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.

Oesophagoscopy can be used to provide a definitive diagnosis of an oesophageal foreign body.

Treatment

Oseophageal foreign bodies should be removed promptly to reduce the incidence of mucosal damage, ulceration and perforation.

Endoscopic removal with grasping forceps is the method of choice for removing foreign bodies unless:

The object is too firmly lodged to pull free, or
Radiographs suggest perforation

Thoracotomy is required in these cases.

If the object too large to be safely removed through the mouth it may be possible to push it into the stomach followed by surgical removal via a gastrotomy.

Treatment post foreign object removal may include:

Oesophageal mucosa should be inspected endoscopically to assess for any damage.
Thoracic radiographs to look for pneumothorax caused by oesophageal perforation.
Antibiotic therapy.
Administration of an H₂ receptor antagonist or proton pump inhibitor.
Prokinetic agents

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