Introduction
Esophageal foreign bodies (EFBs) are most commonly reported in small-breed dogs, with objects such as bones, fishhooks, and rawhide chews all having been reported.1–4 Locations where EFBs most commonly lodge consist of the level of the thoracic inlet, the heart base, and the distal esophagus because of extraluminal structures preventing esophageal dilation at these locations.5,6 Clinical signs of EFBs can include gagging, retching, regurgitation, vomiting, dyspnea, pain, lethargy, and inappetence.6–8
The treatment of choice for removal of EFBs is esophagoscopy, because of its minimally invasive nature and because it allows direct visualization of the EFB as it is being removed and permits assessment of the esophageal mucosa for evidence of esophagitis, ulceration, necrosis, or perforation after EFB removal.9 Use of esophagoscopy for EFB retrieval has reported success rates of 68% to 97%.1–3,5,7,8,10,11 Fluoroscopy is another minimally invasive technique that has been used for removal of EFBs, with a reported success rate of 83%.12 However, the necessary equipment is not widely available, and the technique is only suitable when the EFB is radiopaque. Also, fluoroscopy does not allow direct visualization during retrieval, which could potentially increase the risk of iatrogenic damage to the esophagus.
Surgical management of EFBs is indicated if minimally invasive methods are unsuccessful or unavailable or if there is evidence of full-thickness esophageal perforation, which may be evident before, during, or after EFB removal.13,14 It has been suggested that it is sometimes possible to manage small perforations of the cervical esophagus with medical management consisting of local drainage and withholding food and water for 72 hours.15 However, because of the potentially life-threatening consequences, perforation of the intrathoracic esophagus should be surgically managed,4,7 as is also indicated for most perforations of the cervical esophagus.
The esophagus is reported to have a significantly higher dehiscence rate, compared with other parts of the gastrointestinal tract, because of its segmental blood supply, lack of serosa, and lack of readily available omentum.16–18 Because of this perceived higher surgical risk, surgery to remove EFBs that cannot be retrieved with a minimally invasive approach or to repair a perforation may not always be offered. Also, there is limited information in the published literature on the outcome of dogs that underwent surgical intervention for treatment of EFBs. The survival-to-discharge rate following surgery for treatment of EFBs reportedly ranges from 50% to 93%.2,4–6,19,20 However, most existing reports describe combined outcomes for various methods of EFB removal, making it difficult to differentiate outcomes following minimally invasive versus surgical removal or providing information on only a small number of surgical cases. Binvel et al1 reported a 100% survival-to-discharge rate,1 but they combined information for surgically and endoscopically treated cases, with only 6 of 23 cases treated surgically. Another study3 reported a mortality rate of 5.4% for 223 dogs with EFBs but again included dogs that were surgically and nonsurgically managed, with only 23 dogs being surgically managed.
The objective of the study reported here, therefore, was to retrospectively identify complications associated with and short- and long-term outcomes of surgical intervention for removal of EFBs in a large group of dogs.
Materials and Methods
Inclusion criteria
Medical records of the Royal Veterinary College Queen Mother Hospital for Animals, Langford Vets Small Animal Referral Hospital, University College Dublin Veterinary Hospital, Anderson Moores Veterinary Specialists, Willows Referral Service, North Downs Specialist Referrals, Vets Now Glasgow, Peninsula Vet Emergency and Referral Hospital, and Rowe Referrals were searched to identify dogs examined because of an EFB between 2007 and 2019. Dogs were included in the study if surgery had been performed to remove an EFB, repair an esophageal perforation caused during minimally invasive (endoscopy or fluoroscopy) attempts to remove an EFB, or manage complications attributed to an EFB (eg, perforation, pyothorax, or mediastinal abscess). In addition, dogs were included only if surgery had been performed at least 4 weeks prior to data collection and if surgery had been performed by a surgeon with advanced qualifications (eg, surgical certificate holder, senior surgical resident, or board-certified or board-eligible surgical specialist).
