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Surgical management of esophageal foreign body--report of 2 dogs.

Introduction

Oesophageal foreign bodies are common in dogs and can cause mortality if not treated timely. The frequently encountered oesophageal foreign bodies are bones and bone fragments. Fish hooks, raw hide, wooden sticks, balls, chew treats toys, pieces of plastic or metal and other varied objects had been also reported (Rousseau et al., 2007; Thompson et al., 2012). Common clinical signs associated with oesophageal foreign bodies were regurgitation or vomiting, retching, gagging, lethargy, anorexia, restlessness, distress, ptyalism and cough (Juvet et al., 2010). The severity of clinical signs depended on size, type and location of foreign bodies and duration of obstruction, presence or absence of a stricture or a wall perforation, pneumothorax, pleuritis, pneumomediastinum, hemothorax and/or pyothorax (Gienella et al, 2009).

It has been reported that foreign bodies may be seen in any part of oesophagus, but presence of the anatomically narrowed regions of oesophagus is the most predisposing factor for occurrence of these obstructions. These regions included pharyngeal oesophagus, thoracic inlet, base of heart and distal oesophagus (Houlton et al., 1985). The most commonly noticed location was caudal oesophagus between the heart base and diaphragm (Leib and Sartor, 2008; Thompson et al., 2012). Diagnosis of oesophageal foreign body is usually by radiography, while, for radiolucent foreign bodies endoscopy is helpful. Surgical techniques for removal of esophageal foreign bodies include per oral retrieval, endoscopy, transthoracic esophagotomy and through gastrotomy removal depending upon type and location of foreign body.

This report describes clinical and radiographic findings and removal of oesophageal foreign body by gastrotomy in two dogs.

History and Observations

One year-old Spitz dog weighing about 6 kgs was presented with history of regurgitation and vomition. Moreover, the owner also stated that unlike liquid foods, vomiting was evident after eating the solid foods. Upon clinical examination, regurgitation, dysphagia, hypersalivation, abdominal respiration, cough and depression were observed. In thoracic radiography, presence of an irregular shaped radiopaque foreign body was detected between heart and diaphragm in thoracic part of oesophagus (Fig.1) and it was thought to be a solid foreign body i.e. bone fragment. Decision was made to retrieve the foreign body through gastrotomy as it was close to cardia and thoracic approach may be more cumbersome and risky as the patient was weak.

A three month old spitz dog was presented with 12 hour history of vomition and regurgitation. On clinical examination, pet was depressed and pain was evinced on palpation of cervical region. Cervical radiography revealed a radiodense foreign body with regular edges in caudal cervical esophagus. Since the foreign body was in cervical esophagus decision was made for cervical esophagotomy.

[FIGURE 1 OMITTED]

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Treatment and Discussion

The ventral abdomen prepared aseptically for surgery after premedication of Atropine sulphate @ 0.04 mg / kg b.wt. subcutaneously and Diazepam @ 0.5 mg / kg b.wt. was given intravenously. After 10 minutes, 2.5% Thiopentone sodium was administered at dose rate of 25 mg / kg b. wt. given to effect for induction and maintenance of anesthesia. In case 1, cranial midline inscision was made gastrotomy was performed and foreign body was retrieved by using allis tissue forceps through gastrotomy wound (Fig. 2). The vertebra found to be belonging to ovine cervical vertebra. For case 2, same anaesthetic protocol was used as described above. After anesthetic induction cervical area was palpated for foreign body but it was failed to palpate and locate foreign body. One more fluroscopic image was taken which showed the migration and presence of foreign body in stomach (Fig. 3). Gastrotomy was performed and foreign body (bone) was removed. Gastrotomy wound was closed by double inversion sutures. Post-operatively, both dogs were advocated, Ceftriaxone and Tazobactam @ 20 mg/kg b.wt. was administered intravenously for 7 days. Meloxicam @ 0.3 mg/kg b.wt. was administered daily once for three days subcutaneously. Skin sutures were removed on 10th post-operative day. Both animals recovered uneventfully.

[FIGURE 2 OMITTED]

