In this section we will feature our most interesting case of the month.
"Kiara"
History: “Kiara” is a 4 month old Yorkshire terrier that presented for gagging and foaming at the mouth. Her owner stated that she had aggressively taken a treat away from the housemate 30-40 minutes prior to the symptoms starting. “Kiara” has no other medical conditions and is current on all vaccinations.
Exam: “Kiara’s” physical exam was all normal except for a small amount of regurgitation and persistent gulping.
Diagnostics: Radiographs (see radiographs at bottom of page) revealed a large foreign body lodged in the proximal esophagus. There was also aerophagia noted in the stomach and small bowel due to the increased swallowing of air.
Diagnosis: Suspected esophageal foreign body
Treatment: After discussing all options, risks and costs with the owners, an IV catheter was placed and “Kiara” was placed under anesthesia. While under anesthesia, the foreign body could be felt by digital palpation but was unable to be removed. Alligator forceps were then placed down the esophagus and the foreign body was successfully removed. “Kiara” was kept in the hospital for approximately one hour for observation after anesthesia. She was then released with resolution of all symptoms.
Discussion: Foreign bodies that lodge in the esophagus should be considered an emergency. The longer the foreign body is entrapped, the greater the chances of esophageal damage and perforation, and the more difficult they become to remove. The most commonly encountered esophageal foreign bodies are bones, rawhide chew toys, dental chews (greenies), fish hooks and hairballs (in cats.)
Signs: The most common clinical signs associated with esophageal foreign bodies are painful swallowing or eating, regurgitation, hypersalivation, anorexia and respiratory signs due to aspiration pneumonia. Clinical signs usually develop quickly. Signs of chronic foreign body obstruction are depression, weight loss, severe esophagitis (inflammation), mucosal lacerations or esophageal stricture.
Diagnosis: Most esophageal foreign bodies are radiodense and are clearly visible on survey radiographs. Other common radiographic findings include soft tissue density surrounding the foreign body and an air filled dilated esophagus cranial to the foreign body. If needed, administration of a contrast agent (barium) can facilitate detection of an obstruction.
Treatment: Treatment of esophageal foreign bodies centers on removal of the foreign body. Endoscopic retrieval is the best method for visualization of the foreign body and its removal. The doctor will determine at that point to either remove the foreign body orally or push it into the stomach. If advanced into the stomach the foreign body will either have to be removed surgically or left to be dissolved by the gastric acid to allow passage without surgery, depending on the type of foreign body.
Prognosis: The overall prognosis is good, but is dependent on the type of foreign body, the duration of time present, and the degree of severity of the esophageal damage. The longer the foreign body is impacted within the esophagus, the harder it is to remove, and the greater the chances of perforation. Large perforations warrant a poor prognosis. Most cases of esophagitis that receive appropriate care will heal without complications.
