Oesophageal Obstructions

Question 1

What is an Oesophageal Obstruction

Answer 1

Obstruction of the oesophagus can be either intraluminal (foreign bodies), intramural (tumours of the wall), or extramural (vascular ring stricture). Common foreign bodies are: bones, needles, fishhooks and wood.

Question 2

Signs of Oesophageal Obstruction

Answer 2

Signs of an oesophageal foreign body are hypersalivation, gagging, dysphagia, regurgitation (which can lead to aspiration) and the animal may be making repeated attempts to swallow.

Question 3

Clinical Signs

Answer 3

Clinical signs depend on the location of the obstruction and the degree and duration. Chronic weight loss, anorexia, and lethargy are more serious clinical signs.

Question 4

Why Oesophageal Obstructions an emergency

Answer 4

Animals with these clinical signs must be seen immediately, as these foreign bodies can cause oesophageal perforations, aspiration, strictures, and mega oesophagus. These can be diagnosed via radiographs, contrast studies, or oesophagoscopy.

Question 5

Pre op

Answer 5

The patient should be starved for 6-8 hours and all fluid and electrolyte imbalances should be corrected first. Prophylactic antibiotics should be given.

Question 6

Patient Prep

Answer 6

If the cervical oesophagus is involved the patient will be clipped along the ventral oesophagus, with a wide lateral clip. If the thoracic oesophagus is involved the lateral thorax will need to be clipped. The patient’s skin can then be prepared aseptically.

Question 7

Patient Positioning

Answer 7

The patient is placed in dorsal recumbency with the neck arched over a support bag and extended.

Question 8

Instrument and Material

Answer 8

For an oesophagotomy, self-retaining retractors, laparotomy sponges, saline, suction apparatus and two general surgical kits are required

Question 9

Surgical Procedure

Answer 9

Some foreign bodies can be removed by using a flexible endoscope which is non-invasive, where other may require an oesophagotomy. The patient must be under general anaesthesia for both of these procedures.

Question 10

Post op

Answer 10

The patient should be monitored for signs of pain or respiratory distress. Soft food is introduced slowly post operatively. Animal should be observed for vomiting or regurgitation, evidence of sepsis or aspiration pneumonia. Wounds should be inspected to ensure they are healing well.