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It has been reported that localization of oesophageal foreign bodies in dogs was mostly at thoracic inlet or thoracic region (Moore, 2001; Thompson et al., loc.cit) and commonly observed oesophageal foreign bodies were bones (Sale and Williams, 2006; Rousseau et al., loc cit). In present cases, foreign bodies that were removed from oesophagus were vertebrae which were located between heart and diaphragm. Oesophageal foreign bodies had been mostly reported in small breed dogs (Moore loc.cit; Gienella et al., loc.cit; Thompson et al., loc.cit). On the other hand, Golden Retriever, Labrador Retriever (Gienella et al., loc.cit), German Shepherd Dog, Beagle, Eskimo, English Bulldog, Chow Chow, Pug (Thompson et al., loc.cit), Bull Mastiff, Boxer (Sale and Williams, loc.cit) dogs suffering from oesophageal foreign body had been also reported. In this study, oesophageal foreign body obstructed in a small breed dog such as Spitz was consistent with the above mentioned reports. Mostly seen clinical symptom in dogs having oesophageal foreign body was regurgitation following feeding (Leib and Sartor, loc.cit; Thompson et al., 2012). It had been indicated that clinical symptoms such as regurgitation, gagging and retching following feeding were important observations associated with pharyngeal occlusion, oesophagitis, oesophageal foreign objects, neoplasia, vascular ring anomaly, perioesophageal masses, granulomas, megaloesophagus, oesophageal diverticulum and hiatal diseases (Willard and Weyrauch, 1999). In our study, thoracic radiography showed presence of foreign body which localized between heart base and diaphragm. The process of diagnosis was consistent with Willard and Weyrauch (loc.cit) and it is suggested that direct and indirect thoracic radiography is a basic tool to diagnose oesophageal foreign bodies following clinical symptoms such as regurgitation, vomiting, retching and gagging. Endoscopy was commonly used for removal of oesophageal foreign bodies in dogs (Rousseau et al., 2007; Leib and Sartor, 2008). Pushing oesophageal foreign bodies localized at thoracic area towards stomach by using rigid catheter or removing foreign body with gastrostomy were possible treatment options (Juvet et al., loc.cit; Thompson et al., loc.cit). Moore (loc.cit) had reported that oesophageal foreign bodies could be removed orally with guidance of fluoroscopy and the help of forceps. In the presented cases, the bone was removed by gastrotomy instead of transthoracic esophagotomy since transthoracic oesopha- gotomy had some complications such as pyothorax, mediastinitis, pleural effusion (Sale and Williams, loc.cit), hydrothorax, pleuritis and continued non-healing wound or gall duct (Kyles, 2003). After the surgery, both the dogs were observed for ten days and animals had clinically good health and body condition without any postoperative complications.

In conclusion, the present study describes successful treatment of oesophageal foreign body in two dogs. It is suggested that removal of foreign body through gastrotomy can be applied successfully for caudal oesophageal foreign bodies which was not possible to remove by using endoscopy.

References

Gienella, P., Pfammatter, N.S. and Burgener, I.A. (2009). Oesophageal and gastric endoscopic foreign body removal: complications and follow-up of 102 dogs. J. Small Anlm. Pract. 50: 649-54.

Houlton, J.E.F., Herrtage, M.E., Taylor, P.M. and Watkins, S.B. (1985). Thoracic esophageal foreign bodies in the dog: a review of ninety cases. J. Small Anlm. Pract. 26: 521-36.

Juvet, F., Pinilla, M., Shiel, R.E. and Mooney, C.T. (2010). Oesophageal foreign bodies in dogs: factors affecting success of endoscopic retrieval. Ir. Vet. J. 63, 163-68.

Kyles, A.E. (2003). Surgical diseases of the esophagus, In: Slatter, D. (editor), 3rd ed. Textbook of Small Animal Surgery, WB Saunders, Philadelphia, p. 573-91.

Leib, M.S. and Sartor L.L. (2008). Esophageal foreign body obstruction caused by a dental chew treat in 31 dogs (2000-2006). J. Am. Vet. Med. Assoc. 232: 1021-25.

Moore, A.H. (2001). Removal of esophageal foreign bodies in dogs: use of the fluoroscopic method and outcome. J. Small Anlm. Pract. 42: 227-30.

Rousseau, A., Prittie, J., Broussard, J.D., Fox, P.R. and Hoskinson J. (2007). Incidence and characterization of esophagitis following esophageal foreign body removal in dogs: 60 cases (1999-2003). J. Vet. Emerg. Crlt. Care. 17: 159-63.

Sale, C.S.H. and Williams, J.M. (2006). Results of transthoracic esophagostomy retrieval of esophageal foreign body obstruction in dogs: 14 cases (2000-2004). J. Am. Anlm. Hosp. Assoc. 42: 450-56.

Thompson, H.C., Cortes, Y., Gannon, K., Bailey, D. and Feer, S. (2012). Esophageal foreign bodies in dogs: 34 cases (2004-2009). J. Vet. Emerg. Crlt. Care. 22: 253-61.

Willard, M.D. and Weyrauch E.A. (1999). Esophagitis, In: Kirk, R.W. and Banoguno, J. (editor), 13th edition, Klrk's Current Veterlnary Therapy. Small Anlmal Practlce, WB Saunders, Philadelphia, pp: 607-10.

L. Ranganath and S. Ravikumar (1)

Department of Surgery and Radiology Veterinary College Karnatka Veterinary, Animal Fisheries Sciences University (KVAFSU) Hebbal Bengaluru--560024 (Karnataka)

(1.) Corresponding author.

E-mail: vetravikumars@gmail.com
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Title Annotation:Clinical Article
Author:Ranganath, L.; Ravikumar, S.
Publication:Intas Polivet
Geographic Code:9INDI
Date:Jan 1, 2016
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