Data retrieved from medical records consisted of breed, age, sex, body weight, history of ingestion, clinical signs, diagnostic imaging performed, whether endoscopy or fluoroscopy was attempted prior to surgery, type of EFB, location of EFB, surgical approach, surgical findings, whether a gastrostomy tube was placed, esophageal closure method, intraoperative and postoperative complications, postoperative management details, and outcome. Short-term postoperative complications were defined as those occurring between surgery and discharge, and medium- to long-term postoperative complications were defined as those occurring after discharge from the hospital.21 Major complications were defined as those requiring additional surgery, mechanical ventilation, continuous oxygen supplementation, or resuscitation or those resulted in death.9 Minor complications were defined as those that resolved with medical management or were self-limiting.
Follow-up
Referring veterinary surgeons were contacted by telephone to determine whether dogs were still alive and, if not, the cause of death. For those dogs that were still alive, owners were contacted and asked to complete a short computer-based questionnaire to assess medium- to long-term outcomes (Supplementary Appendix S1). This included information regarding ongoing vomiting or regurgitation, ongoing medications, dietary management, and further investigations required.
Statistical analysis
Data collected by each institution were entered into a spreadsheet (Excel; Microsoft Corp) provided by the primary author (AJCB) and subsequently collated into a single spreadsheet. Data were not anonymized. The following variables were analyzed to determine whether they were associated with survival to discharge (yes vs no): time the EFB was present before surgery, presence of esophageal perforation before surgery, age at the time of surgery, terrier breed (ie, West Highland White, English Bull, Staffordshire Bull, Cairn, Yorkshire, Jack Russell, Norwich, or Wheaten) versus any other breed, whether a thoracotomy was required, whether a gastrostomy tube was placed, and whether the EFB was a bone. Data were tested for normality with the Shapiro-Wilk test. Continuous data were analyzed with an independent samples t test when normally distributed and a Mann-Whitney U test when not normally distributed. Categorical variables were analyzed with χ2 or Fisher exact tests, as appropriate.
All statistical analyses were performed with standard software (SPSS version 19; IBM Corp). Values of P ≤ 0.05 were considered significant.
Results
Study population
Sixty-three dogs met the criteria for inclusion in the study. There were 14 (22.2%) West Highland White Terriers, 9 (14.3%) mixed-breed dogs, 5 (7.9%) English Bull Terriers, 5 (7.9%) Staffordshire Bull Terriers, 4 (6.3%) Cairn Terriers, 3 (4.8%) English Springer Spaniels, 3 (4.8%) Labrador Retrievers, 3 (4.8%) Yorkshire Terriers, 2 (3.2%) Bichon Frise, 2 (3.2%) Jack Russell Terriers, 2 (3.2%) Maltese, and 1 (1.6%) each of the following breeds: Alaskan Klee Kai, Beagle, Bernese Mountain Dog, Chihuahua, Cavalier King Charles Spaniel, English Cocker Spaniel, Golden Retriever, Norwich Terrier, Shih Tzu, Swedish Valhund, and Wheaten Terrier.
Of the 63 dogs, 22 (34.9%) were neutered males, 10 (15.9%) were sexually intact males, 22 (34.9%) were neutered females, and 9 (14.3%) were sexually intact females. Median age was 4 years 11 months (range, 10 months to 12 years 11 months), and median weight was 11.6 kg (range, 3 to 52.9 kg).
History and clinical variables
Median time from ingestion of the EFB (61 dogs) or from the onset of clinical signs (2 dogs for which time of ingestion was not known) to surgery was 3 days (range, 0 to 10 days). Vomiting was the most common clinical sign (n = 31 [49.2%]), followed by inappetence (25 [39.7%]), regurgitation (24 [38.1%]), lethargy (24 [38.1%]), retching (14 [22.2%]), abdominal pain (7 [11.1%]), hypersalivation (4 [6.3%]), restlessness (3 [4.8%]), adipsia (3 [4.8%]), coughing (2 [3.2%]), dyspnea (2 [3.2%]), tachypnea (2 [3.2%]), and oral hemorrhage, panting, diarrhea, trembling, nausea, gulping, pain when eating, and unspecified discomfort (1 [1.6%] each). Five (7.9%) dogs were seen ingesting a foreign object but reportedly did not have any clinical signs.
