AFFECTIONS OF OESOPHAGUS

Dr.K.Jagan Mohan Reddy

Assistant Professor
Department of Surgery & Radiology, College of Veterinary
Science
Rajendranagar, Hyderabad
 Terminology
• Regurgitation:
• Vomiting:
• Dysphagia
• Ptyalism
 Terminology
• Regurgitation: is a passive expulsion of
undigested food or fluid from the pharynx or
esophagus
• Vomiting: is a centrally mediated reflex that
causes expulsion of food from the stomach or
intestine or both
• Dysphagia: difficulty in swallowing food or
liquids
• Ptyalism: Excessive salivation
 CHOKING: OBSTRUCTION OF OESOPHAGUS
• Seat of obstruction
• All animals: Just behind the pharynx and first pair
of ribs (common seat of obstruction)
• Horse: Inferior third of oesophagus (funnel
shaped), being normally constricted.
• Ox & dog: Lower part of cervical region due to its
compression between the thoracic inlet and the
 first rib.
• Cattle : the lumen of the oesophagus is narrower
at its anterior end (trumpet shaped) therefore
post pharyngeal obstruction is cattle is common.
 CHOKING: OBSTRUCTION OF OESOPHAGUS
Chocking objects
• Horse: Carrot, turnip, potato, piece of wood,
extracted tooth and broken balling gun
swallowed accidentally,
• Ox: Turnip, potato, apple, palm or mango
kernel.
• Dog and Cat: Bone or cartilage, (fixation is due
to sharp points) swallowing of foreign bodies
while playing.
 CHOKING: OBSTRUCTION OF OESOPHAGUS
• Symptoms 
• Cessation of feeding.
• Food swallowed may return partly through the nostrils
• Anxious expression and restlessness.
• Makes frequent  gulping movements
• Frequent attempts at vomiting (arches the neck, bring the muzzle towards the
chest).
• Salivation when the obstruction in near the pharynx.
• Cough due to pressure on trachea,
• Difficulty in breathing
• Tympany/bloat in large animals
• swelling / bulging of the esophagus at the cervical region in cervical obstruction
• In cattle important symptoms are lowering of the head and salivation.
• In dog anxious expression appears on the face. Salivation and attempts to
vomiting are characteristic.
• In horse arching of the neck as though attempt to vomit.
 CHOKING: OBSTRUCTION OF OESOPHAGUS
• Diagnosis
• Stomach tube or probang
• If obstruction is partial, the animal able to
drink water but there is difficulty in taking
solid food. Partial obstruction is common in
dog and diagnosed by meat ball test
• The obstruction is confirmed by
radiography., contrast radiography
 CHOKING: OBSTRUCTION OF OESOPHAGUS
• Treatment
• Medical management emetic
• Inject pilocarpine, eserine or arecoline in order to
stimulate peristaltic movement.
• In dog , cat and pigs apomorphine may be given
S/C to induce vomiting.
• Passing the probang to push the foreign body into
the stomach.
• Surgical treatment: Oesophagotomy
• Cervical oesophagotomy
• Thoracic oesophagotomy
 Oesophagatomy (Bovines)
• Indications:
• Oesophageal obstruction
• Anaesthesia and control
• Local infiltration, standing or recumbent
• Anatomy: Lateral to the oesophagus are the carotid
sheath containing the internal jugular vein , carotid artery
and the common trunk of vago-sympathetic and the
sternosuboccipitalis part of sterno cephalicus muscle
• Ventromedially the oesophagus is related to the trachea
and the recurrent laryngeal nerve.
• Dorsally the oesphagus is related to the longus colli
muscle.
 Oesophagatomy
• Blood supply to the oesophagus:
• Branches of the carotid and brancheo-oesophageal
arteries for cervical segment. Short branches of gastric
artery towards the terminal segment. Delicate
branches from intercostal arteries in the thoracic
segment run cirumferentially to supply the
oesophgagus.
• Site of operation:
• On the left side of the neck, along the superior border
of jugular furro, close to the level of obstruction.
 Oesophagatomy
• Technique:
• An incision about 2 inches long is made along the superior
border of jugular furrow cutting through the skin and cervical
cutaneous fascia.
• The jugular vein is retracted by separating it from the brancheo-
cephalicus muscle: to encounter the sterno sub-occipitals which is
pushed downwards, and by blunt dissection the oesophagus lying
adjacent to the trachea can be located.
• The oesophagus is recognised by its characteristic pink colour. The
wall of the oesophagus is incised longitudinally over the desired
length to get into the lumen and the obstruction is relived.
• The mucous membrane is sutured by interrupted apposition
sutures and the outer coat is sutured by interrupted or continuous
apposition sutures .
 AFFECTIONS OF OESOPHAGUS IN SMALL ANIMALS
• Esophageal obstruction – Foreign Bodies
• The most common cause for esophageal obstruction is ingestion of
foreign bodies. Various objects may lodge and produce partial or
complete obstruction in esophagus. The most common foreign body
is bones.
• Others include needle, wooden sticks, rubber toys, plastics and
coins. Cats are more predisposed to ingesting fishhooks and
needles. The ingested foreign bodies become lodged in the cervical
constriction, bronchoaortic constriction, diaphragmatic constriction
and thoracic inlet.
• Most of the foreign bodies produce acute clinical signs because of
either complete obstruction or severe, painful, partial obstruction.
• Longer the duration of large, sharp foreign body, obstruction is more
prone to serious complications.
• Surgical management is indicated when the conservative treatment
fails.
• Thoracic esophagotomy is more complicated than cervical
esophagotomy. If the object is located caudal to the base of the
heart, the foreign body can be removed via an abdominal gastrotomy.
