Oesophageal Fistula
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Description
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 perforation and, as this heals, a tract is formed with the respiratory system. Causes of the initial insult include foreign bodies, neoplasia and severe oesophagitis. Passage of oesophageal luminal contents into the respiratory system may result in localised pneumonia, pleurisy and pulmonary abscessation.
Signalment
Cairn terriers may develop congenital fistulae but the condition is generally rare in cats and dogs.
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:
- Coughing, especially soon after eating or drinking.
- Dyspnoea
- Signs of (aspiration) pneumonia, including dyspnoea, tachypnoea, pyrexia and coughing.
- Regurgitation,
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