Page 803 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

778 CHAPTER 4

VetBooks.ir to form an oesophageal fistula. Perioesophageal Management
Small, acute defects may be treated by attempted
infections should be cultured to optimise antibiotic
debridement and lavage of the interstitium, com-
administration.
bined with inversion and attempted repair of the
OESOPHAGEAL RUPTURE perforation. An indwelling NG tube allows alimen-
tation, which by-passes the defect. All chronic or
Definition /overview heavily contaminated defects are more easily treated
Traumatic disruption of the oesophageal mucosa by surgical drainage of the affected area and the cre-
and other layers. ation of an oesophagostomy caudal to the rupture, to
allow continued feeding (Fig. 4.109) The damaged
Aetiology/pathogenesis area is then left to heal by second intention.
Rupture of the oesophagus can follow pro-
longed obstruction, overaggressive NG tube use OESOPHAGEAL NEOPLASIA
(Fig. 4.107) or ingestion of foreign bodies. Drainage
of saliva results in rapid cervical swelling due to the Oesophageal neoplasia is rare in the horse.
cellulitis, and swallowed air can disperse to form Oesophageal extension of squamous cell carcinoma
subcutaneous emphysema, which can be demon- originating in the gastric mucosa is the most com-
strated on radiographs (Fig. 4.108). Extensive medi- monly reported. The prognosis for such lesions
astinitis carries a guarded prognosis. is very guarded and the prognosis for resection is
dubious.
Clinical presentation
Cervical swelling, dysphagia and dyspnoea are typi- OESOPHAGEAL SURGERY
cally present. Signs of systemic toxaemia may be AND OESOPHAGOSTOMY
apparent.
Oesophageal surgery in the horse, as with other spe-
Diagnosis cies, is associated with a high risk of complications
Oesophagoscopy and contrast radiographs are criti-
cal. Trans-thoracic ultrasound can be used to dem-
onstrate perioesophageal abscesses. 4.108

4.107

Fig. 4.107 Post-mortem appearance of an iatrogenic Fig. 4.108 Contrast oesophagram of the horse in
oesophageal tear that occurred following nasogastric 4.107 with gas shadows in the perioesophageal tissue
intubation. (arrows).