Difference between revisions of "Oesophageal Fistula"

Revision as of 11:35, 28 June 2010

Typical Signalment

Cairn Terrier for congenital fistula
Rarely seen in cats and dogs

Description

An abnormal connection between the oesophageal lumen and surrounding structures most commonly involving the lungs or other respiratory structures. Can be congenital (rare) or acquired. With congenital fistulae, the animals usually have oesophageal foreign bodies. Acquired oesophageal fistulae usually result from foreign bodies (usually bones and grass seeds) leading to lumen perforation and inflammation spreading into adjacent tissues. Secondary complications include:

localized pneumonia
pleuritis
pulmonary abscessation

Diagnosis

Clinical Signs

Congenital fistulae develop signs post weaning
Acquired fistulae develop in later life
Coughing
Dyspnoea
Regurgitation
Lethargy
Anorexia
Fever
Weight loss

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.

Contrast radiography: can provide definitive diagnosis using a barium sulphate oesophogram. Avoid iodinated contrast agenst as they are irritants to the lungs.

Endoscopy: also allows definitive diagnosis if the fistula is large enough to be visualised.

Treatment

Surgical excision and repair. A partial or complete lung lobectomy of the affected lobe is advocated.
Postoperative broad spectrum antibiotics

Prognosis

Guarded in the presence of secondary complications otherwise good.

References

Hall, E.J, Simpson, J.W. and Williams, D.A. (2005) BSAVA Manual of Canine and Feline Gastroenterology (2nd Edition) BSAVA

@@ Line 1: / Line 1: @@
-{{OpenPagesTop}}
+{{review}}
-Also known as: '''''Oesophago-tracheal fistula — Oesophago-bronchial fistula — Broncho-oesophageal fistula — Oesophago-pulmonary fistula
-==Introduction==
+{{cat}}
-An oesophageal fistula is an abnormal connection between the oesophageal lumen and a structure in its immediate vicinity, most commonly the lungs or other respiratory structures (producing a '''bronocho-oesophageal fistula'''). In rare cases, fistulae may be congenital but they are usually acquired phenomena.  Acquired oesophageal fistulae occur when severe inflammation or disruption of the oesophageal wall leads to [[Rupture of the Oesophagus|perforation]] and, as this heals, a tract is formed with the respiratory system.  Causes of the initial insult include [[Oesophageal Foreign Body|foreign bodies]], [[Oesophageal Neoplasia|neoplasia]] and severe [[Oesophagitis|oesophagitis]].  Passage of oesophageal luminal contents into the respiratory system may result in localised pneumonia, pleurisy and pulmonary abscessation.
+{{dog}}
-==Signalment==
+==Typical Signalment==
-Cairn terriers may develop congenital fistulae but the condition is generally rare in cats and dogs.
+*Cairn Terrier for congenital fistula
+*Rarely seen in cats and dogs
+==Description==
+An abnormal connection between the oesophageal lumen and surrounding structures most commonly involving the lungs or other respiratory structures. Can be congenital (rare) or acquired. With congenital fistulae, the animals usually have oesophageal foreign bodies. Acquired oesophageal fistulae usually result from foreign bodies (usually bones and grass seeds) leading to lumen perforation and inflammation spreading into adjacent tissues. Secondary complications include:
+*localized pneumonia
+*pleuritis
+*pulmonary abscessation
 ==Diagnosis==
 ===Clinical Signs===
-Clinical signs associated with congenital fistulae tend to develop after weaning as solid food is more likely to lodge in the fistula and, depending on the food, it may have a higher microbial load than milk.  Acquired fistulae tend to develop later in life and are associated with an injury to the oesophagus.  Clinical signs are usually associated with the respiratory system and gastro-intestinal signs are actually rare:
+*Congenital fistulae develop signs post weaning
-*'''Coughing''', especially soon after eating or drinking.
+*Acquired fistulae develop in later life
-*'''Dyspnoea'''
+*Coughing
-*Signs of '''(aspiration) pneumonia''', including dyspnoea, tachypnoea, pyrexia and coughing.
+*Dyspnoea
-*Signs of systemic illness, such as '''anorexia, lethargy and weight loss''' may occur due to severe chronic respiratory disease.
+*Regurgitation
-*'''Regurgitation''' occurs relatively uncommonly and may be associated with the initial cause of the inflammation, such as a foreign body.
+*Lethargy
+*Anorexia
+*Fever
+*Weight loss
 ===Diagnostic Imaging===
-'''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.
+'''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.
-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]].
-'''Endoscopy''' (oesophagoscopy) can also be used to provide a definitive diagnosis if the fistula is large enough to be visualised.
+'''Contrast radiography''': can provide definitive diagnosis using a barium sulphate oesophogram. '''Avoid iodinated contrast agenst as they are irritants to the lungs.'''
+'''Endoscopy''': also allows definitive diagnosis if the fistula is large enough to be visualised.
 ==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 Body#Treatment|oesophageal foreign bodies should be removed]].
+*Surgical excision and repair. A partial or complete lung lobectomy of the affected lobe is advocated.
+*Postoperative broad spectrum antibiotics
-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==
-If surgical removal is successful, the prognosis is very good.  If post-operative complications develop, the prognosis is guarded.
+Guarded in the presence of secondary complications otherwise good.
-{{Learning
-|Vetstream = [https://www.vetstream.com/canis/Content/Disease/dis00641.asp, Oesophagobronchial fistula]
-|literature search = [http://www.cabdirect.org/search.html?q=%28title%3A%28oesophag*%29+OR+title%3A%28esophag*%29+OR+title%3A%28tracheoesopageal%29+OR+title%3A%28bronchoesophageal%29%29+AND+title%3A%28fistula%29 Oesophageal Fistula publications]
-}}
 ==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''
+[[Category:Oesophagus_-_Pathology]][[Category:To_Do_-_Clinical]]
-{{review}}
-{{OpenPages}}
-[[Category:Oesophagus_-_Pathology]]
-[[Category:Oesophageal Diseases - Cat]][[Category:Oesophageal Diseases - Dog]]
-[[Category:Expert_Review]]