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
- Collapse and shock if esophageal perforation Esophagus: perforation.
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
of foreign body
, 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
.
- May only see secondary changes, eg evidence of inhalation pneumonia or mediastinal/pleural fluid if perforation has occurred
.
- Contrast radiography to detect radiolucent foreign body or perforation.
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
- Esophageal neoplasia/granuloma Esophagus: neoplasia.
- Esophageal stricture Esophagus: stricture.
- Esophagitis, eg post-anesthetic/chemical, eg doxycycline Doxycycline.
- Bronchesophageal fistula.
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.
- 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
- Appropriate antibiotics directed at oral and esophageal contaminants should be routinely instigated, eg amoxycillin Amoxicillin , cephalosporins Cefalexin , clindamycin Clindamycin.
- Amoxycillin Clavulanate or enrofloxacin Enrofloxacin if perforation/mediastinitis.
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.