[Esophageal stenosis as a result of a right aortic arch in 2 cats]. / Ösophagusstenose infolge eines persistierenden rechten Aortenbogens bei 2 Katzen.

A 3-month-old and a 4-year-old cat were presented in the clinic due to regurgitation. The kitten had displayed the symptoms since it had been fed solid foods and was smaller than the litter mates. The 4-year-old cat showed sudden-onset symptoms for 5 days prior to presentation and had a good general condition. Positive contrast thoracic radiographs of both cats in lateral recumbency showed an esophageal dilatation cranial to the heart base and raised a suspicion of foreign material with soft tissue density in this area. In the 4-year-old cat, findings of ventrodorsal thoracic radiographs were compatible with a dextroposition of the aorta and a slightly marked focal left curve of the trachea. The echocardiographic examination of the kitten pictured a right sided aorta, hence a vascular ring anomaly with a dextroposition from the aorta was suspected. Aberrant blood flow as it is seen in a persistent ductus arteriosus was not apparent in the echocardiography. As a result of the sudden development of the clinical signs in the older cat without displaying any former history of regurgitation, an esophagoscopy was performed to exclude an intraluminal esophageal cause for the stricture as well as to extract the foreign material. In this cat, computed tomography imaging also displayed an aberrant left subclavian artery. Both cats recovered well after surgical correction.The diagnosis of a ring anomaly in the kitten via echocardiography is a rare situation. As is the diagnosis of a high-grade esophageal stricture due to a vascular ring anomaly at the age of 4 without a former history of regurgitation.Recovery was excellent in the younger cat. There were no signs of regurgitation 6 months after surgery. The adult cat was in good general condition without clinical symptoms according to the owners when presented for stitch removal. Unfortunately, the adult cat was lost to follow up.

Subtotal Cervical Esophagectomy and Anastomosis in an Ostrich (Struthio camelus domesticus).

An adult, female, captive ostrich (Struthio camelus domesticus) was referred to a veterinary teaching hospital for a 2-week history of lethargy and a mass effect in the proximal cervical region. Physical examination revealed a fistula in the middle cervical esophagus surrounded by devitalized and necrotic tissue; feed material was found leaking from the site. Cervical radiography identified an esophageal stricture with anterior dilation due to the accumulation of feed. After receiving supportive care for 48 hours, the patient's overall status improved, allowing partial esophagectomy and resection of the affected tissues with end-to-end anastomosis. Postoperative management included fasting for 24 hours, followed by the administration of a liquid hand-rearing formula prepared with commercially available ostrich feed and administered via a feeding tube for 15 days. Proper healing of the surgical site was confirmed by esophagoscopy using a flexible endoscope 17 days after surgery. The ostrich was discharged after 27 days, with no complications recorded within the 180 days of the follow-up period. Partial cervical esophagectomy with end-to-end anastomosis along with pre- and postoperative management provided a successful outcome for the treatment of a fistulated esophageal stricture in a captive ostrich, resulting in full recovery without surgical complications.

Congenital esophageal stenosis in a Labrador retriever.

A 1-year-old neutered male Labrador retriever was presented for investigation of chronic regurgitations that had started at weaning. Contrast radiographs and fluoroscopy of the thorax identified a focal narrowing of the proximal intrathoracic esophagus. Examination with CT-angiography excluded extraluminal causes for the narrowing, e.g., vascular ring anomaly. Esophagoscopy revealed the presence of a muscular stenosis with the appearance of a sphincter at the level of the proximal intrathoracic esophagus, without evidence of stricture. A diagnosis of congenital esophageal stenosis was made, suspected secondary to fibromuscular hypertrophy. Regurgitation resolved with conservative management and the dog was well at a 2-year follow-up examination. This case represents one of few small animal cases of congenital esophageal stenosis reported and apparently the only case successfully managed conservatively. Key clinical message: This report describes the clinical presentation, diagnostic imaging findings, and treatment of a rare case of congenital esophageal stenosis in a Labrador retriever. Medical and conservative therapies alone may be sufficient for treatment of congenital esophageal stenosis depending on presentation and suspected histopathological type. These therapies should be considered before initiating interventional procedures.

