Esophageal Foreign Bodies


Key Points

Common foreign bodies that dogs ingest are bones, rawhides, and toys

An endoscope and forceps are generally used to remove an esophageal foreign body

If endoscopy is not successful to remove the foreign object, surgery is needed

Early treatment typically results in a better prognosis

 

Anatomy

  • The esophagus is a muscular tube that extends from the back of the throat to the stomach.
  • The esophagus passes down the entire length of the neck and the chest.
  • The esophagus has the ability to propel food and water down to the stomach.

 

Esophageal foreign bodies

  • Common foreign bodies that dogs ingest are bones, rawhides, and toys.
  • There are 3 main regions that the foreign bodies can get stuck in the esophagus:
    • Lower neck at the inlet to the chest cavity
    • Base of the heart
    • At the level of the diaphragm
    • At these locations the esophagus is somewhat narrower than other regions due to structures surrounding the esophagus.

 

Clinical Signs of esophageal foreign bodies

  • Drooling
  • Regurgitation
  • Pawing at face
  • Anorexia
  • Depression and Fever in some cases

 

Removal of esophageal foreign bodies

  • An endoscope and forceps are generally used to remove an esophageal foreign body. Most esophageal foreign bodies can be removed using this technique. If the foreign body has sharp spikes, as is found with a bone, it will become lodged.
  • In the event that the foreign body cannot be removed with the aide of an endoscope, surgery is needed.
  • Surgery should be done as soon as possible, as the longer the object is stuck in the esophagus, the more damage that will be done to the esophagus.
  • In order to remove the foreign object, it must be surgically approached.
    • If the object is in the lower neck, then a midline incision is made on the bottom of the neck.
    • If the object is lodged at the base of the heart the chest is opened on the right side.
    • If the object is located just in front of the diaphragm the left or right side of the chest is opened. An alternative to opening the chest is to open the abdomen along the mid-line and remove the object by pulling it into the stomach.
    • Below is a radiograph of a dog (patient is laying on his side and most of the chest and half of the abdominal cavity can be seen) that has a foreign body (labeled FB) in the esophagus; the foreign body was a bone and the stomach was also filled with bones that the dog has eaten.

 

Potential complications

  • As with any surgery, complications may arise. Even though rare, anesthetic death can occur. With the use of modern anesthetic protocols and extensive monitoring devices (blood pressure, EKG, pulse oxymetry, inspiratory and expiratory carbon dioxide levels, and respiration rate), the risk of problems with anesthesia is minimal.
  • Infection is a potential complication as an incision is made into a dirty esophagus. Antibiotics will be given to your pet at the time of surgery and in the postoperative period to help prevent against infection. If this problem is to occur, clinical signs usually become evident 2 to 5 days after surgery. Emergency surgery is needed if this occurs.
  • Esophagitis or very bad heartburn can occur and the clinical sign is regurgitation of food or fluids.
  • Seroma formation or fluid accumulation under the skin incision although uncommon can also occur. This problem in general will resolve with time. Occasionally the seroma or fluid that has build up may require draining.
  • Stricture or scaring of the esophagus so that food cannot pass down it can occur. The risk of stricture formation is dependant on amount of esophageal damage caused by the foreign body. Regurgitation is the main clinical sign. If this occurs, a special balloon catheter is used to dilate the esophagus.

 


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