• If possible the foreign body may be crushed into small pieces to help
easy removal. Alternative method is to perform the gastrotomy via a
thoracic, transdiaphragmatic approach. Left sided 8th intercostal
thoracotomy is performed, the lungs are packed off , the diaphragm
is incised to expose the greater curvature of stomach. Spillage of the
gastric content in the thoracic cavity is the important complications in
thoracotomy. 
• Difficulty in swallowing ,regurgitation, gulping, excessive salivation
and inappetance  ( cats) are the acute clinical signs. Chronic signs are
Cervical swelling ,primary malnutrition and aspiration pneumonia.
• Pre operative management of patients with esophageal
disorders correct fluid electrolyte and acid base imbalance
• Prophylactic antibiotics for esophagitis
• Surgical management
• Anesthetic considerations
• Non surgical method may be attempted first.
• If the object has perforated and cannot be removed, surgery can
be used to cut off the extraluminal foreign objects while the
intraluminal foreign body can be recovered with the endoscope.
• If the foreign body is a bone it may be  pushed into the stomach
rather than removed by orally. Most of the bones are quickly
digested in the gastric acids and excreted within 10 days in the
faeces. If the signs develop that may indicate the surgical
removal of the remaining bones.
 ESOPHAGEAL STRICTURES
• Acquired esophageal stricture caused by any damage
to the mucous membrane that produces injury by
foreign body, sequle to previous esophagotomy,
external compression of the lumen by the presence of
parasitic tumour ( spirocerca nodule) , Compression
of the esophagus by tumours, abscess ( extra
esophageal mass ) Congenital esophageal stricture is
rare in dogs.
• Surgical management is more complicated in this
case. If treatment is aimed at resection and
anastomosis , surgeon may inadvertently leave
behind damaged tissue, which leads to reformation of
the stricture.
 ESOPHAGEAL STRICTURES
• The resected esophagus length is more, the
anastomosis may fail due to tension between
anastomosis part. In that situation, patch
grafting, muscle interposition graft, circular
myotomies, suture line reinforcement or
segmental replacement can be use as an
alternative techniques.
• The best treatment is mechanical dilation and
pharmacological intervention with agents that
reduce fibroplasia and collagen cross-linking.
 VASCULAR RING ANOMALIES
• This is the most common cause of extra luminal esophageal
obstruction in dogs and cats. Due to this kind of chronic
partial obstruction, which causes serious complications
include proximal dilation, loss of motility in the dilated
segment, ulcerative esophagitis, cachexia and aspiration
pneumonia.
• Vascular ring anomalies are the result of abnormal
development of definitive vascular structures derived from
embryonic aortic arches.
• Clinical signs result from partial or complete entrapment of
the esophagus between the base of the heart and the
affending vessels. Mechanical obstruction is produced by
vascular ring itself but concurrent fibrosis of the underlying
esophageal wall develops.
 VASCULAR RING ANOMALIES
• Most common vascular ring anomaly in dog and cats results from
persistence of the right fourth aortic arch as the definitive aorta.
Stenosis of the esophagus occurs due to ductus arteriosus.
• Affected animals are considered normal until weaning. Liquids
bypass the esophageal obstruction without difficulty. As an
animal ingests solid foods, postparandial regurgitation occurs.
Megaesophagus develops early in the disease.
• Diagnosis of vascular ring anomalies is based on history, physical
examination, radiography and endoscopy. Megaesophagus may
be diagnosed on physical examination by observing and palpating
a bulge in the ventral cervical and thoracic inlet after swallowing.
• Treatment is surgical, requiring division of the appropriate
portion of the ring to relieve esophageal stenosis.
 PERIOESOPHAGIAL MASSES
• Mechanical obstruction of esophagus may occur
secondary to lesions in surrounding tissues.
Esophageal dysfunction in cervical region caused
by thyroid carcinoma, laryngeal carcinoma, salivary
gland neoplasms, squamous cell carcinoma and
metastatic tonsillar carcinoma in cervical
lymphnodes.
• Abscess and granulomas may also cause this. In
the thoracic inlet, cranial mediastinum and
thoracic cavity other lesions including thymomas,
lymphomas, large lung tumors, abscesses, and
granulomas may occur.
 PERIOESOPHAGIAL MASSES
• Clinical signs of partial obstruction includes regurgitation,
salivation, discomfort, dysphagia, cough and dyspnea if
aspiration occurs. Infiltration through the esophageal
wall can be determined by endoscopy preoperatively.
• Neuromuscular diseases
• Mechanical obstruction of the esophagus and propulsion
of ingesta into the stomach results from inherent
disorders of esophageal function.
• Most of this conditions managed by medically but
surgery is necessary in some cases.
 MEGAESOPHAGUS
• Megaesophagus can develop cranial to the
mechanical obstruction.
• Generalized megaesophagus can result from
affections of vagus,metabolic diseases like
hypoadrenocorticism, hypothyroidism and
immunological diseases like myasthenia gravis,
polymyositis, and certain drugs such as
anticholinergics, general anesthetics ,  and idiopathic
disorders. These are managed well by medically and
feeding in upright position than surgically.
• Other disorders like cricopharyngeal achalasia and
gastroesophageal achalasia also occurs.
 ESOPHAGEAL DIVERTICULUM