Sténose congénitale de l'oesophage chez un Labrador retriever. Un Labrador mâle castré âgé de 1 an a été présenté pour une investigation de régurgitations chroniques qui avaient commencé au sevrage. Les radiographies de contraste et la fluoroscopie du thorax ont identifié un rétrécissement focal de l'oesophage intrathoracique proximal. L'examen par tomodensitométrie-angiographie a exclu les causes extraluminales du rétrécissement, c'est-à-dire une anomalie de l'anneau vasculaire. L'oesophagoscopie a révélé la présence d'une sténose musculaire avec apparition d'un sphincter au niveau de l'oesophage intrathoracique proximal, sans signe de rétrécissement. Un diagnostic de sténose congénitale de l'oesophage a été posé, en raison d'une suspicion d'hypertrophie fibromusculaire. La régurgitation s'est résolue avec une gestion conservatrice et le chien allait bien lors d'un examen de suivi à 2 ans. Ce cas représente l'un des rares cas de sténose congénitale de l'oesophage rapportés chez les petits animaux et apparemment le seul cas traité avec succès de manière conservatrice.Message clinique clé :Ce rapport décrit la présentation clinique, les résultats de l'imagerie diagnostique et le traitement d'un cas rare de sténose congénitale de l'oesophage chez un Labrador. Les thérapies médicales et conservatrices seules peuvent être suffisantes pour le traitement de la sténose congénitale de l'oesophage en fonction de la présentation et du type histopathologique suspecté. Ces thérapies doivent être envisagées avant d'entreprendre des procédures interventionnelles.(Traduit par Dr Serge Messier).

Intralesional steroid injection after endoluminal esophageal stricture dilatation in a cat.

Background: Benign esophageal strictures arise from various etiologies, mostly severe esophagitis. Although endoscopic balloon dilation is still the first-line therapy, refractory or recurrent strictures do occur and remain a challenge to the endoluminal treatment. The aim of this report was to communicate a recurrent esophageal stricture resolution in a cat treated with balloon dilatation and steroid injections in Ciudad de Buenos Aires, Argentina. Case Description: A 1-year-old spayed mix-breed female cat was consulted to the Veterinary Endoscopy Service for recurring regurgitation after two previous esophageal dilations. The cat had received doxycycline for Mycoplasma spp. infection and 20 days after the treatment consulted for dysphagia and regurgitation. Upper esophagogastroscopy (UGE) was performed with an Olympus CV-160 8.7 mm diameter endoscope; an annular 7 mm stricture was observed 3 cm caudal to the cranial esophagus sphincter. Three balloon dilatations procedures were performed with a Boston Scientific Controlled Radial Expansion (CRE) balloon 8-10-12 mm of 1 minute each. Because of ongoing clinical signs, another UGE was performed 15 days from the first procedure: a 3 mm stricture was encountered, balloon dilatation was repeated with 6-10-12 mm diameter, and a four-quadrant triamcinolone was injected in the submucosa. Clinically, the cat could eat with no alterations until day 20, where it started with mild dysphagia. Another UGE was performed, and the known stricture conserved a 11 mm diameter and balloon dilatation 12-15-16.5 mm with triamcinolone injection was repeated 30 days after the previous procedure. The cat could eat kibbles with no clinical signs in an 11-month follow-up. Conclusion: The alternative to triamcinolone injection after balloon dilatation presented in this clinical report was successful and it could be a therapeutic option for recurrent esophageal strictures in cats as it is in human medicine.

The use of Savary-Gilliard dilators in the treatment of an oesophageal stricture in a cat.

