Esophageal diverticula

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Radiographic appearance of an esophageal perforation secondary to Spirocerca lupi diverticula formation, with flow of barium into the pleural cavity[1]

Esophageal diverticula is a congenital disease of mainly young dogs characterized by esophageal wall sacculation and symptoms of regurgitation[2].

Congenital esophageal diverticula are formed by defects in the muscularis layer, allowing mucosa to herniate into the weakened area[3].

Causes of acquired forms of esophageal diverticula include:

Traction diverticula may involve fibrotic adhesion to regional structures such as lung, bronchus or lymph nodes, or may occur as congenital bronchoesophageal fistula[5].

A predisposition has been reported in the West Highland White Terrier, Yorkshire Terrier and Bernese Mountain Dog[6].

Clinically affected dogs often present with chronic vomiting, regurgitation, retching and weight loss, often caused by impaction of food at the diverticulum. Sever cases may result in necrosis of the diverticulum with spillage of esophageal contents into the pleural space, leading to mediastinitis.

Diagnosis is based on clinical history, presenting clinical symptoms and radiographic evidence of an air-filled or tissue-density mass adjacent to or involving the esophagus[7].

Contrast radiography using barium-meal swallows or CT scans are often needed to assist a diagnosis[8].

A differential diagnosis would include megaesophagus, Spirocerca lupi infection, gastroesophageal intussusception, hiatal hernia or diaphragmatic hernia[9].

Medical treatment involves small quantity feeding at regular intervals to minimize food impaction but many small diverticula eventually enlarge over time.

For large esophageal diverticula defects, surgical excision and reconstruction is required[10].

A guarded prognosis should be considered for most cases due to possible complications such as recurrence, stricture formation and segmental hypomotility. However, many cases recovery uneventfully providing good surgical techniques are employed[11].

References

  1. Chavatdaat
  2. Pearson H et al (1978) Oesophageal diverticulum formation in the dog. J Small Anim Pract 19(6):341-355
  3. Iwasaki M et al (1977) Esophageal diverticula in a dog. Mod Vet Pract 58(7):606
  4. Pence DB & Stone JE (1978) Visceral lesions in wild carnivores naturally infected with Spirocerca lupi. Vet Pathol 15(3):322-331
  5. Nawrocki MA et al (2003) Fluoroscopic and endoscopic localization of an esophagobronchial fistula in a dog. J Am Anim Hosp Assoc 39(3):257-261
  6. Gianella P et al (2009) Oesophageal and gastric endoscopic foreign body removal: complications and follow-up of 102 dogs. J Small Anim Pract 50(12):649-654
  7. Brain, PH (2013) Wretched congenital anomalies. The Veterinarian March:29-33
  8. Park HA et al (2012) Characteristics of esophageal diverticula using computed tomography and three-dimensional reconstruction in a Maltese dog. J Vet Med Sci 74(9):1233-1236
  9. McGill SE et al (2009) Nonsurgical treatment of gastroesophageal intussusception in a puppy. J Am Anim Hosp Assoc 45(4):185-190
  10. Pavletic MM (1994) Stapling in esophageal surgery. Vet Clin North Am Small Anim Pract 24(2):395-412
  11. Hill FW et al (1979) An oesophageal diverticulum in a dog. Aust Vet J 55(4):184-187