Gastrotomy approach for removal of an oesophageal foreign body in a dog

A 9-year-old castrated male Kaninchen dachshund dog weighing 4.18 kg was referred to our institution and presented with occasional vomiting and dysphagia. The radiographic examination revealed a long radiopaque foreign body located throughout the thoracic oesophagus. Endoscopic removal was attempted using laparoscopic forceps but was unsuccessful as the foreign body was too large to be grasped. A gastrotomy was therefore performed, and long paean forceps were gently and blindly inserted into the cardia of the stomach. The bone foreign body was grasped with the long paean forceps under fluoroscopy and withdrawn from the oesophagus while checking with an endoscope. A gastrotomy approach using long forceps, endoscopy and fluoroscopy should be considered for removal of oesophageal foreign bodies from patients in which an endoscopic approach has been unsuccessful.

Surgical removal of intestinal foreign bodies using a laparotomy-assisted endoscopic approach in dogs and cats and comparison with enterotomy

OBJECTIVES

To describe a novel surgical technique for intestinal foreign body removal without enterotomy using a laparotomy-assisted endoscopic approach and compare short-term outcomes to enterotomy.

MATERIALS AND METHODS

Medical records of dogs and cats with intestinal foreign bodies that underwent attempted treatment with a laparotomy-assisted endoscopic approach between June 2019 and July 2021 were extracted. The approach consisted in manoeuvring the intestinal foreign body into the stomach during laparotomy and then removing it via a gastroscopy. If the foreign body was unmovable, an enterotomy was performed.

RESULTS

Fifty-eight cases were enrolled and foreign bodies were successfully removed in 25 cases using a laparotomy-assisted endoscopic approach. The median distance between the pylorus and the proximal part of the foreign body was 55 cm (range: 0 to 300). The mean surgical time and median endoscopic time were 49 minutes (±sd 12.8) and 5 minutes (range: 2 to 28), respectively. All but two cases were discharged 1 day postoperatively. In 20 cases, the foreign body was not easily movable, and an enterotomy was performed. In three of these cases, conversion to enterotomy was required due to serosal tears that occurred as a consequence of the attempted retrograde manipulation of the foreign body. Foreign body width, length and distance to pylorus were not significantly different between the two techniques. Mean surgical time was significantly shorter for laparotomy-assisted endoscopic approach compared to enterotomy: 49 minutes (±SD 12.8) versus 61.7 minutes (±SD 14.6).

CLINICAL SIGNIFICANCE

Surgical removal of intestinal foreign bodies through a laparotomy-assisted endoscopic approach is a feasible technique that offers satisfactory outcomes and shorter surgical time than enterotomy. Retrograde manipulation of the intestinal foreign body may result in serosal tears.

Outcomes of esophageal and gastric bone foreign bodies in dogs

Background

Objectives

Animals

Methods

Results

Conclusions and Clinical Importance

Potential Owner-Related Risk Factors That May Contribute to Obesity in Companion Dogs in Aotearoa New Zealand

Approximately a third of all Aotearoa New Zealand (NZ) households include a dog, with 28% of these dogs being overweight or obese, conditions that are associated with many serious health issues. Therefore, healthy weight interventions that focus on the owner’s role are of great importance to companion animal welfare in NZ. Accordingly, the present study explores the feeding practices associated with NZ dogs and identifies potential owner-related risk factors contributing to these animals being overweight or obese. The current study used data collected from a survey conducted online in 2019 between January and March of NZ residents over 18. Along with demographic questions, the respondents were asked questions regarding their dog’s body condition and diet questions related to the body. Nearly a quarter (26%, n = 609) of the survey participants (n = 2358) owned at least one dog. The current study reported that increasing age range, household income and the number of children increased the likelihood of having a dog while increasing qualification level and living in a town/city decreased the likelihood. The majority of the respondents fed their dog(s) treats (59%) and 85% fed them specialised food bought from a pet shop, veterinary clinic and/or different online sources. Just over a third of the participant (39%) reported that they fed their dog(s) biscuits from the supermarket, 36% fed their dog(s) raw meat, and 34% of respondents fee their dog(s) table scraps/human food. These results suggest that many dog owners feed their dog(s) various food types, making it a challenging task to determine the exact amount required from each type in order not to exceed caloric intake. Disagreement regarding the correct body condition were reported among twenty per cent of the respondents. This finding indicates a knowledge gap among the NZ dog-owning population that may negatively affect their dogs’ welfare and wellbeing. Future research into pro-equity approaches to address these issues is needed so that dogs in NZ can live not only a good life but also their best life.