Thoracic or cervical radiography (plain or positive contrast) or both were used to identify the EFB in 61 (96.8%) dogs. In 2 (3.2%) dogs, the diagnosis was made by means of thoracic CT.
Endoscopic removal of the EFB was attempted in 42 of the 63 (66.7%) dogs, and the EFB was successfully removed via the mouth in 6 of the 42 (14.3%) dogs and advanced into the stomach in 2 (4.8%). Fluoroscopic removal of the EFB was attempted in 9 of the 63 (14.3%) dogs, and the EFB was successfully removed via the mouth in 2 of the 9 (22.2%) dogs and advanced into the stomach in 1 (11.1%) dog. Fluoroscopy followed by endoscopy was attempted in 3 of the 63 (4.8%) dogs. In 1 of these 3 dogs, the EFB was advanced into the stomach, but in the remaining 2 dogs, the EFB could not be retrieved with either method. Duration of endoscopy or fluoroscopy was recorded in 31 dogs. Median duration was 35 minutes (range, 5 to 180 minutes).
Forty-two of the 63 (66.7%) dogs underwent surgery after an unsuccessful attempt to retrieve the EFB via the mouth or advance it into the stomach. In 12 of the 63 (19%) dogs, surgery was performed because a minimally invasive approach resulted in esophageal perforation, which was diagnosed immediately after EFB removal (n = 7) or during the subsequent hospitalization period (5; median, 1 day after EFB removal; range, 1 to 2 days after EFB removal). The remaining 9 (14.3%) dogs underwent surgery without first undergoing endoscopy or fluoroscopy because of preexisting radiographic evidence of esophageal perforation.
Foreign body
The most common EFB was a bone (n = 50 [79.4%]), followed by a fishhook (9 [14.3%]), rawhide chew (2 [3.2%]), piece of chicken (1 [1.6%]), and cow hoof (1 [1.6%]). Forty-five (71.4%) EFBs were located in the distal esophagus, 8 (12.7%) were located at the heart base, 6 (9.5%) were located at the thoracic inlet, and 4 (6.3%) were located in the cervical esophagus.
Surgery
Thirty-seven (58.7%) dogs underwent a left intercostal thoracotomy (1 dog underwent a gastrotomy via midline celiotomy at the same time). Twelve (19%) dogs underwent a ventral midline approach to the cervical esophagus (one dog required a median sternotomy in addition, and another dog required a gastrotomy via midline celiotomy). Four (6.3%) dogs underwent a right intercostal thoracotomy. Three (4.8%) dogs underwent a median sternotomy (including the 1 dog previously described that underwent a ventral midline cervical approach and median sternotomy), and one of these also underwent a gastrotomy via midline celiotomy. Eleven (17.5%) dogs underwent a gastrotomy via a midline celiotomy to remove the EFB from the distal esophagus (including the 3 dogs previously described). Esophageal perforation was present at the time of surgery in 42 (66.7%) dogs.
Information regarding the type of suture material used for esophageal closure was available for 42 of 49 dogs. Polydioxanone was used in all dogs in either a simple interrupted (n = 20 [47.6%]) or simple continuous (19 [45.2%]) pattern. The esophageal repair was omentalized in 7 of 49 (14.3%) dogs, 4 of 49 (8.2%) dogs had augmentation of the esophageal repair with a diaphragmatic flap, and 1 dog had augmentation of the esophageal repair with a sternohyoideus muscle patch. In 1 dog, an end-to-end anastomosis of an esophageal avulsion was performed. Median surgical duration was 115 minutes (range, 20 to 380 minutes).
