Transcript Esopahgeal Foreign Body with Multifocal Diverticula

 Veterinary
Specialists of South Florida
Presents
Jim Cellini, DVM
VETERINARY SPECIALISTS
OF SOUTH FLORIDA
 Most
common ingested objects are
bones
• Rawhides, plastic objects, fish hooks, etc.
 Small
breed dogs often affected
 Sites of obstruction
• Thoracic inlet, base of heart, epiphrenic area
• Esophageal dilatation limited at these sites
 Severity
related to
size of object and
duration of
obstruction
 Acute onset regurge,
dysphagia,
odynophagia,
gagging, excessive
salivation
 Ingestion
may be witnessed by the owner
 Physical exam findings vary depending
on complications
• NSF vs. lethargy/fever from aspiration
pneumonia
• Halitosis from tissue necrosis
 Thoracic
radiographs
• Visualization of foreign body
• Evidence of aspiration pneumonia
• Esophageal perforation  pneumomediastinum
 Contrast
studies may be necessary for
radiolucent objects
• No barium if perforation suspected!!!
2
yr FI Yorkie
 Presented to ECC
8/14/09 w/ 2 week hx
vomiting, lethargy,
anorexia, weight loss
 Rx’d Rimadyl by
rDVM, given 2 doses
by owner
 UTD on vaccines,
flea/tick/HW
prophylaxis
 TPR
wnl
 EENT: enlarged salivary glands
 Heart/Lungs: GI noise heard during
auscultation
 Abdomen: soft, non painful, patient
appeared nauseous during palpation
 BCS 3/9, amb x4, L medial patella
luxation, no neuro deficits
 CBC/Chem
• Hypoglycemia, hypokalemia, leukocytosis
 cPLI, Bile
Acids, Lipase wnl
 Resting cortisol 5.4 (1-4.5)
 Abdominal ultrasound
• Mild gastric dilation with atony, no other
abnormalities noted
 Radiography
of the thorax and abdomen
revealed no abnormalities.
 PRIMARY
GI DISEASE
• (ENTERITIS, PARASITISM, OBSTRUCTION, FOOD
ALLERGY, INTUSSCEPTION)
 SYSTEMIC
DISEASE
 Hospitalized
through the weekend w/ IV
fluids +KCL + Dextrose +
Metoclopramide
• Enrofloxacin, Famotidine IV
• Cerenia SQ
 Began hypersalivating the next morning
• Phenobarbital (4 mg) IV BID added for
suspected sialadenitis/sialadenosis
 Continued
weekend.
to hypersalivate through the
Foreign body lodge approximately
halfway between heart base and
lower esophageal sphincter. Tissue
surrounding object appears irritated
with bleeding noted when object
was moved.
Discharged the next day after removal of
a piece of a “hoof treat” with near
complete resolution of ptyalism,
anorexia, and nausea
 Sent home w/ Clavamox and Sucralfate
 Recheck 1 week later

• Gaining weight, normal appetite, no problems
noted at home

Owner complains of hypersalivation
returning again, tries medical
management
• 1 week Famotidine, Sucralfate, I/D
1
week later, hypersalivation has not
resolved, but no other problems noted
 Drop off for upper GI scope 10/6/09
DIVERTICULUM
LOWER
ESOPHAGEAL
SPHINCTER
FOREIGN MATTER
IN DIVERTICULUM
ULCERATION/INFLAMMATION
IN THE DIVERTICULUM WHEN
FOREIGN MATTER WAS BEING
REMOVED
DIVERTICULUM
LOWER
ESOPHAGEAL
SPHINCTER
DIVERTICULUM
 Rarely
seen pouch-like sacculations of
the esophageal wall
 Congenital
• Developmental abnormalities allowing mucosa
to herniate through muscularis
 Acquired
• Pulsion – increased intraluminal pressure
(foreign bodies, strictures, etc.)
• Traction – periesophageal inflammation leading
to fibrotic adhesions which contract and pull to
form outpouches
Most commonly found near thoracic inlet
or just cranial to diaphragm (epiphrenic)
 Most commonly young, small breed dogs

• Cairn Terriers, Miniature Poodles, Jack Russell
Terriers
 Can
be single or multiple
 Due to esophagitis, foreign bodies,
vascular ring anomalies, neuromuscular
dysfunction
 Similar
to esophageal foreign bodies
• Post-prandial regurge, retching, hypersalivation,
anorexia, weight loss
• Respiratory distress if fistula or aspiration
pneumonia
• Lameness due to hypertrophic osteopathy
(slatter)
 Diverticula
impacted with ingesta can
become ulcerated
 Easier to perforate
 Plain
radiographs
• Neck extended to eliminate esophageal redundancy
• Air or food filled masses in the esophagus
 Esophogram
• Outpouching of lumen filled with contrast material
• Important to differentiate from megaesophagus
 Esophagoscopy
• Confirms diagnosis, allows visualization of
esophagitis, ulceration, or other structural
abnormalities
 Medical
management for less severe
cases
• Elevated feedings
• Antibiotics (traction diverticula)
• Treat primary cause if pulsion
 Diverticulectomy
preferred treatment
• Exposure more difficult with epiphrenic location
• Cervical approach, thoracotomy depending on
location of diverticula
Image courtesy of www.cts.net
 PEG
tube placed
10/7/09 to allow
complete esophageal
rest for 1 month
 Begin tube feedings
8 hours post-op
 Developed
cough day after PEG tube
placement.
 Radiographs
revealed an alveolar pattern
infiltrate in the right cranial lung lobe
and air filled esophageal diverticulae
 Reglan, Flagyl
and Clavamox were added
to treatment via PEG tube.
AIR-FILLED ESOPHAGEAL
DIVERTICULAE
INFILTRATE
 Returned
for recheck 1 week later
• Doing well at home
• Ptyalism has improved, no complications with
PEG tube
• 40 ml A/D slurry 4x daily
 Prognosis
guarded

Veterinary Specialists of South Florida would like to
thank you for your continued support and referrals.