Definition

Ingestion of foreign material or foodstuffs too large to pass through the esophagus, causing partial or complete luminal obstruction.

Pathophysiology

Esophageal foreign bodies cause mechanical obstruction, mucosal inflammation with edema, and possibly ischemic necrosis and esophageal stricture formation.

Systems Affected

• Gastrointestinal
• Respiratory-if aspiration pneumonia

Genetics

N/A

Incidence/Prevalence

Unknown

Geographic Distribution

N/A

Signalment

Signs

Causes

Occurs most often with an object whose size, shape, or texture does not allow free movement through the esophagus, causing it to become lodged before it can pass.

Risk Factors

N/A

Differential Diagnosis

• Esophagitis
• Esophageal stricture
• Esophageal neoplasia
• Megaesophagus
• Other esophageal disorders

CBC/Biochemistry/Urinalysis

• Usually unremarkable.
• Occasionally, electrolyte abnormalities, an inflammatory leukogram, and/or hemoconcentration, depending upon the severity of signs and degree of dehydration.

Other Laboratory Tests

N/A

Imaging

Diagnostic Procedures

Esophagoscopy affords direct visualization of both the foreign object and the esophageal mucosa, allowing assessment of the extent of esophageal injury. It also allows for visual interrogation of the mucosa for trauma post-foreign body removal.

Pathologic Findings

N/A

Appropriate Health Care

• Emergencies-treat as inpatient and perform endoscopy as soon as possible after diagnosis.
• If endoscopic retrieval of the foreign body succeeds and esophageal damage is minimal, the patient may be discharged the same day.

Nursing Care

• If the procedure to remove the foreign body is atraumatic and the esophagus has sustained minimal damage, no special aftercare is needed.
• Severe mucosal trauma may require placing a gastrostomy tube for enteral nutritional support during esophageal healing. Fluid therapy may also be required to maintain normal hydration status during periods of prolonged esophageal rest.

Activity

The patient may resume normal activity after a foreign body has been routinely removed.

Diet

No change needed other than, perhaps, altering the food to a more liquid consistency.

Client Education

Discuss the possibility of complications and repeat offenders.

Surgical Considerations

• Endoscopic foreign body extraction is much less traumatic and invasive than surgery.
• Surgery is indicated when endoscopy fails to retrieve the foreign body; when endoscopy enables advancement of the object into the gastric lumen but it is too large to pass through the gastrointestinal tract; or when a large esophageal perforation or area of necrosis requires resection.
• It is often less traumatic to advance a bone foreign body into the stomach than to attempt retrieval transorally via endoscopy. Gastrostomy, if required, may then be performed.
• Most bone foreign bodies can be safely left to dissolve in the stomach without need for surgical removal. Non-digestible foreign objects (wood, metal, plastic) passed into the stomach may need to be removed surgically.

Drug(s) Of Choice

• If there is significant mucosal injury (i.e., esophagitis), recommendations include:
  • Sucralfate slurry (0.5–1 g/dog PO q8h) for mucosal cytoprotection and healing.
  • Proton pump inhibitor (omeprazole or pantoprazole at 1 mg/kg q24h) for robust suppression of gastric secretions which may contribute to reflux esophagitis. H₂-receptor antagonists (e.g., ranitidine, 1–2 mg/kg PO, IV, SC q12h, or famotidine, 0.5–1 mg/kg, PO q12h) may be used in animals with less severe esophagitis.
  • Broad-spectrum antibiotics (amoxicillin or Clavamox) may be administered to animals having small mucosal perforations.
  • Metoclopramide (0.2–0.5 mg/kg IV, SC, PO q8h) or cisapride (0.5 mg/kg q8–12h PO) to stimulate gastric motility and minimize reflux esophagitis.
  • Gastrostomy tube placement for enteral nutrition in animals with severe mucosal trauma.
  • Viscous lidocaine gel administered with water and given 2–3 times daily can be used to help reduce esophageal pain if warranted.

Contraindications

N/A

Precautions

N/A

Possible Interactions

N/A

Alternative Drug(s)

N/A

Patient Monitoring

• Examine the esophagus closely via endoscopy for mucosal damage post-foreign body removal.
• Mild erythema/erosions are not uncommon and tend to heal uneventfully.
• If an esophageal laceration/perforation is detected-parenteral nutrition or gastrostomy tube feedings allow esophageal rest and healing.
• Advise post-procedural survey thoracic radiographs to assess for pneumomediastinum/pneumothorax.
• Monitor at least 2–3 weeks for evidence of stricture formation.
• Esophageal stricture-most common clinical sign is regurgitation with evidence of odynophagia in many animals; esophagram or videofluoroscopy and/or esophagoscopy may be indicated to confirm a stricture.

Prevention/Avoidance

Carefully monitor the environment and what is fed to the pet.

Possible Complications

• Approximately 25% of patients with foreign bodies develop complications.
• Complications most frequently encountered include esophageal perforation, esophageal strictures, esophageal fistulas, and severe esophagitis. Focal, transient esophageal motility disturbances can occur secondary to esophageal trauma.
• Pneumomediastinum, pneumothorax, pneumonia, pleuritis, mediastinitis, and bronchoesophageal fistulas can all occur secondarily to perforation.

Expected Course and Prognosis

• Most patients do well and recover uneventfully.
• With complications, the prognosis is guarded.

Associated Conditions

None

Age-Related Factors

N/A

Zoonotic Potential

None

Pregnancy/Fertility/Breeding

N/A

See Also

• Esophageal Diverticula
• Regurgitation

Internet Resources

Veterinary Information Network: www.vin.com/VIN.plx.

Client Education Handout Available Online