Eighteen of the 63 (28.6%) dogs had an intraoperative complication. The most common intraoperative complication was hypotension (n = 10 [15.9%]), followed by hypoxemia (5 [7.9%]), respiratory arrest (2 [3.2%]), cardiopulmonary arrest (2 [3.2%]), hypoperfusion (2 [3.2%]), and ventricular tachycardia, accidental extubation while the patient was being moved, substantial regurgitation, and profuse hemorrhage when the EFB was removed (1 [1.6%] each). Seven dogs had > 1 intraoperative complication.
Fifty-six of the 63 (88.9%) dogs survived surgery. Five (7.9%) dogs were euthanized intraoperatively because of extensive esophageal damage or necrosis, and 2 (3.2%) dogs developed cardiopulmonary arrest during surgery and died. One of the dogs that developed cardiopulmonary arrest had profuse hemorrhage when the EFB was removed, and subsequent postmortem examination revealed damage to the cranial vena cava. The other dog that developed cardiopulmonary arrest had an extensive laceration extending the length of the intrathoracic esophagus with evidence of pressure necrosis; this dog developed cardiopulmonary arrest during esophageal repair and could not be resuscitated.
Of the 56 dogs that survived surgery, 30 (53.6%) had a gastrostomy tube placed; mean ± SD time the tube remained in place was 14.5 ± 7.6 days. Thoracic drains were placed in 34 of the 56 (60.7%) dogs; median duration was 2 days (range, 0 to 9 days). Food was offered orally a median of 3 days (range, 0 to 20 days) after surgery. Median hospitalization time was 5 days (range, 1 to 14 days).
Outcome
Overall, 47 of the 63 (74.6%) dogs survived to discharge, and 16 (25.4%) died or were euthanized. Fifteen of the 42 (35.7%) dogs with an esophageal perforation at the time of surgery, 15 of the 44 (34.1%) dogs that underwent a thoracotomy, and 7 of the 30 (23.3%) dogs in which a gastrostomy tube was placed died. Presence of an esophageal perforation at the time of surgery (P = 0.012), undergoing a thoracotomy (P = 0.025), and placement of a gastrostomy tube (P = 0.029) were all significantly associated with not surviving to discharge. Time the EFB was present before surgery (P = 0.128), age at the time of surgery (P = 0.142), terrier breed (vs any other breed; P = 0.26), and whether the EFB was a bone (P = 0.15) were not significantly associated with survival to discharge.
Short-term postoperative complications
Of the 56 dogs that survived surgery, 16 (28.6%) had a short-term postoperative complication. In 14 (25%) dogs, this was a major complication, and 9 dogs with major complications died, including 4 dogs with cardiopulmonary arrest 1 to 2 days after surgery, 1 dog with septic pleural effusion 5 days after surgery, 1 dog with septic pleural effusion and cardiopulmonary arrest 6 days after surgery, 1 dog with respiratory arrest 1 day after surgery, 1 dog with poor oxygen saturation after anesthetic recovery, and 1 dog with acute kidney failure and respiratory distress syndrome 1 day after surgery. Five dogs with major complications recovered, including 1 dog with septic pleural effusion that underwent revision surgery, 1 dog with an abscess at the surgical site necessitating surgical debridement, 1 dog that chewed through the gastrostomy tube and underwent surgical revision, and 2 dogs with aspiration pneumonia that received continuous oxygen supplementation and antimicrobial treatment.
The 2 dogs with minor short-term complications developed surgical site infections 6 and 10 days after surgery. Both recovered with antimicrobial treatment.
