgery, 1st Edn., Publ. Saunders Elsevier. pp. 291-300.
M. Laiju Philip (1), A.M. Adarsh (2) and S.M. Varghese (3)
Department of Veterinary Surgery and Radiology College of Veterinary and Animal Sciences Kerala Veterinary and Animal Science University (KVASU) Mannuthy Thrissur - 680651 (Kerala)
(1.) Assistant Professor
(2.) Post Graduate Scholar and Corresponding author. E-mail: email@example.com
(3.) Ph.D. Scholar
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|Title Annotation:||Short Communication|
|Author:||Philip, M. Laiju; Adarsh, A.M.; Varghese, S.M.|
|Article Type:||Clinical report|
|Date:||Jul 1, 2016|
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