Oesophageal Fistula

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