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Esophageal Perforation/Rupture 309

PEARLS & CONSIDERATIONS • Radiation therapy offers excellent long-term procedures, notify the veterinarian so that a
control for treatment of acanthomatous diagnosis and treatment plan can be formulated.
VetBooks.ir • Because peripheral odontogenic fibromas development in the irradiated area several SUGGESTED READING Diseases and Disorders
Comments
ameloblastoma, but malignant tumor
and giant cell granulomas arise from the
years later has been reported.
Fiani N, et al: Clinicopathologic characterization of
periodontal ligament, excision limited to the
in dogs: 152 cases (1995-2005). J Am Vet Med
gingiva will be inadequate, resulting in tumor Prevention odontogenic tumors and focal fibrous hyperplasia
recurrence. Gingival excision, extraction of • Early tumor detection (daily home oral Assoc 238:495-500, 2011.
the involved tooth, and curettage of the hygiene and oral examination at every patient AUTHORS: Sue N. Ettinger, DVM, DACVIM; Alexander
alveolar sockets to remove any remaining visit) M. Reiter, DVM, Dr. med. vet., DAVDC, DEVDC
periodontal ligament will usually be curative. EDITOR: Alexander M. Reiter, DVM, Dr. med. vet.,
• Aggressive surgical excision (mandibulectomy, Technician Tips DAVDC, DEVDC
maxillectomy) is usually curative in dogs with When you identify a gingival swelling/mass
acanthomatous ameloblastoma. during oral examination and dental cleaning

Esophageal Perforation/Rupture Client Education
Sheet

BASIC INFORMATION • Restlessness, weight loss, pain DIAGNOSIS
• Cervical swelling, subcutaneous emphysema
Definition Diagnostic Overview
A full-thickness defect in the esophagus with PHYSICAL EXAM FINDINGS Esophageal perforation can be difficult to
leakage of esophageal contents into the cervical The duration of clinical signs associated with diagnose. Cervical and thoracic radiographs and
tissues, mediastinum, and potentially the pleural esophageal perforation is reported to be longer contrast esophagram and/or esophagoscopy are
space (pp. 312 and 351) than with esophageal foreign body alone. required to confirm the diagnosis of perforation
Physical findings may include and the location of the lesion.
Epidemiology • Fever
SPECIES, AGE, SEX • Subcutaneous emphysema Differential Diagnosis
• No age or sex predisposition • Rapid shallow respiration consistent with • Megaesophagus
• Perforation has been reported in more dogs pneumothorax or pyothorax • Hiatal hernia or gastroesophageal intussuscep-
than cats (attributed to the less discriminating • Moist rales on auscultation, if aspiration tion
feeding behavior of dogs) pneumonia is present • Intrinsic or extrinsic esophageal masses
• Dehydration • Neoplasia
GENETICS, BREED PREDISPOSITION • Parasite infestation
Eighty-six percent of esophageal foreign bodies Etiology and Pathophysiology • Esophagitis
are reported in dogs weighing < 12 kg (26 lb). • Sharp edges of a foreign body may lacer- • Esophageal diverticulum
ate the esophagus and, rarely, the great • Vascular ring anomaly
RISK FACTORS vessels. • Abnormal pharyngeal or esophageal motility
• Foreign body ingestion (p. 351) by dogs • Large foreign bodies can result in pressure
weighing < 10 kg: foreign bodies present necrosis of the esophageal wall; the greatest Initial Database
for 3 days and bone foreign bodies in the damage is usually associated with pressure CBC:
esophagus are risk factors for complica- points of the foreign body against the • Neutrophilic leukocytosis
tions of endoscopic foreign body retrieval. esophageal wall. • More immature neutrophils are present with
Esophageal perforation is more common than • The most common site of foreign body a perforated esophagus than with esophageal
gastric. lodgment is the distal esophagus just cranial foreign body alone.
• Balloon dilation of esophageal strictures to the gastroesophageal junction; other sites Diagnostic imaging:
(p. 310) are the heart base, thoracic inlet, and less • Survey cervical and thoracic radiographs
• General anesthesia with secondary esophageal often, the cervical esophagus. may demonstrate esophageal foreign body
damage • Esophageal perforation can be caused by (radiopaque bone common), air within the
esophageal trauma or balloon dilation of periesophageal tissues, pneumomediastinum,
ASSOCIATED DISORDERS esophageal strictures. pneumothorax, pleural effusion/pyothorax,
• Mediastinal abscess • Full-thickness necrosis of the esophagus has and/or increased lung density with concur-
• Pneumothorax been reported in a dog due to concurrent rent aspiration pneumonia
• Pyothorax use of an esophageal electrocardiogram • Contrast esophagram (p. 1062) should be
• Bronchoesophageal fistula probe and an electrosurgical unit. Mainte- performed with water-soluble contrast if
• Esophageal diverticulum nance of the unit and handpieces to avoid perforation is suspected; the procedure has
fluid contact and corrosion and avoiding a false-negative rate of 14.5%.
Clinical Presentation use of the devices concurrently during Esophagoscopy:
HISTORY, CHIEF COMPLAINT surgery are recommended to avoid the • Performed with care; do not create or worsen
History may include complication. pneumothorax or cause esophageal rupture.
• Retching, regurgitation, vomiting, ptyalism, • Significant esophageal damage secondary to • Evaluate integrity and viability of esophagus,
anorexia general anesthesia for elective procedures has and identify site of perforation.
• Coughing, dyspnea been reported in two cats. • Possible foreign body removal

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