Medium- to long-term postoperative complications
Twelve of the 47 (25.5%) dogs that were discharged from the hospital experienced a complication after discharge. There were 11 dogs with regurgitation or vomiting 10 to 30 days after surgery. Five dogs underwent follow-up endoscopy; 2 had mild strictures with no intervention required, and 3 had mild to moderate esophagitis. In the remaining 6 dogs, vomiting and regurgitation improved or resolved with diet modification or medical management. The remaining dog had a seroma at the median sternotomy site 7 days after surgery that resolved without treatment.
Owner follow-up
Long-term follow-up information was available for 38 of the 47 (80.9%) dogs that survived to discharge. Twenty-three of the 47 (48.9%) dogs were still alive at a mean ± SD follow-up time of 50 ± 28.6 months. Fifteen (31.9%) dogs had died or been euthanized for reasons unrelated to esophageal disease at a median of 43 months (range, 36 to 86 months; n = 4). Nine (19.1%) dogs were lost to follow-up.
Owners of 20 of the 23 (87%) dogs that were still alive responded to the questionnaire. Five (25%) reported that their dogs initially vomited every few weeks to months; vomiting resolved in 3 dogs and remained static in 2. Frequent regurgitation was reported in 6 (30%) dogs postoperatively, resolving in 1 dog after 8 weeks. In 2 dogs regurgitation resolved with diet modification, and the remaining 3 dogs were reported to still have regurgitation 2 to 3 times a month. Only 1 dog was being prescribed regular medication, which consisted of omeprazole (1 mg/kg, PO, q 12 h). Two of these dogs underwent follow-up endoscopy 19 and 32 days after surgery, revealing mild esophagitis but no strictures in both dogs. Two owners reported that their dogs required ongoing postural feeding to manage regurgitation, and 7 owners had made diet modifications since surgery owing to ongoing regurgitation that improved or resolved with these modifications.
Discussion
To our knowledge, the present study represented the largest case series to date investigating the outcome for dogs undergoing surgical intervention for removal of EFBs. The success rate was high, with 88.9% (56/63) of the dogs surviving surgery and 74.6% (47/63) surviving to discharge. When the 5 dogs euthanized intraoperatively were excluded, the survival-to-discharge rate increased to 81% (47/58). Survival-to-discharge rates for dogs undergoing surgery for removal of EFBs have previously been reported to range from 83% to 100%2,5,19,20,22; however, case numbers in those studies ranged from only 12 to 15 dogs.
Pressure necrosis of the esophagus can occur subsequent to an EFB, and the risk of this can increase with EFB duration.13,23 However, despite previous studies3,7 reporting a relationship between EFB duration and a poorer prognosis, we did not find time the EFB was present prior to surgery significantly associated with survival to discharge in the present study. This could have been due to a difference in classification of outcome between studies or the larger number of cases in the present study. Still, timely removal of EFBs is recommended. Importantly, clinical signs such as regurgitation would persist while the EFB was present, potentially leading to an increased risk of complications such as aspiration pneumonia.6,23,24 Although the present study had a larger number of cases than previous studies, the overall number was still relatively low, and this lack of an association between time the EFB was present prior to surgery and survival to discharge could have been due to a type II statistical error.
The most common EFB in our study was a bone, which was consistent with findings of other studies.4,9,12 Bone is more likely to induce pressure necrosis than other objects, such as fishhooks and chews, and could be associated with a greater risk of complications and death if esophageal necrosis occurs. All but 1 of the 16 dogs that did not survive to discharge in the present study had a bone EFB. However, whether the EFB was a bone was not significantly associated with survival to discharge, again possibly because of low case numbers.
