Problems and complications associated with esophageal surgery

Complications associated with esophageal surgery can be overcome by careful surgical technique, patience, and the selection of appropriate treatments for esophageal lesions. Two retrospective studies that evaluated the results of esophageal surgery in dogs and cats reported successful outcomes in 77% and 85% of the cases. By following classic surgical tenets, the use of fine non-reactive suture material, the precise apposition of tissues, and the avoidance of tension on the suture line, the esophagus will heal admirably.

Use of intraoperative ultrasonography to identify a cervical foreign body. A case report

Real-time ultrasound was used to identify a foreign-body abscess causing an extraluminal esophageal obstruction in the neck of a horse. Surgical exploration to remove the foreign body and drain the abscess was performed after 2 months of medical management that had failed to resolve the problem. The abscess could not be visualized because there was no draining tract or other localizing sign of inflammation. Ultrasound was used aseptically to guide surgical dissection to the walled off abscess with minimal damage to adjacent vital structures in the surgical field. The signs of esophageal obstruction abated and have not recurred in 15 months.

Esophageal dysfunction in a weanling thoroughbred

A 6-month-old Thoroughbred colt was examined because of persistent dysphagia noted since birth. Moderately severe regurgitation occurred when the colt ate semi-solid food or drank. Complete esophageal impaction developed when the colt ate solid material. Endoscopic examination revealed ulceration, dilatation and lack of peristalsis in the area of the previous impaction. Barium esophagram demonstrated the dilatation in the area of the previous impaction. Esophageal manometry revealed prolonged simultaneous contractions throughout the esophagus suggesting the presence of a motor abnormality. The colt was maintained on a slurry of complete pelleted feed, but the esophageal dysfunction persisted until euthanasia at 17 months of age. Gross post mortem and histologic examinations showed no abnormalities in the muscularis mucosa, myenteric plexus, vagus nerve, or brain stem. The history, signs, and manometric findings suggested esophageal dysfunction in this colt. Motor disorders of the esophagus should be considered in horses with persistent dysphagia or recurrent episodes of choke and esophageal manometry can help characterize these disorders.

Surgical diseases of the esophagus

The diagnosis and management of surgical diseases of the esophagus are discussed. Esophageal foreign bodies, strictures, esophagobronchial fistulas, diverticula, gastroesophageal intussusception, hiatal hernias, and megaesophagus are included in the discussion.

Use of a nasogastric tube for gastric and esophageal decompression in the dog and cat

Distension of the stomach with air and fluid was treated successfully in 9 of 10 dogs by use of an indwelling nasogastric tube. A nasogastric tube was used to remove swallowed air and gastric fluid after surgery, as a precautionary measure to prevent recurrence of gastric distention in 2 dogs. A nasoesophageal tube was used to remove retained barium sulfate and saliva in a cat with megaesophagus and esophageal obstruction caused by gastroesophageal intussusception. Passage of the tube through the nose into the esophagus or stomach was easily accomplished in 10 of the 13 animals, requiring only mild restraint and an anesthetic instilled locally into the nostril. Moderate restraint and more than one attempt at passage of the tube through the nose (ventral meatus) were required in the other 3 animals. In one of these, passage through the ventral meatus and into the pharynx could not be accomplished. Of the 12 animals in which the tube was inserted successfully, 11 tolerated it. The tubes remained inserted from 5 minutes to 48 hours (average, 18.5 hours) without clinically detected complications. This technique offers an alternative to orogastric, gastrostomy, or pharyngostomy tubes for initial and continuous intubation and decompression of the stomach and/or esophagus in the dog and cat. It was found to be practical and effective for the removal of air or fluid, but not the removal of coarse food particles.