• Focal out pouching of the esophageal wall is called

diverticulum. This may be congenital or acquired but
not common in small animals.
• Congenital diverticulum results from inherent
weakness of the esophageal wall, failure of the
primordial foregut and pulmonary buds to separate or
eccentric vacuole formation in the esophagus.
• Acquired diverticula are two types. Depending on
their cause and histological appearance they are called
as pulsion diverticulum or traction diverticulum.
 Pulsion diverticulum
• This is an outpouching of mucosa through a defect or tear in the overlying
muscularis. This is otherwise called as false diverticulum because not all
layers of the esophagus are represented in the protruding sac. This will
develop after focal pathological pressure applied to esophageal wall from
within the lumen. It may also result from regional abnormalities in peristalsis
in association with obstruction.
• The most common site of diverticula is just proximal to diaphragm.
Dysphagia, regurgitation, gagging, gulping weight loss and respiratory signs
are usual clinical signs. Contrast radiography and endoscopy are effective
diagnostic methods.
• The diverticula may be large and sometimes multiple and often impacted
with ingesta. Small diverticulum may be managed conservatively by diet
modification and upright feedings. If the diverticulum is too large, resection
of the diverticulum is indicated.
• The diverticulum is single and focal, simple excision of the sac with two layer
repair of the esophageal wall is sufficient. For large and multiple diverticula,
resection and anastomosis or hemicircumferential wall resection and
reconstruction is required.
 Traction diverticulum
• This is otherwise called as true diverticulum, which
is composed of all layers of the esophageal wall.
• They termed “traction” because of their presumed
pathogenesis, involving the adhesion and
contraction of fibrous band to esophageal wall
results in outpouching.
• The causes are local inflammation outside the
esophagus which includes disease processes
involving the trachea, lungs, hilar lymph nodes and
pericardium.
 Esophageal perforation and laceration