In 12 of the 63 (19%) dogs in the present study, surgery was performed because of esophageal perforation following minimally invasive removal of an EFB. Perforation was not always evident immediately after EFB removal, with esophageal perforation diagnosed 1 to 2 days after EFB retrieval in 5 dogs. This highlights the importance of not only performing thoracic radiography after removal of an EFB but also closely monitoring patients in the postretrieval period for development of clinical signs that could suggest esophageal perforation. Iatrogenic damage to the esophagus during minimally invasive removal attempts is a recognized complication and can be life-threatening.4
In our study, the presence of esophageal perforation at the time of surgery was significantly associated with a lower survival-to-discharge rate, which has been described by other authors3,4 and is not surprising owing to the consequences of esophageal perforation, such as mediastinitis, pleuritis, pyothorax, and pneumothorax.2,4,7,11 Sutton et al18 reported that esophageal perforation was present in 60% of the dogs in their study at the time of surgery, which was similar to the 66.7% (42/63) in our study, and a 50% perforation rate has been reported for dogs with fishhook EFBs requiring surgery.1 The mortality rate for dogs with esophageal perforation in our study was 35.7% (15/42), which was comparable to rates ranging from 35% to 39% reported in previous studies.3,7,14 Other studies13,15,18 have reported a lower mortality rate, ranging from 13.3% to 20%, for dogs with esophageal perforation. However, in these studies, the percentage of EFBs that were fishhooks (34% to 83.3%) was substantially higher than the percentage in our study (9/63 [14.3%]). Thus, differences between our study and previous studies could be attributed, at least in part, to differences in the types of EFBs.
Dehiscence of the esophagotomy occurred in only 3 of 49 (6.1%) dogs in the present study, which was much lower than percentages previously reported following esophageal surgery.18–20,25 The reason for this low dehiscence rate was not known; however, possible explanations include a difference in underlying etiology and variation in surgical experience and technique. Regardless of the cause, our findings provide useful information because they represent outcomes for a large cohort of dogs from a large number of institutions.
In the present study, dogs that underwent a thoracotomy had a significantly lower rate of survival to discharge than dogs that did not. This likely reflected the severity of the esophageal injury, with 5 dogs that underwent a thoracotomy euthanized intraoperatively because of extensive esophageal damage or necrosis. An intercostal thoracotomy is widely used to treat lesions involving the intrathoracic esophagus and is appropriate for most cases, but other approaches may be possible in certain situations. In the present study, 45 of 63 (71.4%) EFBs were located in the distal esophagus. Aertsens et al20 reported a successful outcome in 82% of dogs with EFBs in the distal esophagus that were removed via a gastrotomy. Another study22 recently described a transdiaphragmatic approach for gastrotomy, with the authors reporting that the benefits included the ability to inspect the entire distal esophagus and convert to an esophagotomy if required through the same approach. The decision to euthanize a dog during surgery is, to a certain extent, surgeon dependent and potentially institution dependent. The present study included cases treated at 9 veterinary hospitals by surgeons with a variety of experience levels and is, therefore, reflective of a wide range of situations, making it useful to help aid veterinarians and owners in decision-making in these cases.
Previous studies2,18 have reported gastrostomy tube placement in 43% to 60% of dogs undergoing surgery because of an EFB, which was comparable to the 53.6% (30/56) of dogs in the present study. Placement of a gastrostomy tube after esophageal surgery and withdrawal of oral feeding for 1 to 7 days are common practices.15,26 In the present study, placement of a gastrostomy tube was associated with a decreased rate of survival to discharge. We suggest 2 potential reasons for this association: first, gastrostomy tubes may have been more likely to be placed in dogs with more severe esophageal injury or perforation. Second, the association could have been a type 1 statistical error. In our opinion, it is prudent to consider placing a gastrostomy tube in dogs with extensive esophageal injury or esophagitis to aid healing while providing adequate nutrition; however, we believe that more study may be needed in this area before evidence-based recommendations can be made.
Half (28/56) of all dogs that survived surgery in the present study had postoperative complications, which was higher than the 17% to 37% previously reported18–20; however, most of these studies do not report the specific nature of the complications or whether they were minor or major. Thus, it is possible that minor postoperative complications were underreported in previous studies.21
Five of 20 (25%) owners who responded to the follow-up questionnaire reported persistent vomiting or regurgitation at the time of long-term follow-up, although these episodes were reported as occurring only once every few weeks or months. We were not able to compare our findings with findings for a comparable group of dogs that did not undergo surgery for removal of EFBs, and it is possible that these rates would have been similar. It is also possible that recall bias artificially increased the number of owners reporting that their dogs had ongoing potentially relatable clinical signs. Therefore, this finding should be interpreted with caution. Nevertheless, the rate was low, suggesting a good long-term outcome in dogs undergoing this type of surgery.