Complications associated with and outcome of surgical intervention for treatment of esophageal foreign bodies in dogs

OBJECTIVE

To identify complications associated with and short- and long-term outcomes of surgical intervention for treatment of esophageal foreign bodies (EFBs) in dogs.

ANIMALS

63 client-owned dogs.

PROCEDURES

Patient records from 9 veterinary hospitals were reviewed to identify dogs that underwent surgery for removal of an EFB or treatment or an associated esophageal perforation between 2007 and 2019. Long-term follow-up data were obtained via a client questionnaire.

RESULTS

54 of the 63 (85.7%) dogs underwent surgery after an unsuccessful minimally invasive procedure or subsequent evidence of esophageal perforation was identified. Esophageal perforation was present at the time of surgery in 42 (66.7%) dogs. Most dogs underwent a left intercostal thoracotomy (37/63 [58.7%]). Intraoperative complications occurred in 18 (28.6%) dogs, and 28 (50%) dogs had a postoperative complication. Postoperative complications were minor in 14 of the 28 (50%) dogs. Dehiscence of the esophagotomy occurred in 3 dogs. Forty-seven (74.6%) dogs survived to discharge. Presence of esophageal perforation preoperatively, undergoing a thoracotomy, and whether a gastrostomy tube was placed were significantly associated with not surviving to discharge. Follow-up information was available for 38 of 47 dogs (80.9%; mean follow-up time, 46.5 months). Infrequent vomiting or regurgitation was reported by 5 of 20 (25%) owners, with 1 dog receiving medication.

CLINICAL RELEVANCE

Results suggested that surgical management of EFBs can be associated with a high success rate. Surgery should be considered when an EFB cannot be removed safely with minimally invasive methods or esophageal perforation is present.

Lethal acute hemorrhage from an aortoesophageal fistula following endoscopy-assisted esophageal foreign body removal in a dog

OBJECTIVE

To describe the clinical presentation of a dog with fatal hemorrhage from an aortoesophageal fistula (AEF) immediately following endoscopic removal of an osseous esophageal foreign body.

CASE SUMMARY

A 12-year-old, male mixed-breed dog presented to a university hospital with a 6-day history of gagging, hematemesis, and anorexia. Physical examination upon arrival was unremarkable. Blood work revealed leukocytosis without anemia. Thoracic radiographs from the referring veterinarian demonstrated the presence of an osseous esophageal foreign body at the level of the heart base. Subsequently, esophagoscopy was performed under general anesthesia. A triangular-shaped, osseous esophageal foreign body was visualized at the level of the heart base and successfully removed. Following its removal, a deep, nonbleeding, presumably nonperforated, esophageal ulcer was revealed. While recovering from anesthesia, the dog's condition acutely deteriorated, with absence of spontaneous respiration, severe tachycardia, hypotension, white-pale mucous membranes, and hypothermia. Severe anemia was present, with hypovolemic shock likely secondary to acute, postprocedural bleeding. Medical management included rapid packed red blood cell transfusion, crystalloid fluid therapy, and tranexamic acid. Despite initial stabilization, several hours later, the dog suffered cardiac arrest and cardiopulmonary resuscitation (CPR) was unsuccessful. At postmortem examination, a 1-mm AEF was identified on the ventral aspect of the aorta that communicated with the overlying esophagus.

NEW OR UNIQUE INFORMATION PROVIDED

Aortoesophageal fistulas should be considered in any patient with severe bleeding following esophagoscopy. A history of hematemesis in a dog with an esophageal foreign body should raise suspicion of an AEF and dictate case management accordingly.

