Page 804 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

Gastrointestinal system: 4.1 The upper gastrointestinal tr act 779

VetBooks.ir 4.109

Fig. 4.109 An oesophagostomy tube.

and should only be undertaken with careful planning Oesophagotomy tubes are left in place for 7–14
and experience. The absence of a serosal layer results days. After removal the stoma heals gradually by
in a high prevalence of dehiscence with attempted second intention, and food and saliva will drain out
repairs or anastomosis. The destructive nature of through it during this period.
exudates containing saliva and food means that any Complications of oesophageal surgery include
leakage results in mediastinal cellulitis and abscessa- drainage of exudates that dissect down the trachea
tion. Dissecting mediastinitis can ensue, which can and in the interstitium, laryngeal paralysis, jugular
progress to severe depression and endotoxic shock thrombosis, Horner’s syndrome, stricture formation
and carries a very poor prognosis. The close proxim- and carotid arterial perforation.
ity of the oesophagus to many vital structures leads
to a high risk of iatrogenic damage to other struc- FURTHER READING
tures including the vagal nerve, sympathetic trunk Auer J, Stick J (2012) Esophagus in Equine Surgery, 5th edn.
and carotid arteries. Elsevier, Philadelphia.
Oesophagostomy is necessary for surgical access Blikslager A, White N, Moore J, Mair T (eds) (2017).
to the oesophagus, allowing indwelling oesoph- Esophagus. In: The Equine Acute Abdomen, Part 1,
agotomy tube placement to enable by-passing 3rd edn. Elsevier, Philadelphia.
of lesions that preclude oral alimentation and Dixon PM, Head KW (1999) Equine nasal and paranasal
to allow healing of cervical oesophageal surgi- sinus tumours: Part 2: a contribution of 28 case
cal wounds. The surgery can be performed under reports. Vet J 157:279–294.
general anaesthesia or sedation and local analge- Easley J (ed) (2013) Advances in equine dentistry. Vet Clin
sia. After aseptic preparation, the oesophagus is North Am Equine Pract 29:273–467.
approached from ventrally and laterally usually in Freestone JF, Seahorn TL (1993) Miscellaneous
the mid-cervical region after displacing the tra- conditions of the equine head. Vet Clin North Am
Equine Pract 9:235–242.
chea to the right. A NG tube should be placed to Knottenbelt D, Snalune K (2016) Equine Clinical Oncology,
delineate the position of the oesophageal lumen 1st edn. Elsevier, Philadelphia.
during the surgical approach. The oesophagus Knowles E J, Tremaine WH, Pearson GR, Mair TS (2016)
is incised longitudinally for 3–5 cm and the NG A database survey of equine tumours. Equine Vet J
tube is replaced with a tube entering and passing 48:280–284.
through the oesophagostomy into the stomach. Schumacher J, Schumacher J (1995) Disease of the salivary
The tube is secured with tape sutured to the skin. glands and ducts of horses. Equine Vet Educ 7:313–319.