98


EQUINE VETERINARY EDUCATION / AE / FEBRUARY 2018


Fig 4: Left guttural pouch endoscopy: opening to the communication with the oesophagus at the bottom of medial compartment (white arrow).


presented its clinical signs for 2 years and it was subjected to euthanasia because of uncertain prognosis. The earlier the surgical intervention is applied, the better prognosis could be expected because of numerous soft tissue adhesions (Craig et al. 1989). Oesophageal mural abscess was confirmed to be caused by Streptococcus equi ssp. zooepidemicus and we suspected that it could be a result of metastatic streptococcal infection. The abscess responded to nonsurgical treatment because it opened spontaneously. The communication between the oesophagus and the guttural pouch was an exceptional case of an acquired condition in a mature horse, which has not been described before. Clinical signs of nonpainful parotid region swelling due to the dilated guttural pouch were noted for 10 months. The abnormal guttural pouch contents caused nasopharyngeal arch deviation that precluded endoscopic examination. To obtain full visualisation of the guttural pouch and its communication with the oesophagus, an external surgical opening of the guttural pouch was required and the food was removed from the affected structures (Figs 4 and 5). Previous studies on oesophageal disorders reported that


aspiration pneumonia is the most frequent complication after oesophageal obstruction and the most frequent cause of patient mortality (Craig et al. 1989; Chiavaccini and Hassel 2010). Aspiration pneumonia was the second most common complication in our study. Its prevalence is lower compared with previous published results (Craig et al. 1989). All except one case in the group of aspiration pneumonias suffered from a simple oesophageal obstruction. A positive correlation between the duration of oesophageal obstruction before treatment and development of aspiration pneumonia was previously reported (Feige et al. 2000), but these data were not available in our group of patients. Aspiration pneumonia was distinguished from aspiration of food and saliva into the trachea without the development of ventral–cranial lung lobe opacity seen on thoracic radiograph and/or lung tissue consolidation seen on thoracic ultrasound and the alteration of respiratory pattern. Feige et al. (2000) found that the extent of tracheal contamination is not associated with subsequent development of aspiration pneumonia. The duration of oesophageal obstruction before admission was a significant risk factor for aspiration pneumonia, because the


© 2016 EVJ Ltd


Fig 5: Oesophageal endoscopy: flexible endoscope inserted in the oesophagus is in the J manoeuvre (white arrow). Opening to the communication with the left guttural pouch with the food remnants is seen (blue arrow).


longer the duration of the obstruction, the longer the dysphagia and consequently the risk of tracheal con- tamination (Feige et al. 2000; Chiavaccini and Hassel 2010). Some of the oesophageal disorders in our group lasted for a long period without the development of aspiration pneumonia. The most common complication found in our study was oesophagitis and it typically followed intraluminal obstruction. The degree of oesophageal damage has been strongly associated with the development of other complications, particularly oesophageal stricture, and an endoscopic examination of the oesophagus after a chronic oesophageal obstruction is strongly recommended (Chiavaccini and Hassel 2010). In conclusion, the most common equine oesophageal


disorder with excellent prognosis was simple oesophageal obstruction which represented half of the cases in our study. The rest of the cases included different conditions with relatively low numbers of cases. Morphological abnormalities showed a good outcome when treated surgically. Our study represents the first descriptive analysis of oesophageal disorders in horses at a referral clinic in the Czech Republic, but because of the high number of different disorders, further study on more cases could be helpful in the future.


Authors’ declaration of interests No conflicts of interest have been declared.


Ethical animal research Retrospective clinical case study, no approval needed.


Source of funding None.


Acknowledgements


The authors acknowledge the kind assistance and data received from the Equine Clinic and Faculty of Veterinary Medicine, UVPS Brno.


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68  |  Page 69  |  Page 70  |  Page 71  |  Page 72  |  Page 73  |  Page 74  |  Page 75  |  Page 76