Evaluation of teeth injuries in Beagle dogs caused by autoclaved beef bones used as a chewing item to remove dental calculus

Dental calculus (DC) is the most widespread oral problem in domestic dogs. Chewing items are used to remove DC from the tooth surface; they also favor oral health and animal welfare. Raw beef bone mastication also shortly reduces DC in adult dogs. However, it can cause oral lesions and hence is not popular. This study evaluated the impact of bone mastication on the dental roots, enamel, and gingiva of dogs. Twelve adult Beagle dogs were randomly divided into 2 treatment groups in a completely randomized block design: cortical bone (CB) or spongy bone (SB). Intraoral radiographs were obtained on days 0 and 14, and calculus assessment was performed using images captured on days 0, 3, 6, 9, 12, and 14; an integration program was used to measure the proportion between the area covered by calculus and the total area of teeth. DC was completely removed from the first and second premolars and molars from both the arcades in less than 3 days of supplementation, indicating that these teeth were frequently used for chewing (P < 0.10). Bones were highly effective for DC removal and gingival inflammation reduction. Despite the hardness of bones, no lesions or teeth root and enamel fracture, or esophageal or intestinal obstructions—complications related to bone ingestion—were noted. However, SB showed some gingival lesions (n = 4) and bone remnants between teeth (n = 2). Gingival lesions were caused by the daily and continuous supply of new pieces of bone for 13 days. Specific pieces of bone should be used for oral home care programs because they shortly remove almost 90% of DC, allowing longer intervals between periodontal cleaning procedures. Long-term studies are required to evaluate the use of bones and evaluate their impact on teeth and periodontium after prolonged supplementation.

Transdiaphragmatic Gastrotomy for the Extraction of Distal Esophageal Foreign Bodies in 13 Dogs (1997-2016)

The records of 13 dogs with distal esophageal foreign body obstruction not amenable to endoscopic management that had transdiaphragmatic gastrotomy (TG) for the foreign body extraction were reviewed. West Highland white terriers were over-represented. Mean age of the dogs at presentation was 38.6 mo, and mean duration of clinical signs associated with esophageal foreign bodies was 5.8 days. A TG was performed via an eighth or ninth left intercostal thoracotomy, and clinical results were successful in 12 dogs. In 1 dog, gastrotomy failed to retrieve a foreign body and esophagotomy was performed. Foreign bodies that were removed included 3 fishhooks and 10 animal bones. Postoperatively, all dogs developed esophagitis, 1 dog showed esophageal stricture, and 1 dog died of pyothorax associated with esophageal perforation 1 day postsurgery. Overall, 12 dogs survived and were free of clinical signs after a median follow-up time of 17 mo. TG is an effective surgical technique for the retrieval of distal esophageal foreign bodies.

Endoscopic retrieval of gastric and oesophageal foreign bodies in 52 cats

OBJECTIVES

To assess the outcomes and major complications in cats that require oesophageal and gastric endoscopic foreign body removal.

MATERIALS AND METHODS

The medical records of 52 cats with oesophageal and gastric foreign bodies that underwent endoscopic foreign body retrieval during a 13-year period (2006 to 2018) were retrospectively reviewed to characterise the clinical and radiographic signs, endoscopic findings, outcomes and major complications.

RESULTS

Endoscopic foreign body retrieval was successful in 49 of the 52 cats (94.2%). Radiographs confirmed the foreign material in 24 of the 50 cats (48%). Major complications occurred in eight of the 52 cats (15.4%) and included pleural effusion (n=2), aspiration pneumonia (n=2), unsuccessful removal of foreign material with endoscopy (n=3), oesophageal stricture formation (n=3) and cardiopulmonary arrest (n=1). Cats with oesophageal foreign bodies were more likely to experience major complications than those with gastric foreign bodies.

CLINICAL SIGNIFICANCE

Endoscopic foreign body removal in cats was associated with good overall outcomes and a low complication rate in this study sample. These results will help veterinarians better understand the outcomes of endoscopic foreign body removal in cats.