Oesophageal strictures in cats and dogs are relatively rare and the cause of this disorder can be multifactorial. However, the most common cause in cats is an inflammatory process.Conservative treatment strategies for this disorder includes image-guided interventions. Endoscopic methods are a form of a minimally invasive surgical treatment of the oesophageal strictures. Several endoscopic methods for the therapy of this condition are known, one of them is Savary-Gilliard dilators technique.In the present study of a case of oesophageal stricture in a cat, caused probably by doxycycline treatment without water administration, the authors used the Savary-Gilliard dilators as a therapy for its condition. The animal underwent 3 endoscopy procedures, where in the third one no abnormality in the oesophagus was observed. Moreover, the cat was asymptomatic 6 months after the last oesophagoscopy.In the authors opinion, based on the present case, some experience of the authors and previously described studies, the Savary-Gilliard dilators seems to be a safe, effective, relatively cheap and minimally invasive method of the oesophageal stricture therapy in the cat.

Oesophageal Obstruction in a Donkey Due to Mediastinal Lymphadenitis Caused by Mycobacterium avium Complex.

Mycobacterial infections are rare in horses, donkeys and mules. Although there are a few reports in horses, mycobacterial disease is poorly documented in the donkey. Mycobacterial infection of equine species typically affects the alimentary tract, causing granulomatous enterocolitis resulting in diarrhoea and chronic weight loss, while lymph nodes and liver may also be affected. We now document recurrent oesophageal obstruction, secondary to cranial mediastinal lymphadenitis caused by Mycobacterium avium complex (MAC). To the best of our knowledge, this is the first report of MAC infection in a donkey in the UK.

Permanent Implantable Medical Devices in Exotic Pet Medicine.

Medical devices are defined as implantable if they are intended to remain in the body after the procedure. In veterinary medicine, use of such devices is marginal but may find some indications. Use in exotic pet medicine is even more challenging due to size restriction and the limited data available. This review focuses on the esophageal and tracheal stent in the case of stricture, ureteral stent and subcutaneous ureteral bypass in the case of ureteral obstruction, permanent urinary diversion in the case of bladder atony, and pacemaker in the case of severe arrythmias. Comparative aspects are developed.

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.

Prospective evaluation of an indwelling esophageal balloon dilatation feeding tube for treatment of benign esophageal strictures in dogs and cats.

BACKGROUND: Despite multiple dilatation procedures, benign esophageal strictures (BES) remain a recurring cause of morbidity and mortality in dogs and cats. OBJECTIVE: Investigate the use of an indwelling Balloon Dilatation esophagostomy tube (B-Tube) for treatment of BES in dogs and cats. ANIMALS: Nine dogs and 3 cats. METHODS: Animals with BES were recruited for our prospective study. Endoscopic and fluoroscopic evaluation of the esophagus and balloon dilatation were performed under general anesthesia, followed by placement of an indwelling B-Tube. The animals' owners performed twice daily at-home inflations for approximately 6 weeks. Repeat endoscopy was performed before B-Tube removal. Animals were reevaluated for changes in modified dysphagia score (MDS) after B-Tube removal. RESULTS: The B-Tube management was relatively well tolerated and effective in maintaining dilatation of a BES while in place. These animals underwent a median of 2 anesthetic episodes and were monitored for a median of 472 days (range, 358-1736 days). The mean MDS before treatment was 3.1 ± 0.5/4.0 and final follow-up MDS were significantly (P < .0001) improved at 0.36 ± 0.65/4.0. Eleven of 12 animals (91.7%) had improved MDS at the end of the follow-up period, with 8/12 (66.7%) having an MDS of 0/4, 2/12 (16.7%) an MDS of 1/4, and 1/12 (8.3%) an MDS of 2/4. One dog died. CONCLUSIONS AND CLINICAL IMPORTANCE: The B-Tube offers an effective, and more economical method, and often decreased anesthetic time to repeated balloon dilatation procedures for the treatment of BES in dogs and cats.

