Esophageal Foreign Bodies

 (continue) Esophageal Foreign Bodies 

The bone was successfully removed using a snare. On re-exploration, the region was markedly ulcerated. The lower esophageal sphincter still had not been visualized.

On closer inspection of the ulcerated region, a full thickness esophageal perforation was identified. The heart could be seen beating in the thoracic cavity.

Immediately following this, the patient became cyanotic, and esophagoscopy was discontinued. Within seconds, the patient arrested, and CPR performed for 15 minutes did not result in a spontaneous return to circulation.

Discussion
Bones are the most common type of foreign body involved in canine esophageal foreign bodies1–4. Other common types of foreign bodies include fish hooks, treats, balls, and wooden sticks^1,2,5. Young small breed dogs, such as West Highland White Terriers, Jack Russell Terriers, Shih Tzus, and Chihuahuas, are over-represented^1,3. Patients may present with gagging, retching, coughing, vomiting, regurgitation, hypersalivation, dysphagia, and/or odynophagia^1,3,5. Diagnosis is typically achieved through radiography^3,5.

Possible complications of esophageal foreign bodies include esophagitis, esophageal stricture, esophageal perforation, and aspiration pneumonia^1,2,5. The duration of clinical signs before presentation is correlated with the severity of esophagitis, risk for esophageal perforation, and need for surgical intervention^1,3,4,6. Bones, fish hooks, and esophageal foreign bodies present for greater than 72 hours have been associated with an increased risk of perforation¹.

Endoscopy is the treatment of choice for removal of the foreign body or dislodgement of the foreign body into the stomach for digestion or surgical extraction^1,4,5. Esophageal perforation or hemorrhage during the procedure are associated with increased mortality². Undergoing surgery after failed endoscopic attempts and repeating endoscopy if surgery is recommended but declined are also associated with increased mortality².

If an esophageal perforation is identified, surgery is often recommended⁵. In patients in which surgery is not an option, medical management with IV fluids, IV antimicrobials, analgesia, and gastroprotectants may be an option^1,5.

Conclusion
Dogs with esophageal foreign bodies should be referred for emergency esophagoscopy +/- surgery, as the duration of clinical signs is associated with increased morbidity and mortality. Although emergency surgery for an esophageal perforation remains the gold standard, some dogs with an esophageal perforation may survive to discharge with medical management alone.

 

Authored by: 

Melody Chen, DVM, MS

Practice Limited to Internal Medicine

melody.chen@vca.com

References
1. Sterman AA, Mankin KMT, Ham KM, Cook AK. Likelihood and outcome of esophageal perforation secondary to esophageal foreign body in dogs. J Am Vet Med Assoc. 2018 Oct 15;253(8):1053–6.

2. Burton AG, Talbot CT, Kent MS. Risk Factors for Death in Dogs Treated for Esophageal Foreign Body Obstruction: A Retrospective Cohort Study of 222 Cases (1998-2017). J Vet Intern Med. 2017 Nov;31(6):1686–90.

3. Thompson HC, Cortes Y, Gannon K, Bailey D, Freer S. Esophageal foreign bodies in dogs: 34 cases (2004-2009): Esophageal foreign body in dogs. J Vet Emerg Crit Care. 2012 Apr;22(2):253–61.

4. Juvet F, Pinilla M, Shiel RE, Mooney CT. Oesophageal foreign bodies in dogs: factors affecting success of endoscopic retrieval. Ir Vet J. 2010 Dec;63(3):163.

5. Teh H, Winters L, James F, Irwin P, Beck C, Mansfield C. Medical management of esophageal perforation secondary to esophageal foreign bodies in 5 dogs: Medical management of esophageal perforation. J Vet Emerg Crit Care. 2018 Sep;28(5):464–8.

6. Rousseau A, Prittie J, Broussard JD, Fox PR, Hoskinson J. Incidence and characterization of esophagitis following esophageal foreign body removal in dogs: 60 cases (1999?2003). J Vet Emerg Crit Care. 2007 Jun;17(2):159–63.