[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.

Oesophageal stricture in a cat with true pleuroperitoneal hernia.

A 2-year-old neutered male Bengal cat presented with solid food dysphagia and chronic regurgitation for >5 months. There were no clinical abnormalities on haematological or radiographic examinations. Thoracic radiography revealed a soft tissue opacity mass adjacent to the diaphragm in the caudoventral thorax. Ultrasonography revealed a protruding liver lobe surrounded by a hyperechoic lining from the diaphragm towards the thorax, and a pleuroperitoneal hernia was diagnosed. An endoscopy was performed to examine the cause of regurgitation, and an oesophageal stricture was observed. Endoscopic balloon dilation of the oesophageal stricture was performed, and the regurgitation was resolved immediately. However, regurgitation relapsed 2 months later, and computed tomography was performed to ascertain the cause. Computed tomography revealed oesophageal mural thickening and true pleuroperitoneal hernia with partial liver lobe herniation. A second endoscopy with balloon dilation was performed to treat the relapsing oesophageal stricture, and the clinical signs resolved without the need for herniorrhaphy. Nevertheless, oesophageal stricture could occur due to gastroesophageal reflux related to a pleuroperitoneal hernia; however, a definite link could not be elucidated in this case. This report describes a case of oesophageal stricture and concurrent true pleuroperitoneal hernia in a cat.

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.

Outcome of dogs and cats with benign oesophageal strictures after balloon dilatation or stenting: 27 cases (2002-2019).

OBJECTIVES: Acquired oesophageal strictures remain challenging to manage in canine and feline patients. The aims of this study were to describe the treatment, complications, short-term outcome and long-term follow-up of benign oesophageal strictures treated by balloon dilatation or stenting in dogs and cats and to describe adjunctive techniques to minimise the complication rate of stent placement. MATERIALS AND METHODS: Retrospective analysis of medical records of dogs and cats with benign oesophageal stricture diagnosed under endoscopy between 2002 and 2019. RESULTS: Eighteen dogs and nine cats were included, representing 39 strictures. Balloon dilatation was used as first-line therapy, with a good outcome in 59% of cases. Stents were placed in eight cases due to stricture recurrence; 88% had a long-term satisfactory outcome. Short-term complications occurred in six of eight cases; migration and aberrant mucosal reaction were uncommon. In three cases, progressive mesh cutting during follow-up reduced discomfort and trichobezoars formation and improved long-term stent tolerance. Overall median survival time was 730 days. CLINICAL SIGNIFICANCE: Long-term prognosis of balloon dilatation as a first-line therapy for esophageal strictures and of stenting as a rescue therapy was considered satisfactory. Although discomfort associated with stenting was frequent, tolerability might be improved by per-endoscopic adjunctive techniques.

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.

Videofluoroscopy, CT angiography, and ultrasonography of congenital esophageal stenosis in a Labrador retriever.

A 7-week-old Labrador retriever presented for further investigation into acute onset regurgitation, following weaning from liquid to solid food. A videofluoroscopic swallow study demonstrated a severe, focal esophageal dilation in the mid-cervical region, with marked luminal narrowing distally. Computed tomography with angiography revealed esophageal stenosis, extending from C4-T2, secondary to circumferential esophageal wall thickening. With the concern for development of secondary aspiration pneumonia, the owners elected to euthanize the dog and consented to postmortem examination. A diagnosis of segmental, cervical esophageal muscular hypertrophy was made on necropsy, consistent with the fibromuscular thickening type of congenital esophageal stenosis reported in humans.

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.

BENIGN IDIOPATHIC ESOPHAGEAL STRICTURE IN A LION ( PANTHERA LEO): DILATION BY AN ACHALASIA BALLOON.

