96


EQUINE VETERINARY EDUCATION / AE / FEBRUARY 2018


Diverticulum (n = 1) Cyst (n = 1) Abscess (n = 1) Communication of GP


with oesophagus (n = 1)


Megaoesophagus (n = 2)


Rupture (n = 3)


Stricture (n = 3)


Oesophagitis (n = 5)


Oesophageal obstruction (n = 22)


Fig 3: Oesophageal disorder distribution within the group of oesophageal cases.


oesophagitis as a complication of gastro-oesophageal reflux due to severe chronic pyloric ulceration (3/5, 60.00%). Reflux oesophagitis occurred concurrently with severe squamous mucosa ulceration. In two cases (40.00%), circular single lesions in proximal oesophagus were seen and we suspected previous intraluminal feed impaction and ischaemic necrosis of oesophageal mucosa to be the cause of oesophagitis. Stricture formation was a result of kick injury by another horse in two cases (2/3, 66.67%, type 1, distal third of cervical oesophagus). The other oesophageal stricture happened after long-term intraluminal obstruction (type 3, proximal third of cervical oesophagus). Two cases of oesophageal rupture (2/3, 66.67%) were caused by external blunt trauma and the third case followed long-term intraluminal obstruction and oesophageal wall necrosis. All ruptures affected the cervical oesophagus. The cyst was of embryonic origin, located in the proximal oesophagus and was the only congenital disorder in our group. The intramural abscess was caused by Strepococcus equi spp. zooepidemicus. Oesophageal diverticulum, megaoesophagus and communication between oesophagus and guttural pouch had unknown aetiologies. The range of duration of clinical signs prior to admission at


the clinic varied between 1 and 728 days. The longest duration was with oesophageal diverticulum, oesophagitis and communication between the oesophagus and the guttural pouch. All simple oesophageal obstructions, oesophagitis cases,


megaoesophagus, cyst and abscess were treated medically. All oesophageal strictures, two ruptures and communication between the oesophagus and the guttural pouch were treated medically and surgically. The response to individual treatment was not evaluated. Medical management varied according to the disorder but included sedatives, broad spectrum antibiotics, spasmolytics, oxytocin, nonsteroidal anti-inflammatory drugs, antiulcer medication, slurry diet, lavage of the oesophagus via naso-oesophageal tube (hydropropulsion), balloon dilation and bouginage in strictures and transendoscopic lavage of the spontaneously opened mural cyst and abscess. Surgical methods included oesophagomyotomy with esophagopexy in a stricture type 1, partial resection and anastomosis with distal oesophagostomy in stricture type 3,


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cervical exploration of the ventral neck area with extensive debridement of devitalised tissue and distal oesophagostomy in oesophageal rupture and closure of communication between the oesophagus and the guttural pouch with distal oesophagostomy in the other case. The horse with an oesophageal rupture after long-term oesophageal obstruction and the other individual with an oesophageal diverticulum were subjected to euthanasia before the treatment was attempted due to the poor prognosis. Complications developed in 28 (71.79%) of all cases with


oesophageal disorders. One complication was presented in 11 cases (28.21%), and two or more were seen in 17 (43.58%) of cases. Complications included oesophagitis (16, 41.02%), aspiration pneumonia (11, 28.20%), aspiration of food and saliva into the trachea (7, 17.95%), left laryngeal hemiplegia (5, 12.82%), post-obstructive megaoesophagus (4, 10.26%), dyspnoea due to tracheal compression (3, 7.69%), cellulitis (3, 7.69%), mediastinitis (2, 5.13%), colic (1, 2.56%) and re-stricture (one, 2.56%). Aspiration of food and saliva into the trachea was diagnosed during oesophagoscopy. Aspiration pneumonia was defined as the respiratory compromise together with ventral–cranial lung consolidation found during thoracic ultrasonography and/or patchy pattern or irregular soft tissue opacity on the lung fields ventral-cranially found during thoracic radiography. In the group of simple oesophageal obstruction there was no statistically significant correlation between the length of clinical signs before the admission and the development of aspiration pneumonia. Survival to discharge in all oesophageal cases was 79.49%


(n = 31/39) with 20.51% (n = 8/39) that died or were subjected to euthanasia (two of them before the treatment). Short-term survival was excellent in simple oesophageal obstruction (21/22, 95.45%). Oesophagitis had 60.00% (3/5) short-term survival rate, stricture 66.67% (2/3), idiopathic megaoesophagus 50.00% (1/2) and rupture 33.33% (1/3). The case with the diagnosis of oesophageal diverticulum was subjected to euthanasia before treatment. The patients with oesophageal cyst, abscess and communication between the oesophagus and the guttural pouch survived short term. Long-term survival data were obtained in 27 of the 31


discharged cases (range 6–47 months, average 16.3 months). Twenty-three horses were without problems (85.19%). In two horses (7.41%; simple obstruction), the obstruction reoccurred


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