Page 562 - Clinical Small Animal Internal Medicine

530 Section 6 Gastrointestinal Disease

Figure 49.19 A selection of manipulating
VetBooks.ir useful in retrieval of foreign bodies within
and retrieval instruments, which may be
the esophagus and/or gastric lumen. The
rightmost two instruments are repurposed
laparoscopic surgery graspers. From left to
right, a four‐wire basket forceps, a netting
loop snare, and flexible alligator forceps.
The flexible instruments are appropriate
for use through the working channel of a
larger endoscope, and can be utilized in
the esophagus and stomach, but lack
significant grasping power. The
repurposed laparoscopic instruments
have much larger working graspers and
better grasping power. These rigid
instruments are introduced to the
esophagus either through a large rigid
endoscope or along the side of a flexible
endoscope. They are not appropriate for
use in the gastric lumen.

firmly wedged. If the foreign body can be solidly grasped, bodies to assess for early signs of esophageal perfora-
a number of attempts to remove it via the oral cavity can tion such as pneumomediastinum or pneumothorax.
be made, but if the object is not mobilized by moderate If the patient has evidence of severe esophagitis
traction and the esophageal mucosa is showing increas- and mucosal ulceration/abrasion, placement of a PEG
ing evidence of trauma/hemorrhage, a new strategy tube for postoperative nutritional support is strongly
should be followed. If the foreign body can be pushed recommended.
aborally into the stomach, this is often a preferable
option. Many bone foreign bodies or impacted dog
chews will dissipate once within the gastric lumen, while Esophageal Stricture Management
indigestible foreign bodies can be removed via celiotomy Esophageal stricture recognition and management via
and gastrotomy with much lower risk of complications either bougienage or balloon dilation are discussed in
than arise from a transthoracic route. detail in Chapter 52.
When attempting to retrieve foreign bodies, great
care should be taken that the gastrointestinal tract
wall is not compromised, either by excessive force
application or inadvertent perforation by sharp objects Future Directions of Gastrointestinal
(bone fragments, needles, etc.) as they are withdrawn. Endoscopy
It is also critical to assess the site of impaction after
withdrawal for evidence of mucosal ulceration and After the unavoidably small size of biopsies achievable
abrasion. Within the gastric lumen, it is usually possible using flexible endoscopy, probably the greatest
to visualize the site of impaction after initial grasping of limitation of endoscopy in the gastrointestinal tract
the object, but with esophageal foreign bodies it will be of veterinary patients is the lack of ability to assess the
necessary to reintroduce the endoscope to assess the entire gastrointestinal tract. While many diseases
mucosa. Severe circumferential mucosal damage, par- that affect the gastrointestinal tract are diffuse, and
ticularly if there is exposure of the submucosa, leaves thus duodenoscopy and distal ileoscopy will commonly
the patient with a high risk for esophageal stricture for- result in meaningful diagnostic findings, solitary lesions
mation. It is also recommended to obtain thoracic in the deeper jejunum and proximal ileum are not
radiographs following removal of esophageal foreign unknown.