Oesophageal Foreign Body

Typical Signalment

• Any age group can be affected
• Can occur in cats or dogs
• Dogs more commonly affected due to their less discriminating eating habits

Description

Almost anything can become lodged in the oesophagus. Objects with sharp points are very common and include:

• bones
• fish hooks
• needles
• sticks
• toys

The most common foreign bodies found in dogs are bones, bone fragments and coins. In cats play objects are most common. Many forign objects are regurgitated or are transported through the gastrointestinal tract. Those that are too large to pass through the oesophagus remain lodged causing mechanical obstruction.

Common sites of obstruction:

• thoracic inlet
• base of the heart
• immediately in front of the diaphragm

The severity of oesophageal damage is dependent on the size, angularity or sharp pointedness of the foreign body as well as the duration of obstruction.

Diagnosis

Clinical Signs

include:

• history of foreign body ingestion
• regurgitation (acute onset)
• retching
• salivation
• odynophagia
• dysphagia
• ptyalism
• anorexia
• tachypnoea

Diagnostic Imaging

Palpation of the cervical oesophagus can occasionally reveal a foreign body but a definitive diagnosis usually requires radiography. Plain thoracic radiographs reveal oesophageal foreign bodies that are radiodense. Poultry bones or other items that are less radiodense may be more difficult to visualise. It is important to look for signs of oesophageal perforation such as pneumothorax, pleural effusion and fluid in the mediastinum. Contrast radiography is rarely necessary but may be used to identify radiolucent foreign objects Contrast agents must be used with caution if there is suspicion of oesophageal perforation.

The oesophagus is generally normal on routine survey radiographs. Signs of aspiration pneumonia may be seen in ventral lung lobes. It can be better differentiated using barium-contrast studies which may show:

• an irregular mucosal surface
• narrowing
• a dilated oesophagus
• oesophageal hypomotility

To better diagnose oesophagitis, endoscopy with biopsies can be used. Severe oesophagitis will be seen with an oedematous mucosa that is hyperaemic, ulcerated and actively bleeding, whilst less severe cases may require several mucosal biopsies to diagnose the condition.

Treatment

Mild oesophagitis:

• withdraw oral food for 2-3 days and manage as an outpatient.

More severe oesophagitis:

• may need admitting to the hospital, Nil Per Os and animal may require enteral or parenteral nutritional support.

Drugs:

• oral sucralfate suspension
• gastric acid secretory inhibitors (e.g. ranitidine, omeprazole) can be useful in cases of gastro-oesophageal reflux
• broad spectrum antibiotics in animals with sever oesophagitis or aspiration pneumonia
• analgesics

Prognosis

Mild oesophagitis has a good prognosis whereas ulcerative oesophagitis and animals suffering from aspiration pneumonia have a more guarded prognosis.

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