Esophageal foreign body

From Dog
Triangular-shaped foreign body lodged at the cardiac base at fifth rib in a dog with concurrent patent ductus arteriosus with left to right shunting[1]
Esophageal foreign body (bone), leading to esophagitis[2]

Esophageal foreign bodies are a common clinical presentation in canine medicine.

The majority of reported cases involve bone or raw hide chews[3], but any number of objects can be indiscriminately consumed, such as fishhooks, needles and wood.

Although the majority become lodged at the thoracic inlet, some can be lodged at the pharynx, heart base or caudal esophagus cranial to diaphragm.

Temporary distension of the esophagus is followed days later by esophageal ischemia, and after one week, esophageal necrosis is evident, leading to esophagitis[4], localised abscessation, subcutaneous emphysema and perforation. In these cases, depending on location of the foreign body, pleuritis, pneumothorax, mediastinitis, pyothorax[5], hemothorax[6], pericarditis and bronchoesophageal or aortic fistula[7] and transient megaesophagus[8] may ensue.

Esophagitis invariably leads to esophageal stricture formation, with long-term complications.

Clinical signs vary depending on location of obstruction but include ptyalism, gagging, dysphagia, regurgitation, vomiting, hemoptysis, and repeated attempts to swallow[9]. In chronic cases, weight loss, anorexia and lethargy are observed.

Diagnosis is often based on presenting clinical signs and radiographic evidence of a foreign body. Contrast esophagram or esophagoscopy may be required for radiolucent foreign bodies such as plastics. In cases where esophageal perforation is suspected, iodinated contrast medium should be employed to minimize risk of mediastinitis.

Surgical removal may be accomplished using endoscopic forceps, or if distally located, pushing the foreign body into the stomach and removing by gastrotomy. With large cervical and caudal esophageal foreign bodies, a transthoracic esophagotomy is often necessary, with esophageal access via midline thoracotomy with cervical obstructions, or right lateral thoracotomy for thoracic heart base and right or left thoracotomy for caudal esophageal obstructions. With lateral thoracotomy approaches, accessing the cardiac esophagus usually requires removing the fifth, sixth or seventh rib via a lateral rib resection.

While long-term prognosis is excellent with early intervention, addressing esophagitis is critical for maximizing long-term recovery. Dogs with cervical emphysema associated with esophageal necrosis have a guarded prognosis[10].

Use of topical or systemic antacids is recommended together with parenteral broad-spectrum antimicrobials. Dietary restriction is also advised for the first 2 - 3 days to minimize trauma to the esophageal mucosa and reduce fibroblastic reaction responsible for stricture formation[11].

References

  1. ACVR.org
  2. 4Shared
  3. Thompson HC et al (2012) Esophageal foreign bodies in dogs: 34 cases (2004-2009). J Vet Emerg Crit Care (San Antonio) 22(2):253-261
  4. Glazer A & Walters P (2008) Esophagitis and esophageal strictures. Compend Contin Educ Vet 30(5):281-292
  5. Sale CS & Williams JM (2006) Results of transthoracic esophagotomy retrieval of esophageal foreign body obstructions in dogs: 14 cases (2000-2004). J Am Anim Hosp Assoc 42(6):450-456
  6. Cohn LA et al (2003) Fatal hemothorax following management of an esophageal foreign body. J Am Anim Hosp Assoc 39(3):251-256
  7. Keir I et al (2010) Fatal aortic oesophageal fistula following oesophageal foreign body removal in a dog. J Small Anim Pract 51(12):657-60
  8. van Ee RT et al (1986) Bronchoesophageal fistula and transient megaesophagus in a dog. J Am Vet Med Assoc 188(8):874-876
  9. Leib MS & Sartor LL (2008) Esophageal foreign body obstruction caused by a dental chew treat in 31 dogs (2000-2006). J Am Vet Med Assoc 232(7):1021-1025
  10. Doran IP et al (2008) Acute oropharyngeal and esophageal stick injury in forty-one dogs. Vet Surg 37(8):781-785
  11. Zimmer JF (1984) Canine esophageal foreign bodies: endoscopic, surgical, and medical management. J Am An Hosp Assoc 20:669-677