Comparison of three feeding techniques after esophageal mucosal resection and anastomosis in the horse

The effects of 3 feeding techniques on healing of a cervical esophageal mucosal resection and anastomosis were investigated in 16 horses. Horses were fed a moistened pelleted diet 1 of 3 ways: 1) per os (n = 5), 2) by nasogastric (n = 5) or 3) by esophagostomy tube (n = 6) until the 14th postoperative day. The pelleted diet was then fed orally in all horses until euthanasia on the 60th postoperative day. Immediate postoperative feeding per os was unsatisfactory, as only 2 of 5 horses survived in this group. Endoscopic evaluation revealed that mucosal dehiscence of varying degrees occurred, with subsequent stricture formation in all horses. Although the incidence of some complications (fistula, sinus tract and traction diverticulum) was higher in the nasogastric tube-fed horses, 2 of 6 horses in the esophagostomy tube-fed group did not survive to the end of the study. There was more cervical phlegmon in the esophagostomy tube-fed group, and this resulted in increased periesophageal fibrosis on histopathologic examination. Radiographic measurements showed that esophageal lumen diameter increased predominantly between 30 and 45 days postoperatively. The mucosal healing time was significantly faster (p = 0.05) in the esophagostomy tube-fed group.

Medical management of esophageal stricture in seven horses

Esophageal strictures developed in 7 horses that were treated for esophageal obstruction. A soft diet was fed to all horses, with intermittent nasogastric tube feeding in one, and medication included nonsteroidal anti-inflammatory drugs. Maximal reduction in esophageal lumen diameter was evident by 30 days following circumferential esophageal ulceration, after which lumen diameter increased rapidly. Five horses were clinically normal by 60 days after the esophageal injury. Two horses were euthanatized at the owner's request, 16 and 17 days after the original insult.

Prevalence of equine sarcocystis in British horses and a comparison of two detection methods

Sarcocystis was detected in oesophageal samples from 245 (62 per cent) of 394 horses and ponies killed at a Cheshire abattoir between February and August 1981. Prevalence of infection was closely related to age, increasing from 28.6 per cent of animals up to two years old to 88.9 per cent of those over eight years old. There were no significant regional differences in prevalence between horses from north west England, Yorkshire or South Wales. Significantly more female horses were infected (69.7 per cent) compared with males (56.2 per cent). Gross examination methods detected fewer than 55 per cent of all infections compared with a tissue digest method. Sarcocysts ranged from 1 to 15 mm in length (mean 5.5 mm) and were up to 0.5 mm wide. Cyst wall morphology and bradyzoite dimensions suggest that the species involved is Sarcocystis bertrami (syn equicanis).

Gastrointestinal disorders of the cat

Several areas of feline gastroenterology deserve critical attention in the near future. For example, as compared with the dog, little is known about the various causes of malabsorptive disease in the cat. So frequently, intestinal biopsy samples reveal nothing more than intestinal thickening with fibrosis and nonspecific mild cellular infiltration, and the inciting cause is never determined. It is, perhaps, wrong to be critical about the use of the bark of Berberis vulgaris and the root of Rheum in modern feline gastroenterology, since most of us occasionally use unconventional therapies. It has been rumored that I have been known to advocate the daily addition of a tablespoon of pumpkin-pie filling to the food of cats suffering from recurrent constipation and acquired megacolon. The rumors are true, and colonic evacuation is sometimes promoted with the use of this unusual bulking agent after traditional drug therapy has failed. We all have our weaknesses!

Gastroesophageal ulceration and candidiasis in foals

Gastroesophageal candidiasis in association with ulceration was diagnosed in 5 foals in which signs of colic had been nonresponsive to medical treatment. The ulceration was found in the stomach of all foals and in the esophagus of 1 foal. Candida colonized hyperkeratotic mucosa surrounding the ulcers, and the associated inflammation resulted in splitting of the mucosal epithelium. Loss of the superficial mucosa may have allowed invasion by bacteria, leading to ulceration.

[A pony with "false" colic]

Report on the case of a pony with colic submitted a to the department of internal medicine. However, the animal was found to be affected with dilatation of the oesophagus which had given rise to acute pleurisy resulting from rupture of the wall of the oesophagus. The diagnosis was established after death.

The Key-Gaskell syndrome: the current situation

During the past 12 months an apparently new disease of cats has occurred with increasing frequency throughout the United Kingdom causing high morbidity and mortality and arousing considerable interest both within and outside the profession. The purpose of this paper is to report what is known about the disease and to indicate lines of current research. As there is an urgent need to communicate information it will be appreciated that this paper is incomplete in certain areas such as pathology and epidemiology where studies are still in progress.