Page 674 - Cote clinical veterinary advisor dogs and cats 4th

309.e4 Esophageal Diverticulum

esophagus, resulting in retention of ingested Initial Database Nutrition/Diet
material within the diverticulum. Diverticula • CBC, serum chemistry profile, and urinalysis As for megaesophagus (p. 642)
VetBooks.ir esophageal luminal pressure secondary to • Plain thoracic radiographs Possible Complications
results normal unless there is systemic inflam-
can be acquired as a consequence of increased
matory disease (e.g., aspiration pneumonia).
obstruction (e.g., cicatrix, foreign body) and/
• Perforation of diverticulum leading to pleural
or mediastinal sepsis
or weakening of the esophageal wall (e.g.,
ulceration due to foreign body, esophagitis) ○ Look for a localized soft-tissue density. • Aspiration pneumonia
○ Distinguish focal from generalized
or similar problems. Congenital diverticula esophageal disease (e.g., megaesophagus).
can be secondary to an inherent weakness ○ Look for evidence of aspiration pneumonia. PROGNOSIS & OUTCOME
in the esophageal wall or an abnormality ○ Look for evidence of mediastinitis or pleu-
during development. ritis (e.g. mediastinal widening, pleural Guarded. Too few such cases have been identi-
• Traction diverticula are caused by an extra- effusion) as can occur with esophageal fied and treated to produce objective prognostic
esophageal lesion such as maturing fibrous perforation. information. No instances of self-resolution
connective tissue in a scar, or an adhesion • Contrast esophagram (p. 1062) have been documented.
between the esophagus and another intratho- ○ Look for localized collection of contrast
racic structure such as a hilar lymph node. in a pouch outside the expected plane of PEARLS & CONSIDERATIONS
The adhesion pulls a portion of the esophageal the esophageal lumen.
wall out of position as the connective tissue ○ Distinguish esophageal disease from Comments
matures and contracts, creating a pouch. The pleural, mediastinal, or pulmonary disease. • A rare condition in dogs and cats
most likely cause of traction diverticula in ○ Distinguish from normal redundant • Must distinguish from the clinically insig-
dogs is believed to be penetrating esophageal esophagus commonly seen in bulldogs, nificant redundant esophagus often seen in
foreign bodies that cause adhesions between pugs, French bulldogs, Boston terriers, brachycephalic breeds (e.g. bulldogs, pugs,
the esophagus and periesophageal tissues and Shar-peis. Boston terriers) and Shar-peis
(p. 351). • Can be difficult to recognize during
• The main reason for differentiating types Advanced or Confirmatory Testing esophagoscopy. If food is retained in the
is that surgery may correct a traction • Esophagoscopy (p. 1098): find the outpouch- diverticulum, it can be seen easily during
diverticulum (release adhesion), but pulsion ing, and distinguish traction from pulsion esophagoscopy. However, if the diverticulum
diverticula are often not amenable to surgical types. is empty, it may look like a fold of tissue that
correction. • Thoracic CT or MRI before surgical approach can be disregarded, especially if there is inad-
may be helpful for traction types. equate insufflation of the esophagus during
DIAGNOSIS • Histopathologic evaluation of resected pouch the endoscopic examination. Adequate insuf-
to look for cause of traction diverticulum flation to facilitate evaluation may require
Diagnostic Overview manually occluding the proximal esophagus
Esophageal diverticulum may first be suspected TREATMENT to hold air in the esophageal lumen.
based on clinical presentation (regurgitation) or
based on radiographic abnormalities. Confirma- Treatment Overview Technician Tips
tion generally occurs during esophagoscopy • Consider resection of pouch in animals Watch for fever, tachypnea, nasal discharge,
with direct visualization of the lumen of that show clinical signs but do not have and depression (signs of aspiration pneumonia
the diverticulum or with a barium contrast generalized or segmental esophageal weak- or septic pleuritis/mediastinitis).
esophagram. ness; however, there is risk of dehiscence and
stricture formation. This should be performed SUGGESTED READING
Differential Diagnosis by trained surgical specialists. Jergens AE: Diseases of the esophagus. In Ettinger SJ,
Regurgitation: • Clinically silent diverticula should gener- et al, editors: Textbook of veterinary internal medi-
• Esophagitis ally be left alone unless there appears to be cine, ed 7, St. Louis, 2010, Saunders, 1487-1499.
• Esophageal weakness, which can be acquired substantial risk of perforation on endoscopy
(idiopathic or secondary to systemic disease), or contrast radiography. However, animals ADDITIONAL SUGGESTED
or congenital. In general, diverticula cause with clinically silent diverticula are at risk READING
focal esophageal enlargement, whereas gener- for future retention of esophageal foreign Woods CB, et al: Esophageal deviation in four English
alized esophageal enlargement should prompt bodies. bulldogs. J Am Vet Med Assoc 172:934-939, 1978.
the consideration of causes of megaesophagus
(pp. 642 and 1252). However, esophageal Acute General Treatment RELATED CLIENT EDUCATION
weakness can be segmental instead of general- • Treat aspiration pneumonia (p. 793) if
ized, making differentiation more difficult present. SHEETS
when esophageal weakness results in a large • Treat septic pleuritis/mediastinitis (p. 857) Consent to Perform Endoscopy, Upper GI
esophageal dilation between the thoracic inlet if present. (Gastroduodenoscopy)
and the base of the heart, somewhat similar • Treat esophagitis (p. 12) or esophageal Consent to Perform Radiography
to that seen with a vascular ring anomaly. stricture (see p. 310) as appropriate. Pneumonia
The weakness is not a surgical lesion and is • Remove diverticulum surgically if appropriate.
not a true diverticulum. AUTHOR: Michael D. Willard, DVM, MS, DACVIM
• Esophageal mass Chronic Treatment EDITOR: Rance K. Sellon DVM, PhD, DACVIM
• Esophageal stricture None unless esophageal stricture or esophageal
• Vascular ring anomaly (e.g., persistent right hypomotility is present after diverticulectomy
aortic arch)

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