Limitations of the present study included its retrospective nature, which resulted in some data points being missing for some cases. Another consideration is that 9 institutions were included in the study, and case management, surgical technique, and surgical experience varied among surgeons and institutions. We only included dogs in which surgery was performed by an individual with advanced surgical qualifications in an attempt to limit some of this variation. However, an advantage of a multicenter study is that it provides a more complete overview of the disease and treatment, making it more clinically relevant, rather than highlighting the success of a single institution.
Overall the present study demonstrated that a high survival-to-discharge rate can be achieved in dogs requiring surgery for treatment of an EFB. Esophageal perforation was significantly associated with a lower survival-to-discharge rate, as would be expected, but only 6.1% of esophagotomy incisions dehisced. At long-term follow-up, most dogs had a good outcome with few long-term complications. We concluded that surgery should be considered when an EFB cannot be removed safely with minimally invasive methods or if esophageal perforation is present. Our findings may help to guide veterinarians and owners when making decisions regarding these cases.
Supplementary Materials
Supplementary materials are posted online at the journal website: avmajournals.avma.org
Acknowledgments
This study was supported and facilitated by the Association of Veterinary Soft Tissue Surgeons Research Cooperative.
No third-party funding was received in connection with this study or the writing or publication of the manuscript. The authors declare that there were no conflicts of interest.
References
- 1. ↑
Binvel M, Poujol L, Peyron C, Dunie-Merigot A, Bernardin F. Endoscopic and surgical removal of oesophageal and gastric fishhook foreign bodies in 33 animals. J Small Anim Pract. 2018;59(1):45–49.
- 2. ↑
Deroy C, Corcuff JB, Billen F, Hamaide A. Removal of oesophageal foreign bodies: comparison between oesophagoscopy and oesophagotomy in 39 dogs. J Small Anim Pract. 2015;56(10):613–617.
- 3. ↑
Brisson BA, Wainberg SH, Malek S, Reabel S, Defarges A, Sears WC. Risk factors and prognostic indicators for surgical outcome of dogs with esophageal foreign body obstructions. J Am Vet Med Assoc. 2018;252(3):301–308.
- 4. ↑
Burton AG, Talbot CT, Kent MS. Risk factors for death in dogs treated for esophageal foreign body obstruction: a retrospective cohort study of 222 cases (1998–2017). J Vet Intern Med. 2017;31(6):1686–1690.
- 5. ↑
Juvet F, Pinilla M, Shiel RE, Mooney CT. Oesophageal foreign bodies in dogs: factors affecting success of endoscopic retrieval. Ir Vet J. 2010;63(3):163–168.
- 6. ↑
Houlton JEF, Herrtage ME, Taylor PM, Watkins SB. Thoracic oesophageal foreign bodies in the dog: a review of ninety cases. J Small Anim Pract. 1985;26(9):521–536.
- 7. ↑
Gianella P, Pfammatter NS, Burgener IA. Oesophageal and gastric endoscopic foreign body removal: complications and follow-up of 102 dogs. J Small Anim Pract. 2009;50(12):649–654.
- 8. ↑
Rousseau A, Prittie J, Broussard JD, Fox PR, Hoskinson J. Incidence and characterization of esophagitis following esophageal foreign body removal in dogs: 60 cases (1999–2003). J Vet Emerg Crit Care (San Antonio). 2007;17(2):159–163.
