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.

 

 

Simple steps to protect your pet.

What happened and what you need to know!

Today, news about CIRDC- Canine Infectious Respiratory Disease Complex began populating in the local media alerting dog owners to this highly contagious virus spreading throughout South Florida.

As your partner in pet care, we want to ensure you know the facts about CIRDC and exactly what to do to ensure your pups are protected.

What is CIRDC? CIRDC is a disease caused by exposure to multiple viruses and bacteria which infect the respiratory tract of dogs and can cause severe upper respiratory infections like pneumonia, sometimes referred to as "kennel cough."

What can you do? You can protect your pet by ensuring they are up-to-date on their routine vaccines, especially

1. Bordetella vaccine ("Kennel Cough vaccine")
2. K9 Influenza H3N8/H3N2 vaccine (CIV vaccine)
3. Also, this is a good time for dog distancing. Avoiding nose-to-nose meet-ups like at dogs parks and pet events will keep your pet safer.

Need your pet's vaccine status?

To check your pup's vaccine status log onto our myVCA App. Don't have the app, download it here!

Download myVCA App

Need to update your pet's vaccines?

Contact us to set up a Vaccine Clinic Appointment. Vaccine clinic appointments apply only to Bordetella and CIV vaccine services and are provided outside of the regular schedule of appointments. Therefore, you and your pet get in and out faster!

Roxy, A Canine Cancer Success Story!!!

Roxy is a 4 ½ year old female spayed small breed dog that presented to the Oncology Service for the first time on 4/21/21 for evaluation of a solitary right cranial pulmonary mass that was diagnosed on thoracic radiographs on 3/21/21 while she was being evaluated for coughing. An abdominal ultrasound was performed, which was normal, and cytology of the mass was performed and consistent with carcinoma. A chest CT was then performed with the goal of evaluating if Roxy was a good surgical candidate, but it unfortunately revealed multiple pulmonary nodules that were not visualized on radiographs. She was then diagnosed with metastatic pulmonary carcinoma and started on chemotherapy. 

Roxy was treated with a combination of carboplatin and gemcitabine chemotherapy. She received a total of 8 cycles of chemotherapy and her total protocol duration time was 6 months. She did not experience any side effects from chemotherapy and her quality of life was excellent while undergoing treatment. She had thoracic radiographs performed prior to cycles #4 and #8, and both showed no evidence of cancer, which means she entered complete remission with chemotherapy. She was then transitioned to maintenance oral chemotherapy and was still in complete remission on 10/13/21 when she had radiographs last performed. Thanks to chemotherapy, she has been alive for 7 months after a diagnosis of metastatic pulmonary cancer. Without chemotherapy, her expected survival time was less than 3 months.

In summary, dogs with pulmonary carcinoma can have positive outcomes if treated appropriately and if no negative prognostic factors are identified. The presence of one or more identified negative prognostic factors can negatively affect prognosis. Although surgery is the mainstay treatment for this type of cancer, the addition of chemotherapy in efforts to prolong survival time in pets with identified negative prognostic factors can be helpful. For dogs that are not good surgical candidates, chemotherapy is a palliative option that can be pursued as in Roxy’s case.

A Case of Canine Metastatic Pulmonary Carcinoma

Irene Vazquez, DVM, MS, DACVIM (Oncology)

Irene.Vazquez@vca.com

Oncology Services

Monday-Thursday

References

1. Rebhun, R.B., Culp, W.T.N., (2007). Pulmonary Neoplasia. In Withrow & MacEwen's Small Animal Clinical Oncology (5th ed., p. 453-459). St. Louis, MO: Saunders Elsevier.

2. Brody RS, Craig PH: Primary pulmonary neoplasms in the dog: a review of 29 cases, J Am Vet Med Assoc 147:1628-1643, 1965.

3. Griffery SM, Kraegel SA, Madewell BR: Rapid detection of K-ras gene mutations in canine lung cancer using single-strand conformational polymorphism analysis, Carcinogenesis 19:959-963, 1998.

4. Meuten DJ: Tumors in domestic animals, ed 4, Ames, Iowa, 2002, Iowa State University Press.

5. Hahn FF, Muggenburg BA. Griffith WC: Primary lung neoplasia in a beagle colony, Vet Pathol 33:633-638, 1996.

6. Moulton JE, von Tscharner C, Schneider R: Classification of lung carcinomas in the dog and cat, Vet Pathol 18:513-528, 1981.

7. Nielsen SW, Horava A: Primary pulmonary tumors of the dog. A report of sixteen cases, Am J Vet Res 21:813-830, 1960.

8. D’Costa S, Yoon B-I, Kim DY, et al: Morphologic and molecular analysis of 39 spontaneous feline pulmonary carcinomas, Vet Pathol DOI 10.117710300985811419529, 2011.