A 1-yr old female lion ( Panthera leo) was referred with a 10-mo history of dysphagia for solid food (meat), episodic regurgitation, and poor weight gain. Esophagoscopy confirmed an esophagitis (midesophagus) and a stricture estimated to be of 13 mm diameter. This was subsequently dilated using a 20-mm-diameter balloon for 2 min followed by a 35-mm achalasia balloon for 3 min. The etiology remains undetermined in spite of a thorough history. The animal progressed satisfactorily, reaching 124 kg after 1 yr and has had no further signs. To the authors' knowledge, neither idiopathic esophageal stricture nor dilation using an achalasia balloon has been reported in Panthera spp.

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.

Aberrant Left Subclavian Artery in a Beagle Puppy With a Persistent Right Aortic Arch. Use of Cone Beam Computed Tomography to Diagnose a Vascular Ring Anomaly.

A 7-week-old, 1.045kg female beagle dog was referred to investigate a supposed vascular ring anomaly. Cone beam computed tomography with contrast enhanced arterial phase accomplished by a rapid manual intravenous injection of iodinated agent during the scanning process revealed a persistent right aortic arch and an aberrant left subclavian artery that compressed dorsally the esophagus in the cranial mediastinum. Third left intercostal thoracotomy was performed to transect the left subclavian artery. This is the first description of a vascular ring anomaly that was diagnosed with a cone beam computed tomography in veterinary medicine.

Diagnosis and treatment of esophageal foreign body or stricture in three ferrets (Mustela putorius furo).

CASE DESCRIPTION 3 ferrets (Mustela putorius furo), aged 1 to 2 years, were referred for evaluation of a 4-day to 2-week history of gastrointestinal signs, including anorexia, regurgitation, and vomiting. CLINICAL FINDINGS All 3 ferrets had clinical signs suggestive of dysphagia or esophagitis on initial examination. Esophagoscopy, barium-contrast esophagography, or both revealed foreign bodies with mucosal inflammation in 1 patient and an esophageal foreign body with stricture in 2 patients. One of the latter ferrets had a recent history of gastrotomy to remove a foreign body. TREATMENT AND OUTCOME 1 ferret was treated with endoscopic retrieval of the foreign bodies. Esophageal stricture was treated in 2 ferrets by means of endoscopic balloon dilation accompanied by placement of an esophageal stent in 1 ferret. After resolution of clinical signs and completion of all prescribed treatments, 2 of 3 ferrets successfully transitioned to a regular hard kibble diet; 1 ferret remained on a soft diet for 2 years. All owners were satisfied with the outcome of treatment. CLINICAL RELEVANCE Ferrets are prone to foreign body ingestion. Results of this small series of cases suggested that minimally invasive techniques may be useful for the management of esophageal disease in this species.

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.

Esophageal stenting for treatment of refractory benign esophageal strictures in dogs.

BACKGROUND: Benign esophageal strictures can recur despite multiple dilatation procedures and palliative management can be challenging. OBJECTIVE: To describe the technique and determine the outcome of esophageal stenting for treatment of refractory benign esophageal strictures (RBES) in dogs. ANIMALS: Nine dogs with RBES. METHODS: Retrospective review of records for dogs with RBES. Indwelling intraluminal esophageal stents were placed transorally with endoscopy, fluoroscopic guidance, or both. Follow-up information was obtained via medical record or telephone interview. RESULTS: Nine dogs had 10 stents placed including biodegradable stents (BDS) (6/10), self-expanding metallic stents (SEMS) (3/10), and a self-expanding plastic stent (SEPS) (1/10). All dogs had short-term improved dysphagia. Complications included ptyalism, apparent nausea, gagging, vomiting, or regurgitation (8/9), confirmed recurrence of stricture (6/9), stent migration (3/9), stent shortening (1/9), megaesophagus (1/9), incisional infection (1/9), and tracheal-esophageal fistula (1/9). Eight of 9 dogs required intervention because of the complications of which 4 of 8 dogs were eventually euthanized because of stent-related issues. One dog was lost to follow-up examination. CONCLUSIONS AND CLINICAL IMPORTANCE: Findings suggest that esophageal stent placement was safe and technically effective, but unpredictably tolerated in dogs with RBES. If a stent is placed, dogs should be monitored carefully for stent migration, dissolution of absorbable stents, and recurrence of strictures.