- 9. ↑
Bongard AB, Furrow E, Granick JL. Retrospective evaluation of factors associated with degree of esophagitis, treatment, and outcomes in dogs presenting with esophageal foreign bodies (2004–2014): 114 cases. J Vet Emerg Crit Care (San Antonio). 2019;29(5):528–534.
- 10. ↑
Dollo V, Chambers G, Carothers M. Endoscopic retrieval of gastric and oesophageal foreign bodies in 52 cats. J Small Anim Pract. 2020;61(1):51–56.
- 11. ↑
Thompson HC, Cortes Y, Gannon K, Bailey D, Freer S. Esophageal foreign bodies in dogs: 34 cases (2004–2009). J Vet Emerg Crit Care (San Antonio). 2012;22(2):253–261.
- 12. ↑
Moore AH. Removal of oesophageal foreign bodies in dogs: use of the fluoroscopic method and outcome. J Small Anim Pract. 2001;42(5):227–230.
- 13. ↑
Sterman AA, Mankin KMT, Ham KM, Cook AK. Likelihood and outcome of esophageal perforation secondary to esophageal foreign body in dogs. J Am Vet Med Assoc. 2018;253(8):1053–1056.
- 14. ↑
Wyatt SR, Barron PM. Complications following removal of oesophageal foreign bodies: a retrospective review of 349 cases. Aust Vet J. 2019;97(4):116–121.
- 15. ↑
Teh H, Winters L, James F, Irwin P, Beck C, Mansfield C. Medical management of esophageal perforation secondary to esophageal foreign bodies in 5 dogs. J Vet Emerg Crit Care (San Antonio). 2018;28(5):464–468.
- 16. ↑
MacManus JE, Dameron JT, Paine JR. The extent to which one may interfere with the blood supply of the esophagus and obtain healing on anastomosis. Surgery. 1950;28(1):11–23.
- 17.
Aronson LR, Brockman DJ, Brown DC. Gastrointestinal emergencies. Vet Clin North Am Small Anim Pract. 2000;30(3):555–579.
- 18. ↑
Sutton JS, Culp WT, Scotti K, et al. Perioperative morbidity and outcome of esophageal surgery in dogs and cats: 72 cases (1993–2013). J Am Vet Med Assoc. 2016;249(7):787–793.
- 19. ↑
Sale CS, Williams JM. Results of transthoracic esophagotomy retrieval of esophageal foreign body obstructions in dogs: 14 cases (2000–2004). J Am Anim Hosp Assoc. 2006;42(6):450–456.
- 20. ↑
Aertsens A, Hernandez J, Ragetly GR, Poncet CM. Surgical extraction of canine oesophageal foreign bodies through a gastrotomy approach: 12 cases. J Small Anim Pract. 2016;57(7):354–359.
- 21. ↑
Follette CM, Giuffrida MA, Balsa IM, et al. A systematic review of criteria used to report complications in soft tissue and oncologic surgical clinical research studies in dogs and cats. Vet Surg. 2020;49(1):61–69.
- 22. ↑
Delligianni A, Papazoglou LG, Savvas I, et al. Transdiaphragmatic gastrotomy for the extraction of distal esophageal foreign bodies in 13 dogs (1997–2016). J Am Anim Hosp Assoc. 2020;56(1):17–22.
- 23. ↑
Leib MS, Sartor LL. Esophageal foreign body obstruction caused by a dental chew treat in 31 dogs (2000–2006). J Am Vet Med Assoc. 2008;232(7):1021–1025.
- 24. ↑
Spielman BL, Shaker EH, Garvey MS. Esophageal foreign body in dogs: a retrospective study of 23 cases. J Am Anim Hosp Assoc. 1992;28:570–574.
- 25. ↑
Flanders JA. Problems and complications associated with esophageal surgery. Probl Vet Med. 1989;1(2):183–194.
- 26. ↑
Zimmer JF. Canine esophageal foreign bodies: endoscopic, surgical, and medical management. J Am Anim Hosp Assoc. 1984;20(4):669–677.