Estenose esofágica em duas cadelas após ovário-histerectomia: relato de caso / Esophageal stricture in two female dogs after ovariohysterectomy: case report

A estenose esofágica benigna é uma afecção rara em pequenos animais, comumente secundária a esofagites ulcerativas. O refluxo gastroesofágico, frequente durante procedimentos anestésicos, é a principal causa de esofagite grave, com consequente formação de cicatriz esofágica. O presente trabalho tem por objetivo descrever dois casos de estenose esofágica ocorrentes após ovário-histerectomia, com destaque para os procedimentos diagnósticos realizados. Em ambos os casos, a combinação dos sinais clínicos sugestivos e os achados de esofagograma e esofagoscopia foram determinantes. No primeiro caso, devido ao tempo avançado de desenvolvimento dos sinais clínicos, o paciente veio a óbito antes mesmo que a intervenção direta da região de estenose fosse realizada. Já no segundo, o procedimento de gastrostomia para melhor manejo alimentar, associado à dilatação esofágica via esofagoscopia e à terapia com medicamentos antiácidos, resultou em melhora clínica.(AU)

Benign esophageal stricture is a rare affection in small animals, usually secondary to ulcerative esophagitis. Gastroesophageal reflux, frequent during anesthetic procedures, is the main cause of severe esophagitis with consequent formation of esophageal cicatrix. The objective of this work is to describe two cases of esophageal stricture occurring after ovariohysterectomy, highlighting the diagnostic procedures performed. In both cases, the combination of the suggestive clinical signs and findings from an esophagram and an esophagoscopy were determinants. In the first case, due to the advanced stage of the clinical signs, the patient died before direct interventions on the stenosis region were performed. But in the second case, the gastrostomy procedures for better feed management associated with esophageal dilatation by esophagoscopy and therapy with antacids resulted in clinical improvement.(AU)

Endoscopic Balloon Dilation of Esophageal Strictures in 9 Horses.

BACKGROUND: Medical treatment of esophageal strictures in horses is limited and the use of balloon dilatation is described in few cases. Long-term follow up after balloon dilatation and the use of intralesional corticosteroids has not been evaluated. OBJECTIVES: To describe the use of endoscopic guided, esophageal balloon dilatation in horses for cervical and thoracic esophageal strictures and administration of intralesional corticosteroids at the time of dilatation. ANIMALS: Nine horses from the hospital population with benign esophageal strictures. METHODS: Retrospective study: Medical records were reviewed from horses presented to the William R. Pritchard, Veterinary Medical Teaching Hospital at UC Davis from 2002 to 2013. Records were searched using the key words: equine, horse, balloon dilatation, bougienage, and esophageal stricture. RESULTS: Nine horses with esophageal strictures were treated with esophageal balloon dilatation. Five horses survived (survival at writing ranged from 2 to 11 years after discharge) and all nonsurvivors were <1 year of age and presented with concurrent problems or developed complications including megaesophagus, unresolved esophageal obstruction requiring esophagostomy, or severe aspiration pneumonia. Four horses were treated with intralesional corticosteroids with no adverse effects noted in the survivors (n = 3). Four horses available for long-term follow up were alive at 2, 5, 6, and 11 years after presentation and 3 of these horses were being fed a hay-based diet. CONCLUSIONS: Resolution of esophageal strictures in the horse can be performed successfully, safely, and under standing sedation using balloon dilatation. Intralesional corticosteroids might reduce the incidence of recurrent strictures.

Recovery of normal esophageal function in a kitten with diffuse megaesophagus and an occult lower esophageal stricture.

An 8-week-old male domestic shorthair was presented to the Internal Medicine Service at North Carolina State University for regurgitation. Radiographic diagnosis of generalized esophageal dilation and failure of esophageal peristalsis were compatible with diagnosis of congenital megaesophagus. Endoscopic examination of the esophagus revealed a fibrous stricture just orad to the lower esophageal sphincter. Conservative management to increase the body condition and size of the kitten consisted of feeding through a gastrostomy tube, during which time the esophagus regained normal peristaltic function, the stricture orifice widened in size and successful balloon dilatation of the stricture was performed. Esophageal endoscopy should be considered to rule out a stricture near the lower esophageal sphincter in kittens with radiographic findings suggestive of congenital megaesophagus. Management of such kittens by means of gastrostomy tube feeding may be associated with a return of normal esophageal motility and widening of the esophageal stricture, and facilitate subsequent success of interventional dilation of the esophageal stricture.