Retrospective evaluation of factors associated with degree of esophagitis, treatment, and outcomes in dogs presenting with esophageal foreign bodies (2004-2014): 114 cases

OBJECTIVE

To characterize a population of dogs presenting for esophageal foreign body removal and evaluate factors associated with degree of esophagitis and minor and major complications.

DESIGN

Retrospective evaluation of dogs who presented for esophageal foreign body removal between January 2004 and December 2014.

SETTING

University veterinary teaching hospital.

ANIMALS

Data collected from 114 dogs included signalment, history, clinical signs, physical examination findings, duration and location of foreign body, degree of esophagitis, foreign body removal success, feeding tube placement, and clinical outcomes. Owners were contacted for outcome data not available in the medical record. Data were analyzed for breed predispositions, whether duration or type of foreign body was associated with degree of esophagitis or complications, and factors associated with feeding tube placement.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

The overall success rate for foreign body removal via esophagoscopy was 95% with a complication rate of 22%. Small breed dogs were overrepresented. Dogs with a foreign body present for >24 h were significantly more likely to have severe esophagitis (P < 0.001) and major complications (P = 0.0044). Foreign body type did not predict degree of esophagitis or complications, though fishhooks were more likely to require surgical removal (P = 0.033). Feeding tubes (15 gastrostomy, 1 nasoesophageal) were placed in 14% of dogs and were more likely to be placed if the foreign body had been present for >24 h (P < 0.001).

CONCLUSIONS

Consistent with previous studies, esophageal foreign bodies, appropriately identified and endoscopically removed, carry a good prognosis, particularly if they have been present for ≤24 h.

Likelihood and outcome of esophageal perforation secondary to esophageal foreign body in dogs

OBJECTIVE To determine the likelihood and outcome of esophageal perforation secondary to an esophageal foreign body (EFB) in dogs. DESIGN Retrospective observational study. ANIMALS 125 dogs evaluated for EFB at 2 veterinary teaching hospitals from January 2005 through December 2013. PROCEDURES Data were retrieved from the medical record of each dog regarding variables hypothesized to be associated with esophageal perforation, whether esophageal perforation was present, and survival to hospital discharge. Variables were examined for associations with various outcomes. RESULTS Bones (55/125 [44%]) and fishhooks (37/125 [30%]) were the most common types of EFBs. Fifteen (12%) dogs had an esophageal perforation (10 with a fishhook EFB and 5 with a bone EFB). No association was identified between dog body weight and esophageal perforation. Esophageal perforation was more likely in dogs with a fishhook EFB (10/37 [27%]) versus other EFBs (5/88 [6%]; OR, 6.1; 95% confidence interval, 1.9 to 9.6). Median interval from fishhook or bone ingestion to initial evaluation was significantly longer for dogs with (12 and 96 hours, respectively) versus without (1 and 24 hours, respectively) perforation. Thirteen of 15 (87%) dogs with esophageal perforation survived to hospital discharge, including all 10 dogs with perforation secondary to fishhook ingestion. Eight survivors with esophageal perforation required no surgical intervention. CONCLUSIONS AND CLINICAL RELEVANCE Esophageal perforation was uncommon in the evaluated dogs with an EFB, and no surgical intervention was required for a large proportion of them. Fishhooks and delay between EFB ingestion and initial evaluation were risk factors for perforation.

Complications following removal of oesophageal foreign bodies: a retrospective review of 349 cases

AIM

To determine the incidence and types of complications associated with oesophageal foreign body (FB) removal in dogs, as well as to evaluate potential risk factors for the development of complications.

METHODS

Clinical records were searched within Animal Emergency Service and Veterinary Specialist Services databases between July 2001 and March 2017. Data were collected regarding signalment, FB type, method of removal, medical management and complications. Follow-up records from the referring veterinarian were then obtained by either phone call or email.

