Difference between revisions of "Oesophageal Diverticula"

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*No important breed or sex predisposition
 
*No important breed or sex predisposition
 
==Description==  
 
==Description==  
A circumscribed sacculation of the oesophageal wall. These can be divided into congenital or acquired. Congenital diverticula are due to a herniation of the mucosa through a muscularis defect. Acquired diverticula can be subdivided into:
+
A circumscribed sacculation of the oesophageal wall. These can be divided into '''congenital''' or '''acquired'''. Congenital diverticula are due to a herniation of the mucosa through a muscularis defect. Acquired diverticula can be subdivided into:
 
#'''Traction forms''' consists of all the oesophageal layers and results from peri-oesophageal inflammation and fibrosis and develop mainly in the cranial and mid-oesophageal body. Sacculations are created by adhesions to adjacent tissues.
 
#'''Traction forms''' consists of all the oesophageal layers and results from peri-oesophageal inflammation and fibrosis and develop mainly in the cranial and mid-oesophageal body. Sacculations are created by adhesions to adjacent tissues.
 
#'''Pulsion forms''' includes the epithelium and connective tissue and results from:
 
#'''Pulsion forms''' includes the epithelium and connective tissue and results from:
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'''Endoscopy''': will confirm the diagnosis
 
'''Endoscopy''': will confirm the diagnosis
 
==Treatment==
 
==Treatment==
*Small diverticula - managed by feeding bland soft or liquid diets.
+
*'''Small diverticula''' - managed by feeding bland soft or liquid diets.
*Small pulsion diverticula - should be surgically corrected as food impaction may enlarge the diverticula.
+
*'''Small pulsion diverticula''' - should be surgically corrected as food impaction may enlarge the diverticula.
*Larger diverticula - require surgical excision and reconstruction of the wall of the oesophagus.
+
*'''Larger diverticula''' - require surgical excision and reconstruction of the wall of the oesophagus.
 
==Prognosis==
 
==Prognosis==
 
Fair to guarded due to post-op complications of oesophageal hypomotility and oesophageal stricture formation.
 
Fair to guarded due to post-op complications of oesophageal hypomotility and oesophageal stricture formation.
 
==References==
 
==References==
 +
Hall, E.J, Simpson, J.W. and Williams, D.A. (2005) '''BSAVA Manual of Canine and Feline Gastroenterology (2nd Edition)''' ''BSAVA''
 +
 +
Merck & Co (2008) '''The Merck Veterinary Manual'''

Revision as of 11:42, 10 August 2009



Typical Signalment

  • Rare in small animals
  • More common in dogs than cats
  • No important breed or sex predisposition

Description

A circumscribed sacculation of the oesophageal wall. These can be divided into congenital or acquired. Congenital diverticula are due to a herniation of the mucosa through a muscularis defect. Acquired diverticula can be subdivided into:

  1. Traction forms consists of all the oesophageal layers and results from peri-oesophageal inflammation and fibrosis and develop mainly in the cranial and mid-oesophageal body. Sacculations are created by adhesions to adjacent tissues.
  2. Pulsion forms includes the epithelium and connective tissue and results from:
  • an increase in intraluminal oesophageal pressure
  • abnormal local oesophageal motiltiy
  • deep oesophageal inflammation
  • a stenosis interupting normal peristalsis
  • vascular ring abnormalities
  • lodged foreign bodies

Diagnosis

Clinical Signs

usually result from food/fluid impaction in the sacculated area and can present as:

  • regurgitation
  • odynophagia
  • retching
  • postprandial dyspnoea
  • anorexia
  • sepsis if the diverticulum becomes perforated
  • may be subclinical if small

Laboratory Tests

Normal

Diagnostic Imaging

Survey radiography: may show an air/soft tissue density next to or involving the oesophagus

Contrast radiography: will show focal dilation or a partial or complete filling of contrast media in the lumen of the oesophagus.

Endoscopy: will confirm the diagnosis

Treatment

  • Small diverticula - managed by feeding bland soft or liquid diets.
  • Small pulsion diverticula - should be surgically corrected as food impaction may enlarge the diverticula.
  • Larger diverticula - require surgical excision and reconstruction of the wall of the oesophagus.

Prognosis

Fair to guarded due to post-op complications of oesophageal hypomotility and oesophageal stricture formation.

References

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

Merck & Co (2008) The Merck Veterinary Manual