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{|cellpadding="10" cellspacing="0" border="1"
| Also known as:
| Oesophago-tracheal fistula
| Oesophago-bronchial or broncho-oesophageal fistula
| Oesophago-pulmonary fistula
|}
==Description==
==Description==
*'''Dyspnoea'''
*'''Dyspnoea'''
*Signs of '''(aspiration) pneumonia''', including dyspnoea, tachypnoea, pyrexia and coughing.
*Signs of '''(aspiration) pneumonia''', including dyspnoea, tachypnoea, pyrexia and coughing.
*'''Regurgitation''',
*Signs of systemic illness, such as '''anorexia, lethargy and weight loss''' may occur due to severe chronic respiratory disease.
*'''Regurgitation''' occurs relatively uncommonly and may be associated with the initial cause of the inflammation, such as a foreign body.
===Diagnostic Imaging===
===Diagnostic Imaging===
'''Survey radiography''': localized lung patterns (alveolar, bronchial and/or interstitial) mainly in right caudal, right intermediate and left caudal lung lobes. The oesophagus appears normal unless a foreign body can be observed.
'''Plain radiographs of the chest''' may show localised areas with particular lung patterns (mainly alveolar with pneumonia but also bronchial and/or interstitial), mainly in the right caudal, right intermediate and left caudal lung lobes. The oesophagus usually appears normal unless a foreign body is visible as a radio-opaque mass within the lumen.
Administration of a '''positive contrast medium''' may be used to define the fistula and provide a definitive diagnosis. However, if barium is used, granulomas may form in the mediastinum or lungs whereas water soluble iodine-containing agents are irritant to the pulmonary parenchyma and may cause [[Pulmonary Oedema]].
'''Contrast radiography''': can provide definitive diagnosis using a barium sulphate oesophogram. '''Avoid iodinated contrast agenst as they are irritants to the lungs.'''
'''Endoscopy''' (oesophagoscopy) can also be used to provide a definitive diagnosis if the fistula is large enough to be visualised.
==Treatment==
==Treatment==
Surgical repair of the fistula is required to prevent continued leakage of ingesta into the respiratory tract or mediastinum. An oesophagotomy incision is made to excise the fistula and the defect in the wall is then closed in a longitudinal orientation to reduce the risk of stricture formation. If one or more lobes of the lung are severely consolidated due to the presence of ingested material, these may be removed in a complete lobectomy. Any oesophageal foreign bodies should be removed as described [[Oesophageal Foreign Body|here]].
Post-operatively, food should be withheld for 24-48 hours and the animal should receive only soft food thereafter. Sucralfate can be used to reduce any residual oesophagitis or ulceration and the patient should receive a full (4-6 week) course of antibiotics to clear any remaining respiratory infection. The choice of antibiotic should ideally be guided by culture of pulmonary fluid obtained during a lobectomy, if this is performed.
Possible complications include dehiscence of the surgical site, continued respiratory infection and persistent [[Megaoesophagus|megaoesophagus]] if the fistula was left untreated for a prolonged period.
==Prognosis==
==Prognosis==
If surgical removal is successful, the prognosis is very good. If post-operative complications develop, the prognosis is guarded.
==References==
==References==
Ettinger, S.J, Feldman, E.C. (2005) '''Textbook of Veterinary Internal Medicine''' (6th edition, volume 2)
Hall, E.J, Simpson, J.W. and Williams, D.A. (2005) '''BSAVA Manual of Canine and Feline Gastroenterology (2nd Edition)''' ''BSAVA''
Hall, E.J, Simpson, J.W. and Williams, D.A. (2005) '''BSAVA Manual of Canine and Feline Gastroenterology (2nd Edition)''' ''BSAVA''
[[Category:Oesophagus_-_Pathology]]
[[Category:Oesophagus_-_Pathology]]
[[Category:To_Do_-_James]]
[[Category:To_Do_-_James]]
[[Category:Cat]][[Category:Dog]]