Use of a self-expanding metallic stent to palliate esophageal neoplastic obstruction in a dog.

CASE DESCRIPTION: An 11-year-old spayed female Collie was evaluated because of regurgitation, dysphagia, severe ptyalism, coughing, and weight loss of approximately 12 weeks' duration. Esophageal squamous cell carcinoma had been diagnosed prior to referral on the basis of results of radiographic and endoscopic examination and histologic evaluation of biopsy samples. A percutaneous endoscopically placed gastrostomy (PEG) tube had been inserted 2 weeks prior to referral, and the dog was being treated for infection at the gastrostomy site. CLINICAL FINDINGS: Physical examination findings included marked ptyalism, stertor, and inflammation and discharge at the gastrostomy site. TREATMENT AND OUTCOME: Surgical options were declined by the owner, and palliative treatment was chosen to alleviate clinical signs and facilitate PEG tube removal. With fluoroscopic guidance, a self-expanding metallic stent was placed in the esophageal lumen at the site of obstruction. Botulinum toxin A was injected into the mandibular salivary glands under ultrasonographic guidance as treatment for severe ptyalism. Following discharge, clinical improvement was reported until euthanasia for unrelated disease 12 weeks after stent placement. Necropsy revealed that the stent had not migrated and had remained patent with some tumor ingrowth but no evidence of stricture or obstruction. CLINICAL RELEVANCE: Esophageal stenting effectively treated obstruction and improved clinical signs and may be beneficial for palliative treatment in other animals with malignant esophageal tumors. Although the degree to which botulinum toxin A injection into salivary glands improved clinical signs could not be determined, it may potentially be useful as adjunctive treatment to reduce severe ptyalism.

Thoracoscopic correction of a congenital persistent right aortic arch in a young cat.

A 9-week-old kitten was diagnosed with a congenital vascular ring anomaly by means of an esophageal contrast study. At 6 mo of age, a non-selective vascular study was used to diagnose a persistent right aortic arch (PRAA). Left-sided thoracoscopic surgery was performed, using a Liga-Sure vessel sealant device to seal and transect the ligamentum arteriosum.

A comparative study evaluating the esophageal transit time of eight healthy cats when pilled with the FlavoRx pill glide versus pill delivery treats.

Retention of tablets or capsules in the feline esophagus can be associated with esophagitis and esophageal stricture formation. The objective of this study was to evaluate the esophageal passage of tablets and capsules when administered with either a one-step pill gun with flavored liquid (FlavoRx pill glide) or a pill delivery treat (Pill Pockets). Four different medication administrations were evaluated on different days in eight normal cats: tablets with FlavoRx pill glide (T-FG), tablets with pill delivery treats (T-PP), capsules with FlavoRx pill glide (C-FG) and capsules with pill delivery treats (C-PP). The estimated average transit time was 36s for T-FG, 60s for T-PP, 16s for C-FG, and 24s for C-PP. The results of this study suggest that either pill delivery method is acceptable for successful passage of tablets or capsules into the stomach of cats using a single replicate.

Surgical repair of an oesophageal stricture and prestenotic dilatation in a horse.

Prestenotic oesophageal dilatation and stricture were diagnosed in a horse with a history of trauma in the cervical area and recurrent oesophageal obstruction. The diagnosis was established on the basis of the clinical examination, endoscopy, and positive contrast oesophagography. Conservative treatment was unsuccessful and surgical intervention was necessary. Oesophageal myectomy combined with myoplasty was performed, simultaneously relieving the dilatation and the stricture. No abnormalities were detected 8 weeks after surgery. The horse was on a normal diet and oesophageal obstruction did recur in the subsequent 14 months.

