Esophageal Diverticulum Associated With a Trichobezoar in a Cat

Gastric diverticula in six cats: a case series (2011-2020)

CASE SERIES SUMMARY

Gastric diverticulum (GD) is a rare condition that is described adequately in humans but has not been reported in cats. This case series describes six cats with GD, including three that were published in a previous abstract. All cats presented for a variety of gastrointestinal disorders, including chronic vomiting, weight loss and anorexia, and underwent negative contrast radiography to diagnose GD. All but one cat underwent surgical resection of the GD via partial gastrectomy, while the remaining cat was euthanized. Resection of the GD was associated with reduction of reported clinical signs.

RELEVANCE AND NOVEL INFORMATION

Gastric diverticula have never been reported in the cat. Negative contrast radiography appears to be a superior imaging technique in the diagnosis of feline GD. In cats with a vague chronic history, including vomiting, anorexia and weight loss, GD should be considered among the differential diagnoses. Further study and more cases need to be identified to better assess clinical problems referable to GD in the absence of other comorbidities. Maine Coon cats with GD appear to be over-represented.

Uncommon cause of respiratory failure due to a bezoar in the hypopharynx: a case report

Background

Trichotillomania and trichophagia cause trichobezoars, which are masses made of hair. The main presentation of this condition is abdominal pain. However, other complications include gastric outlet obstruction, nausea, vomiting, weight loss, malnutrition, hematemesis, diarrhea, and constipation.

Case presentation

A 57-year-old woman with trichotillomania was admitted to the Emergency Department with the chief complaints of dyspnea on exertion, shortness of breath, dysphagia, generalized weakness, and hoarseness. Spiral chest computed tomography (CT) scan did not reveal any parenchymal lesions Pulmonary CT angiography did not reveal pulmonary embolism. The patient was admitted to the Surgery Department for hand fasciotomy due to contrast leakage, and during laryngoscopy, a trichobezoar was detected that was removed with Magill forceps.

Conclusions

Rare cases of trichobezoars can be observed in humans with gastrointestinal and respiratory symptoms. Precise and timely diagnosis are key for the prevention of more invasive diagnostic procedures.

Surgical management of a cervical esophageal diverticulum in and long-term outcome for a five-month-old cat

CASE DESCRIPTION

A 5-month-old domestic shorthair cat was presented for recurrent regurgitation and hypersalivation after eating, which had been evident since adoption 2 months earlier.

CLINICAL FINDINGS

Physical examination was unremarkable. Plain thoracic radiography, positive contrast esophagography, endoscopy, CT, electromyography, and blood analysis were performed. A caudal cervical esophageal diverticulum, likely congenital, was diagnosed.

TREATMENT AND OUTCOME

A diverticulectomy was performed with a surgical stapler while an endoscope was in the esophageal lumen. No intra- or postoperative complications were reported. Postoperative and short-term outcomes were excellent, with resolution of clinical signs and no endoscopic esophageal abnormality 3 months after surgery. The cat remained without clinical signs 8 months after surgery.

CLINICAL RELEVANCE

An esophageal diverticulum in a cat is rare. The cat of this report had a good outcome following surgical management of a cervical esophageal diverticulum. Surgery is worth considering for similarly affected cats, but additional cases are required to confirm the benefit of surgery versus conservative management.

Oesophageal obstruction due to trichobezoars in two cats

Case series summary

This case series describes two cats diagnosed with oesophageal obstruction due to trichobezoars. Both cases presented for acute dyspnoea, with thoracic radiographs revealing changes consistent with oesophageal foreign material causing ventral displacement of the trachea. Endoscopic removal was unsuccessful and both cases required surgical intervention. Case 1 died within 24 h of trichobezoar removal, likely from aspiration pneumonia. Case 2 developed laryngeal collapse 10 days after trichobezoar removal and required a permanent tracheostomy. Case 2 has been followed up for >1 year without any further complications.

Relevance and novel information

There is minimal published information on oesophageal trichobezoars in cats. These cases provide information on presentation, radiographic findings and complications associated with oesophageal trichobezoars. The intention of this case series is to increase the index of suspicion for this syndrome among clinicians treating feline patients.

Repair of a sliding (type I) hiatal hernia in a cat via herniorrhaphy, esophagoplasty and floppy Nissen fundoplication

Case summary

A 10-month-old domestic shorthair cat was evaluated for severe esophagitis and protracted vomiting and regurgitation secondary to a sliding (type I) hiatal hernia. The hernia and concurrent upper airway obstruction (nasopharyngeal polyp) were diagnosed with a multi-modality approach, including thoracic and abdominal radiographs, abdominal ultrasound, computed tomography and endoscopy. Following unsuccessful attempts at medical management, lower esophageal incompetence was successfully treated by employing a combination of surgical techniques, including herniorrhaphy, esophagopexy and modified (floppy) Nissen fundoplication.

Relevance and novel information

A multi-modality imaging approach was valuable in completely assessing the extent of this cat’s disease. Although an untraditional approach, the authors report herein the first clinical description of the use of combined surgical techniques with the floppy Nissen fundoplication technique (an antireflux procedure) in a cat. This procedure was used as a first-line surgical technique in this cat with severe lower esophageal incompetence, and may be a viable option for cases non-responsive to other therapeutic interventions. Further investigation of this surgical technique is warranted.

Hair balls in cats: a normal nuisance or a sign that something is wrong?

PRACTICAL RELEVANCE

Vomiting of hair balls is a common problem in domestic cats, to the extent that it is considered by many owners and veterinarians to be a normal feline behaviour. Whether this is ever the case remains unclear but in most shorthaired cats the frequent elimination of hair balls is an indicator of an underlying chronic disease that is causing increased ingestion of fur or altered gastrointestinal motility. Pruritic skin disease, flea infestation and/or an underlying dietary intolerance are common contributing factors that should not be overlooked.

EVIDENCE BASE

Studies concerning this common problem are lacking and there are no previously published data regarding the incidence of hair balls in pet cats or potential predisposing causes. Although a range of commercial hair ball control diets are available there is no objective information in the public domain regarding their efficacy. Similarly, no studies have evaluated the success of other commonly recommended preventive strategies.

CLINICAL CHALLENGES

Despite the lack of evidence-based information, veterinarians are faced with the day-to-day challenge of helping owners to limit the extent to which their cats produce hair balls. The problem is at best an unpleasant nuisance for both cat and owner, and at worst may be a cause of significant morbidity and even, in rare cases, mortality.

Imaging evaluation of dogs and cats with Dysphagia

The current literature is reviewed in this paper regarding the application of diagnostic imaging in the evaluation of swallowing disorders of the dog. The applications of radiography, contrast radiography, and contrast videofluoroscopy are discussed with pertinent case examples provided for emphasis. The indications for image-guided interventions are also described.