Contributors: Phil Nicholls, Ed Hall

 Species: Feline   |   Classification: Diseases

Introduction Pathogenesis Diagnosis Treatment Outcomes Further Reading

Introduction

  • Acquired by hunting and playing behavior.
  • String, fish hooks, needles, bones and hair balls.
  • Common sites: thoracic inlet, heart base, cardia.
  • Signs: regurgitation: dysphagia, gagging, retching, anorexia, pyrexia.
  • Diagnosis: radiography, endoscopy.
  • Treatment: removal.
  • Prognosis: guarded.

Presenting Signs

  • Acute onset.
    • Regurgitation.
    • Dysphagia.
    • Hypersalivation.
    • Gagging.
    • Retching.
  • Respiratory signs (due to regurgitation and aspiration).

Needle ingestion

  • Thread wrapped round tongue or protruding from mouth.

Chronic obstruction

  • Dehydration +/- electrolyte loss (due to persistent regurgitation).

Pathogenesis

Etiology

  • Acquired by hunting and playing behavior.

Pathophysiology

  • Persistent regurgitation   →   dehydration   →   electrolyte loss.
  • Penetration of the cervical esophagus   →   contamination and cellulitis of the cervical tissue.
  • Thoracic perforation   →   catastrophic mediastinitis and pleurisy.
  • Larger foreign bodies   →   rapid deterioration because of the greater likelihood of pressure necrosis and perforation.

Diagnosis

Client History

  • Acute onset.
  • Regurgitation   Regurgitation  .
  • Dysphagia.
  • Gagging/retching.

Clinical Signs

  • Always check base of cat's tongue for string or thread.
  • Hypersalivation.

Diagnostic Investigation

Radiography

Endoscopy

  • See esophagoscopy   Esophagoscopy  .
  • Direct visualization of obstruction via rigid endoscope through mouth.

Gross Autopsy Findings

  • Systematic examination including oral cavity, esophagus, and stomach.
  • Inspect mouth prior to dissection, then systematically dissect oral cavity and esophagus along entire length.
  • Leave esophagus attached to pluck during dissection, to allow correlation of site of obstruction with anatomical features, and evidence of mediastinitis.
  • Examine stomach and intestinal tract for evidence of other ingested foreign bodies.
  • Check lungs and airways for evidence of aspiration and signs of pneumonia.
  • Obstructed esophagus may have congested or inflamed walls, possibly with ulcerated mucosa.
  • Rule out intramural or extramural masses (neoplasia, enlarged nodes, etc) as predisposing causes.
  • Consider pleural and mediastinal swab on opening thorax if history suggests perforation.

Histopathology Findings

  • Fix affected and normal esophageal mucosa, stomach and other affected tissues.
  • Recent obstruction may show regional vascular congestion.
  • Progresses to include inflammatory cells and ulceration, and marked inflammation with many neutrophils if perforation occurs.

Treatment

Initial Symptomatic Treatment

  • Esophagoscopic retrieval with forceps.
  • Esophagoscopic advancement into the stomach (bony material will then dissolve).
  • Open, rigid esophagoscope +/- muscle relaxants   Muscle relaxant: overview  .
    CARE not to lacerate or perforate mucosa   Esophagus: perforation  .
  • 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

Esophagotomy
  • Continue post-operative fluid support.
  • Withhold oral food and water for 5 days post-operatively if severe trauma.
  • Use non-oral method of alimentation, eg gastrotomy tube   Gastrostomy: percutaneous tube (endoscopic)  .
  • Introduce liquids for 48 hours and then gruel for similar period.
  • Follow with soft foods for 2 weeks.

Antibiotic therapy

  • Appropriate antibiotics directed at oral and esophageal contaminants should be routinely instigated, eg amoxycillin   Amoxicillin  , cephalosporins   Cefalexin  .

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.

Expected Response to Treatment

Reasons for Treatment Failure

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Cerny J H (1996) Alternative method for retrieving fishhooks from dogs and cats. JAVMA 208 (2), 184 PubMed.
  • Michels G M, Jones B D, Huss B T et al (1995) Endoscopic and surgical retrieval of fishhooks from the stomach and esophagus in dogs and cats - 75 cases (1977-1993). JAVMA 207 (9), 1194-1197 PubMed.
  • Hurov L (1985) What is your diagnosis? Esophageal foreign body. JAVMA 187 (7), 749-750 PubMed.
  • Van Stee E W, Ward C L, Duffy M L et al (1980) Recurrent esophageal hairballs in a cat (a case report). Vet Med Sm Anim Clin 75 (12), 1873-1878 PubMed.
  • Kleine L J (1974) Radiologic examination of the esophagus in dogs and cats. Vet Clin North Am 4 (4), 663-686 PubMed.

Other Sources of Information