Retrospective analysis of 74 horses with disorders of the oesophagus

Abstract

Retrospective analysis of 74 horses with disorders of the oesophagus 74 cases of horses which had been admitted to the Department of Large Animal Internal Medicine between 2000 and the beginning of 2010, have been analyzed retrospectively. Five of these horses are described in detail. A primary obstruction of the esophagus was diagnosed in 60 horses. The diagnosis based on the inability to pass a nasogastric tube and the treatment of choice was the esophageal lavage technique. Other diseases were esophageal dysfunction without any morphological changes, esophageal diverticula, hypertrophy of the esophageal musculature following a chronic dilatation of the stomach, distinctive ulceration of the esophagus, esophagitis because of reflux, esophageal perforation and megaesophagus. Diagnostic was made by endoscopy and radiology (with or without contrast medium). In four horses, the esophageal obstruction was removed at the time of admission in the large animal hospital. The most common localisation of obstruction was the thoracic inlet. The gullets were obstipated with beet pulp, hay or straw, pellets or beets. All horses with primary esophageal obstruction could be cured and discharged. In two cases with diverticula of the esophagus, a surgical therapy was not possible due to the localisation. Based on the poor prognosis, horses A and B were euthanized as well as horse C with chronic dilatation of the stomach, one stallion with a perforation of the esophagus (horse E) and one mare (horse F) with high grade esophagitis. Necropsy of horse A revealed a false diverticulum (11.5 x 11.0 x 8.5 cm) of Pars abdominalis of the esophagus. This outpouching contained 560 g of compact plant-derived material. Horse B showed a false diverticulum of Pars thoracica of the esophagus (length: 18 cm, maximum circumference: 32.5 cm). Cardia and Pars proventricularis were obstructed with a firm and dry conglomerate of wood shavings. Besides gastric alterations consistent with chronic dilatation of the stomach, horse C also exhibited chronic changes of the rear part of the esophagus: interstitial fibrosis in conjunction with muscular degeneration and hypertrophy, respectively. Regarding horse E, two complete transections could be detected 19 and 35 cm behind the epiglottis. Tissue surrounding esophagus was characterized by a severe chronic-active purulent and necrotisizing inflammation, which extended to the diverticula tubae auditivae. One mare (horse D) with a high-grade ulcerative primary esophagitis has been treated with omeprazol, prednisolone, amoxicillin and gentamicin. After three weeks of treatment with omeprazol and prednisolone, endoscopy showed that the esophagitis had been cured almost completely. The horse was released from the clinic with a good prognosis. If recurrent esophageal obstructions occur in adult horses, esophageal diverticula have to be considered as one differential diagnosis. Regarding the two described cases, the morphological alterations have to be classified as pulsion diverticula (false diverticula). In cont...

Esophageal disorders in horses – a review of literature

“…Craig et al (1989) reported that recurrent obstructions are common after esophageal lavage, most probably due to following anatomical complications and this decreases long-term survival rates. But a more favorable prognosis following esophageal lavage for treatment of simple choke in horses was reported by Feige et al (2000) and Breuer et al (2011).…”

“…Esophageal obstruction (choke) is the commonest esophageal disorder in the horse (Stick 1987, Knottenbelt et al 1992, Fubini 2002, Breuer et al 2011. The most commonly observed clinical sign in horses with esophageal obstruction is regurgitation.…”

“…Feed esophageal impaction has been associated with greed and poor dentition (Craig et al 1989, Hyllier 1995. The most common sites of simple obstruction are the cranial cervical esophagus caused by pieces of apples, the esophagus at the thoracic inlet and the caudal esophageal sphincter in the hiatal area caused by dry sugar beet (Feige et al 2000, Breuer et al 2011. Diagnosis is based on the typical clinical presentation and inability to pass a nasogastric tube into the caudal esophagus.…”

“…Secondary esophageal obstruction occurs due to other pathology (esophageal stricture, diverticulum, mural or extramural masses etc.) (Craig et al 1989, Feige et al 2000, Fubini 2002, Stick 2006, Breuer et al 2011.…”

“…In some horses spontaneous resolution of esophageal obstruction may happen with sedation only (Fubini 2002, Duncanson 2006. If spontaneous resolution does not occur, other medicaments including butylscopolamin bromide and metamizol should be applied (Breuer et al 2011). Oxytocin may also have a profound effect on the relaxation of striated muscle of the cranial esophagus and can assist in the alleviation of esophageal obstruction (Hance et al 1997, Meyer et al 2000.…”