Contributors: James Simpson, Kenneth Simpson

 Species: Canine   |   Classification: Diseases

Introduction Pathogenesis Diagnosis Treatment Outcomes Further Reading

Introduction

  • Cause: bones and fish hooks are most common foreign body encountered.
  • Common sites: thoracic inlet or between heart base and cardia.
  • Signs: salivation, repeated swallowing and regurgitation.
  • Diagnosis: radiography, esophagoscopy.
  • Treatment: removal by endoscopy or surgery.
  • Prognosis:
    • Guarded if chronic or moderate/severe esophageal damage.
    • Good if prompt removal and minor esophageal trauma.
    • Guarded/poor if perforation.

      Print off the owner factsheet Oesophageal foreign bodies in dogs Oesophageal foreign bodies in dogs to give to your client.

Presenting Signs

  • Regurgitation.
  • Dysphagia or odynophagia.
  • Anorexia.
  • Retching.
  • Hypersalivation.
  • Respiratory signs (due to regurgitation and aspiration), eg cough, pyrexia if aspiration, dyspnea.

Chronic obstruction

  • Dehydration plus or minus electrolyte loss (due to persistent regurgitation).
  • Inappetence, anorexia, weight loss.

Acute Presentation

Pathogenesis

Pathophysiology

  • Persistent regurgitation/lack of oral intake → dehydration → electrolyte imbalance.
  • Pressure necrosis may lead to:
    • Penetration of the cervical esophagus → contamination and cellulitis of the cervical tissue.
    • Thoracic perforation → catastrophic mediastinitis and pleurisy.

Timecourse

  • Hours to days.

Diagnosis

Presenting Problems

  • Regurgitation.
  • Dysphagia.

Client History

  • Known ingestion of foreign body.
  • History of scavenging or chewing.
  • Regurgitation Regurgitation.

Clinical Signs

  • Dysphagia.
  • Repeated swallowing.
  • Hypersalivation.
  • May appear to resolve, then when perforation occurs:
    • Pyrexia.
    • Dehydration.
    • Depressed.
    • Tachypnea.
    • Dyspnea.
    • Cough.
    • Collapse.

Diagnostic Investigation

Esophagoscopy

  • Allows direct visualization Endoscopy: esophageal foreign body of foreign body Esophagotomy 01 exposure , may permit removal Esophagoscopy.
  • Also allows examination of esophagus after removal for assessment of potential damage.

Radiography

  • Plain cervical and thoracic radiograph Radiography: thorax may be sufficient if foreign body is radio-opaque Esophagus foreign body - radiograph lateral.
  • May only see secondary changes, eg evidence of inhalation pneumonia or mediastinal/pleural fluid if perforation has occurred Esophagus foreign body with perforation - radiograph.
  • Contrast radiography to detect radiolucent foreign body or perforation.
Do not use barium sulphate.Use iodine contrast with care.

Biochemistry

  • Potassium concentrations Blood biochemistry: potassium to identify potential electrolyte abnormalities, eg hypokalemia Hypokalemia.
  • Complete blood count - neutrophilia and left shift if perforation or pneumonia.

Differential Diagnosis

Treatment

Initial Symptomatic Treatment

  • IV fluids - LRS or 0.9% NaCl + KCl as required.
  • Antibiotics - amoxycillin or cephalosporin; more aggressive if perforation.
  • Gastric antisecretory drugs, eg IV ranitidine/cimetidine.
  • PEG tube placement may be useful in severe damage.

Removal

  • If no evidence of perforation/mediastinitis on radiograph:
    • Esophagoscopic Esophagoscopy retrieval with forceps or push objects into stomach, +/- retrieval from stomach.
    • Open, rigid esophagoscope plus or minus muscle relaxants.
    CARE not to lacerate or perforate mucosa.
  • Post-procedure radiography r/o perforation.
  • If evidence of perforation/mediastinitis on radiographs, or failed esophagoscopy:
    • Esophagotomy.

Cervical esophagotomy

  • Allows access to foreign bodies in the cervical esophagus and cranial thoracic esophagus as far as the second rib.

Transthoracic esophagotomy

High risk - for use only if all other attempts have failed.

Subsequent Management

Treatment

  • Esophagoscopic removal and minimal damage:
    • IV fluids (24-48 h).
    • Antibiotics (7-14 days).
    • Antisecretories (21 days), eg H-2 blockers IV then PO + carafate (oral) slurry as mucosal protectant.
    • Fast 24 h then clear liquids for 24 h, followed by re-introduction of soft food if regurgitation persists.

 Esophagotomy

  • Place gastrostomy tube, bypass esophagus for >7 days.
  • Provide all food/fluid via peg tube.
  • Test-feed after 5-7 days - PEG feeding.
  • Endoscopic re-examination and check for stricture.
  • Antibiotics (7-14 days) + antisecretory agents (21 days) + carafate (21 days).
  • Return to normal.

Antiobiosis

Other

  • Tube thoracostomy Drainage: thorax may be indicated if pleural infection develops.
  • Drains may be employed if cervical contamination occurs.

Outcomes

Prognosis

  • Highly variable.
  • Depends on duration, location and nature of foreign body and degree of esophageal damage.

Expected Response to Treatment

  • Removal of obstruction allows normal eating.

Reasons for Treatment Failure

  • Damage/perforation of esophagus during removal.
  • Severe pressure necrosis of esophagus → esophageal rupture.
  • Esophageal stricture develops → recurrence of regurgitation 7-14 days after obstruction removed.

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Spielman B L, Shaker E H & Garvey M S (1992) Esophageal foreign body in dogs - a retrospective study of 23 cases. JAAHA 28 (6), 570-574 VetMedResource.
  • Houlton et al (1985) Thoracic esophageal foreign bodies in the dog - a review of 90 cases. JSAP 26 (9), 521-536 VetMedResource.
  • Zimmer J F (1984) Canine esophageal foreign bodies - endoscopic surgical and medical management. JAAHA 20 (4), 669-677 VetMedResource.

Other sources of information

  • Washabau R J (1996) Swallowing disorders. In: Manual of canine and feline gastroenterology Eds L D A Thomas, J W Simpson & E J Hall. Cheltenham: BSAVA. pp 67.

Other Sources of Information