RESULTS

A total of 349 FB cases were reviewed. The majority of FBs were bones (77.4%), with Staffordshire Bull Terriers (12.3%) and West Highland White Terriers (9.8%) the most common breeds seen. Complications at the time of FB removal occurred in 20 cases (5.9%), with 14 cases of perforation. Persistent gastrointestinal signs were reported in 4.7% of cases within the initial 72-h period following FB removal and 11.9% cases outside this time period. Respiratory signs such as dyspnoea and coughing were also reported in 8 cases (2.3%), all of which occurred within 72 h after FB removal. Follow-up of at least 1 month was available in 151 cases. Delayed complications occurred in 11 cases (7.3%), with stricture occurring in 4 cases (2.6%); 16 animals were either euthanased (n = 14) or died (n = 2) post-FB removal, resulting in a case fatality rate of 4.6%.

CONCLUSION

Use of antacid medications and FB type did not have a statistically significant relationship with complications following FB removal.

Raw meat-based diets for dogs: survey of owners' motivations, attitudes and practices

BACKGROUND

The popularity of raw meat-based diets (RMBDs) for pets has been increasing in recent years even if the reputed health benefits are mainly anecdotal. A web-based survey was developed to better understand the motivations and habits of owners who decided to feed their dogs RMBDs.

RESULTS

The questionnaire was completed by 218 dog owners, 62 of whom were living with people whose immune system was impaired or weakened. Internet was the preferred source of information for more than half of the respondents, and feeding dogs a more natural and healthier diet was the main reason behind owners' interest in RMBDs. About 80% of the participants completely abandoned commercial pet food and showed marked distrust especially towards the lack of clarity on the ingredients used (n = 169). The vast majority of owners interviewed (94%) believed RMBDs to be absolutely safe for dogs, and shinier coat, muscle mass gain, and cleaner teeth were the principal improvements seen on their pets. Controlling the composition and quality of the ingredients provided to their animals was the main advantage of RMBDs for 57% of the owners, while the main disadvantages were related to the purchase of some components (38%) and the time required (22%) for the preparation of the diet. Only 8% of the respondents relied on veterinarians for RMBD formulation, and a wide variety of feeding regimens and combinations of ingredients was observed.

CONCLUSIONS

As revealed by this study, most owners are unaware of the risks posed by the feeding of RMBDs for both animal and human health, and they often rely on questionable sources for advice on pet nutrition. Owners see RMBDs as a more natural and healthier alternative to commercial pet food even if the actual benefits remain unproven. Consulting veterinarians for proper information and board-certified nutritionists for the formulation of complete and balanced RMBDs should be promoted.

Medical management of esophageal perforation secondary to esophageal foreign bodies in 5 dogs

OBJECTIVE

To describe 5 cases of conservative management of substantial esophageal perforation in dogs.

SERIES SUMMARY

Five dogs presented with an esophageal foreign body (EFB) and resultant esophageal perforation. Clinical signs at presentation included tachycardia, tachypnea, and increased respiratory effort. Thoracic radiography was performed in all cases, and in each case, pleural and mediastinal effusion was present, suggesting esophageal perforation prior to endoscope-guided removal. A full thickness esophageal defect was visualized after foreign body removal in 4/5 cases. Treatment included IV crystalloid fluid therapy, IV antimicrobials, analgesia, and proton pump inhibitors in all cases. Two dogs had a percutaneous endoscopically placed gastrostomy feeding tube placed and 1 dog received prednisolone sodium succinate IV because of marked pharyngeal inflammation. Complications after EFB removal included pneumothorax (n = 2) and pneumomediastinum (n = 4). Four of the 5 dogs survived to discharge and did not have complications 2-4 weeks following discharge. One dog was euthanized as result of aspiration pneumonia following EFB removal.

NEW OR UNIQUE INFORMATION PROVIDED

Traditionally, surgical management of esophageal perforations has been recommended. This can be a costly and invasive procedure and requires a high degree of surgical skill. In this report, conservative management of substantial esophageal perforation in 5 dogs is described; medical management may be a viable treatment option in dogs with perforation of the esophagus due to EFB.

Endoscopic and surgical removal of oesophageal and gastric fishhook foreign bodies in 33 animals

OBJECTIVES

To describe the location, retrieval, frequency of surgery and complications associated with fishhook foreign bodies.

MATERIALS AND METHODS

Retrospective evaluation of the medical records of cats and dogs admitted between 2010 and 2016 after fishhook ingestion.