• This may occur from inside or outside the

esophagus. Bite wounds, gunshot wounds
lacerations due to vehicle injuries may result in
perforation or laceration of esophagus. Also results
from ingestion of sharp foreign bodies with or
without signs of obstruction.
• Clinical signs depend on the location, extent and
duration of the perforation and associated leakage.
• The inflammation, hypoxia and necrosis in local
tissues may predispose to massive infection. Saliva,
ingesta and microorganisms may leak from the
esophagus which causes local cellulitis and abscess.
 Esophageal perforation and laceration

• The perforation confirmed with esophagoscopy or

contrast esophagography. Conservative management
includes antibiotics, with holding of food and water
for several days and maintenance of hydration and
electrolyte balance.
• In leakage, the perforation is exposed and the
esophagus repaired primarily. If the wound is
unhealthy, and they are debrided and a two-layer
closure technique can be used. If the wound is
chronically infected, a reinforcing technique is used.
Postoperative care includes 3 to 5 days of esophageal
rest, using parenteral or gastric alimentation.
 Esophageal fistula
• Esophageal fistula is an abnormal communication between the
esophagus and the trachea, bronchus, lung parenchyma or the skin.
• Congenital fistulas occur due to failure in complete separation of the
developing foregut and respiratory tracts. Acquired fistulas are more
common which arises secondary to trauma.
• Esophagobronchial fistulas are more common than esophagotracheal
and esophagopulmonary fistulas. In dogs the fistulas most commonly
occurs between esophagus and the right caudal lung lobe. In cats,
they are in the accessory lobe and left caudal lung lobe.
• Cough induced by ingestion of food or liquids but in some cases
chronic signs of pneumonia or lung abscessation may occur. Positive
contrast radiography can be used to demonstrate direct
communication between esophageal lumen and respiratory tract.
• Treatment involves thoracotomy to expose the esophagus , fistula
and affected portion of the respiratory system.
 Dilatation of Oesophagus
(Ectasia of Oesophagus)
• May also be caused by local injury as may
happen during careless use of probang.
• Outer coats of the Oesophagus may rupture
due to dilatation and the mucous coat may
protrude through it, similar to hernia. This is
called oesophagocele (Jabot)
• Incidence:
• More commonly seen in cattle and horse.
• Symptoms:
• Accumulation of food materials in the dilated portion causes
obstruction of the oesophagus.
• While feeding regurgitation through mouth or nose may be
noticed.
• Liquids may be taken normally
• If the cervical region is affected, the swelling can be palpated.
• No pain usually.
• Difficulty in respiration if much pressure on trachea. The
contents of the diverticulum may pass on to the stomach in
small quantities and then the animal feeds normally for
sometimes till there is a obstruction.
• Progressive debility.
 Treatment
• Feeding on semi liquid diet.
• Surgical treatment is not usually successful but
may be tried.
• Oesophagotomy may be performed at the
seat of diverticulum.
 Paralysis of oesophagus
• Difficulty in swallowing. Swallowed food
materials are returned through the mouth and
nose.
• No satisfactory treatment.
 Impaction of Crop in Birds
• The crop (ingluvius)in birds may get impacted
with food material. This condition is
predisposed with presence of parasites.
• Trichostomum contortum which perforatesw
the mucous membrane of the oesophagus
and paralyses the muscular coat.
• Treatment
• Gentle massaging
• Surgical opening of the crop. (Ingluviotomy).