Page 802 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

Gastrointestinal system: 4.1 The upper gastrointestinal tr act 777

VetBooks.ir cellulitis, abscessation and oesophageal dysfunction. inflammatory sepsis with pain, swelling and rapid
shock (Fig. 4.106). Such lesions will prove challeng-
Fortunately, such lesions are uncommon in horses
because they are relatively fastidious feeders.
ing to identify once such inflammation is present.
Aetiology/pathogenesis Management
Perforation of the oesophageal mucosa by sharp Some foreign bodies can be retrieved from the
ingested foreign bodies leads to egress of saliva into oesophagus endoscopically, but contrast radiog-
the interstitium and development of an initial cel- raphy may be necessary to demonstrate their loca-
lulitis, which eventually suppurates. This results in tion. Endoscopic retrieval using basket forceps or a
pain, peristaltic dysfunction, food impaction proxi- snare is the least traumatic method. In some cases,
mal to the site and in some cases, mediastinitis and advancement into the stomach is possible where
endotoxic shock. extraction proves impossible. Sharp barbed twigs
or thorns can be extremely traumatic to the lumen
Clinical presentation during retrieval, and lubrication or ensheathing in
Dysphagia, oesophageal obstruction (choke), painful a NG tube may be attempted to help reduce this.
swellings of the neck, hypersalivation, pyrexia and A surgical exploration under general anaesthesia
acute endotoxic shock. may be necessary to remove the foreign body and
allow effective drainage of any surrounding septic
Differential diagnosis exudates. The presence of any perioesophageal cel-
Primary choke, injection abscesses, diverticula, lulitis or an abscess may cause pain on swallowing
mediastinitis from other sources. and oesophageal dysfunction. The abscess may burst
into the lumen of the oesophagus or subcutaneously
Diagnosis
Oesophagoscopy may reveal the mucosal defect
when the oesophageal lumen is fully dilated with air, 4.106
although these can prove to be elusive (Fig. 4.105).
Contrast oesophagrams may be helpful although
false-negative images are possible. A small mucosal
perforation allows the inoculation the mediasti-
num with bacteria and saliva, and provokes an acute

4.105

Fig. 4.105 Oesophagoscopy of a perforated Fig. 4.106 Exudation from the oesophagus can
oesophagus indicating the difficulty identifying the cause a painful dissecting cellulitis.
perforation (arrow).