RESULTS

A total of 33 cases (2 cats and 31 dogs) were included. The most common locations were the proximal oesophagus [12/33 (36%)] and stomach [11/33 (33%)]. Endoscopic retrieval was successful in 27 of 33 cases (82%); oesophageal perforation was the only recorded complication, occurring in six of 33 (18%) cases. Surgery was performed in six cases (18%), and no early complications were recorded. The survival rate was 100%.

CLINICAL SIGNIFICANCE

The endoscopic removal of ingested fishhooks is highly successful. In the present study, survival to discharge was 100%, even in cases of oesophageal perforation or in cases requiring surgery.

Risk Factors for Death in Dogs Treated for Esophageal Foreign Body Obstruction: A Retrospective Cohort Study of 222 Cases (1998-2017)

Background

Limited data exist describing risk factors for death, and long‐term outcomes in dogs with esophageal foreign body (EFB) obstruction.

Hypothesis/Objectives

To evaluate short‐ and long‐term outcomes, and analyze risk factors for death in dogs with EFB obstruction. We hypothesized duration of entrapment and treatment type would affect outcome.

Animals

A total of 222 dogs were treated for EFB obstruction at an emergency and referral hospital between March 1998 and March 2017.

Methods

Medical records for dogs with EFB were retrospectively evaluated.

Results

Foreign material most frequently was osseous (180/222 [81%]), with distal esophagus the most common location (110/222 [49.5%]). Duration of clinical signs was not associated with risk of death (OR = 1.08, 95% CI 0.99–1.17; P = 0.2). Entrapment was treated by endoscopy (204/222 [91.8%]), surgery after endoscopic attempt (13/222 [5.9%]), and repeat endoscopy after surgery was recommended but declined (5/222 [2.3%]). In‐hospital case fatality rate was 11/222 (5%). Risk of death was significantly higher with surgery (OR = 20.1, 95% CI 3.59–112.44; P = 0.001), and 5/5 (100%) of dogs died if undergoing endoscopy after surgery was recommended but declined. Increasing numbers of postprocedural complications (OR = 3.44, CI 2.01–5.91; P < 0.001), esophageal perforation (OR = 65.47, CI 4.27–1004.15; P = 0.003), and postprocedure esophageal hemorrhage (OR = 11.81, CI 1.19–116.77; P = 0.04) increased in‐hospital risk of death. Esophageal strictures were reported in 4/189 (2.1%) of survivors available for follow‐up.

Conclusions and Clinical Importance

Death is uncommon in canine EFB; however, treatment type affects outcome, and these data should be used to guide decision‐making in dogs with EFB.

Oesophageal foreign bodies in dogs: factors affecting success of endoscopic retrieval

Oesophageal foreign bodies are common in dogs. Endoscopic removal is a viable treatment option but few studies have assessed the clinical and radiographic features that would be useful in decision-making and prognosis.Dogs (n = 44) with oesophageal foreign bodies presented to the University Veterinary Hospital were assessed. Terriers and West Highland White Terriers were significantly overrepresented (p < 0.0001) and in those breeds the foreign body was significantly (p < 0.0001) more likely to be located caudal to the heart base. The majority (88.6%) of foreign bodies were bones or bone fragments.Group 1 (n = 30) included animals where endoscopic removal was successful and Group 2 (n = 14) animals where it was unsuccessful or not attempted because of evidence of oesophageal rupture. There was no statistically significant difference in age, sex, body weight, type, location and size of foreign body, recovery rate, short-term complications and long-term outcome between the two groups. Duration of signs prior to presentation and time to spontaneous oral feeding were significantly longer (p < 0.01 in each case) in Group 2 (five days and 120 hours, respectively) compared to Group 1 (2 days and 24 hours, respectively). Mortality was 11.1%. Long-term follow-up of 29 dogs suggested oesophageal stricture formation manageable by feeding alone in seven (24.1%) cases.Terriers appear predisposed to oesophageal foreign bodies. Success of endoscopic removal is adversely affected by duration of signs prior to presentation. Surgical removal negatively influences time to recovery. Stricture formation appears to be a relatively common complication and alternate measures for its prevention should be sought.