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Compendium July 2007 (Vol 29, No 7)

Abstract Thoughts—Transthoracic Esophagotomy for Foreign Body Retrievals

by Joseph Harari, MS, DVM, DACVS

    Sale CS, Williams JM: Results of transthoracic esophagotomy retrieval of esophageal foreign body obstructions in dogs: 14 cases (2000-2004). JAAHA 42:450-456, 2006.

    Abstract: In this retrospective study from a referral practice in England, the medical records of 14 dogs that had undergone transthoracic esophagotomy for foreign body retrieval were reviewed to determine the associated complications and outcome. The mean age of the variably-sized dogs was 5 years. In 13 cases, the owners had observed ingestion of the foreign body. A lateral thoracic radiograph was diagnostic for the condition, and endoscopy failed to remove or advance the foreign object in all cases. Bones were the most common (11 cases) ingested object.

    Left lateral thoracotomy was performed in all cases--most frequently (eight cases) at the eighth intercostal space. Five dogs had an esophageal perforation. A longitudinal incision was made overlying the foreign body, and the object was removed by gentle manipulation. The esophagus was closed in two layers, and a temporary thoracostomy tube was used to evacuate the chest. Three dogs had pleural effusion, and indwelling tubes were used until the drainage ceased. Postoperative complications (i.e., pyothorax, subcutaneous seroma) were treated and resolved in two dogs. One dog was euthanized at surgery because of pyothorax, mediastinitis, and pleural effusion. The 13 remaining dogs began eating 3 days after surgery, and 11 owners (mean follow-up: 15 months) described their dogs as normal. The authors concluded that surgery was an effective treatment because it provided a 93% recovery rate.

    Commentary: Esophageal foreign body ingestion can cause high morbidity and mortality rates in dogs. Nonsurgical retrievals are often attempted before surgery because of complications historically associated with poor healing of the esophagus and because of the increased use of endoscopy by clinicians. Some surgeons advocate the use of muscular or omental patches to augment single- or double-layer esophageal closures. The results of this study reveal a high recovery rate in surgical patients and minimal complications in cases involving perforation and unsuccessful endoscopic retrieval. It is interesting to note that the authors performed repeat esophagoscopy on the first eight dogs that survived surgery at a mean time of 6.6 days, and all had evidence of healed mucosal incisions.

    NEXT: Canine Pericardial Effusion: Diagnosis, Treatment, and Prognosis

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