Risk factors and outcome of bougienage for treatment of benign esophageal strictures in dogs and cats: 28 cases (1995-2004).

OBJECTIVE: To determine outcome of bougienage for treatment of benign esophageal stricture (BES) in dogs and cats and identify risk factors for the condition. DESIGN: Retrospective case series. ANIMALS: 20 dogs and 8 cats with BES. PROCEDURES: Medical records were reviewed for information on signalment, clinical features, and outcome. Long-term outcome information was obtained with a questionnaire. RESULTS: Esophageal bougienage was performed with dilators ranging from 5 to 15 mm in diameter; median numbers of bougienage procedures were 3 (dogs) and 4.5 (cats). A good outcome, defined as tolerance of solid food with regurgitation less than once a week, was achieved in 14 dogs and 6 cats. Complications were minimal, with nonfatal esophageal perforation occurring in 1 cat. Four dogs and 1 cat were euthanized or died because of esophageal disease. Dogs with BES were more likely to be female, have a recent history of general anesthesia, have received an antimicrobial orally, or have a history of vomiting than were dogs in a reference population. Cats with BES were more likely to have a recent history of general anesthesia, vomiting, or gastrointestinal tract trichobezoars than were cats in a reference population. Doxycycline-induced esophagitis was the suspected cause of BES in 3 cats. Although general anesthesia was associated with development of BES in 18 dogs and 5 cats, concurrent potential causes of esophageal injury were common. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that esophageal bougienage was a safe and effective treatment for most dogs and cats with BES, with outcomes similar to those reported for balloon dilation.

Esophageal stricture in a cougar (Puma concolor).

A 7-mo-old female cougar (Puma concolor) was presented with a 2-wk history of anorexia and a 1-wk history of regurgitation. Barium contrast esophagogram and gastroesophagoscopy revealed the presence of a segmental intraluminal esophageal stricture in the middle third of the esophagus. The stricture was potentially secondary to a previous anesthetic episode. Three endoscopic balloon dilations allowed increasing the luminal diameter to a size that enabled the cougar to eat food softened with water without any signs of discomfort or regurgitation. Two months after being discharged, the cougar was doing well, had gained weight and was eating horsemeat softened with water.

Delayed primary surgical treatment in a dog with a persistent right aortic arch.

A 5-year-old, 1.36-kg, neutered male Yorkshire terrier was referred for evaluation of a persistent right aortic arch with concurrent megaesophagus. The dog was 3 months old when clinical signs were first noted, 2 years of age when diagnosed with megaesophagus, and 4 years of age when diagnosed with vascular ring anomaly (VRA). Surgical correction of the VRA was performed when the dog was 5 years of age, after gastrostomy tube feeding for 1 year to maintain nutritional requirements and mitigate the degree and duration of the esophageal distention. Thirteen months after surgery, the dog was eating soft dog food with no vomiting or regurgitation.

Recurrent single oesophageal stricture treated with a self-expanding stent in a cat.

A 1-year-old, female spayed domestic shorthair cat was presented with a 4-week history of dysphagia and regurgitation soon after oral treatment with clindamycin. Fluoroscopic and endoscopic examinations confirmed the presence of a single cervical oesophageal stricture 4 cm caudal to the pharynx. A fluoroscopically and endoscopically guided balloon dilation was performed six times consecutively over a period of 3 weeks as reformation of the stricture appeared within 3-7 days. Feeding via percutaneous endoscopic gastrostomy-tube as long-term management of the condition was declined by the owner. A self-expanding metal oesophageal stent with the following dimension was subsequently implanted: fully open diameter 16 mm, length 30 mm. After stent implantation, the cat was fed on mashed canned food and did not show any clinical signs for 12 months. Twelve months post-implantation the cat was no longer able to eat even liquid food, became lethargic and the owner opted for euthanasia. On post-mortem examination the stent surfaces were overgrown by oesophageal mucosa by approximately 50%. Stent obstruction was detected and caused by swallowed hair which also seemed to have hampered mucosal integration in the distal part of the stent.