Oesophageal foreign body in a dog

6 Oesophageal foreign body in a dog




Initial presentation


Dysphagia, regurgitation


Signalment: 8-month-old entire male Labrador retriever, body weight 20 kg



Case history


The dog had been regurgitating for about 2 days. He was still interested in eating, but appeared to be uncomfortable when trying to swallow. After swallowing, undigested food was frequently regurgitated, usually within 5 minutes. He was able to swallow water, although occasionally appeared to also regurgitate water. His faeces had been normal, although he had not passed any faeces for 1 day before admission.


Prior to this he had been a healthy puppy, had received his initial course of vaccinations and had been de-wormed twice with fenbendazole. His regular diet was a premium quality puppy food and he was given treats of human food. The owners were suspicious that the dog could have eaten a bone that he scavenged from the rubbish.



Physical examination


At presentation, the dog was quiet but alert. He had a body condition score of 5/9 and was estimated to be about 6% dehydrated. His mucous membranes were pink and slightly tacky; his capillary refill time was about 3 seconds. Halitosis was noted during the oral examination and there was evidence of dried saliva around his mouth. A gag reflex was present, the dog could move his tongue normally and the oral cavity appeared normal.


Thoracic auscultation and abdominal palpation revealed no abnormalities and his lymph nodes were of normal size. His rectal temperature was 38° C, respiratory rate 40 breaths per minute and heart rate was 80 beats per minute.



Problem list and discussion of problems


The dog’s problems were regurgitation and halitosis. The discomfort in trying to swallow appeared to be due to oesophageal dysphagia and was thought to be related to the cause of the regurgitation. There was also evidence of drooling, with the dried saliva present around his mouth. The dehydration was thought to be secondary to his swallowing problems.



Differential diagnosis


Causes of regurgitation include:


• Pharyngeal disorders
• pharyngeal obstructive disorders, such as foreign bodies, tonsillar neoplasia or retropharyngeal lymphadenopathy

• pharyngeal neuromuscular disorders, such as myasthenia gravis, cranial nerve (IX, X) neuropathies, brain stem or cerebellar disorders, cricopharyngeal achalasia, botulism, rabies (although rabies is unlikely in the UK)

• Oesophageal disorders
• oesophagitis

• oesophageal obstructive disorders, such as foreign bodies, stricture, neoplasia, vascular ring anomalies, perioesophageal masses

• oesophageal neuromuscular disorders, such as megaoesophagus or motility disorders

• oesophageal diverticula

• hiatal hernia

Differential diagnoses for halitosis include:


• Diet related cases, such as food remaining in the mouth, pharynx or oesophagus, and coprophagia

• Cheilitis

• Oral cavity or pharyngeal disorders such as foreign bodies or inflammatory lesions

• Nasal cavity or sinus disorders with inflammation or necrosis

• Dental disease

• Oesophageal diseases with food remaining in the oesophagus

• Malassimilation

• Systemic disorders such as uraemia or liver disease

Drooling can be due to excessive saliva production or failure to adequately swallow saliva. Some dogs also drool in anticipation of feeding and some cats while purring. With the concurrent history of regurgitation, the drooling in this dog was thought to be due to a swallowing problem or oesophageal discomfort.



Case work-up


Initial treatment included administration of intravenous crystalloid fluid therapy to correct the estimated 6% dehydration.



Minimum data base


Haematology showed a packed cell volume of 0.516 l/l (reference range 0.39–0.55 l/l). While this is within the reference range, it is higher than expected for a Labrador retriever and the increase was likely due to dehydration. Serum chemistry results, including electrolyte values, were within the reference ranges except for urea which was just above the upper end of the reference range at 8.1 mmol/l (reference range 1.7–7.4 mmol/l). The serum creatinine was within the reference range at 111 µmol/l (reference range 40–132 µmol/l). Elevations in urea can be due to haemoconcentration from dehydration, but can also occur due to renal causes or from bleeding into or from the gastrointestinal tract.


The urine specific gravity of this dog was 1.047, indicating good urine concentrating ability and consistent with dehydration, and as the serum creatinine was not elevated, renal or post-renal causes of the elevated urea were unlikely.



Imaging


Thoracic and abdominal radiographs showed a foreign body of mineral density in the caudal oesophagus at the level of the diaphragmatic hiatus (Figs 6.1 and 6.2) and another foreign body of mineral bone density inside the stomach. There was no evidence of aspiration pneumonia and no evidence of mediastinitis or pneumomediastinum, so the foreign body did not appear to have penetrated the oesophagus.


image

Figs 6.1

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Sep 22, 2016 | Posted by in SMALL ANIMAL | Comments Off on Oesophageal foreign body in a dog

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