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in a weanling foal and Reichelt et al. (2012) described 2 successful cases of mature horses suffering from repeated episodes of choke. Both reports described acquired oesophageal strictures, not congenital problems. In humans, dogs and cats the method is well established with positive results in noncomplicated acquired cases (Siersema 2008; Bisset et al. 2009). Since there are no detailed descriptions on how to perform oesophageal balloon bougienage procedures in neonate foals, the method performed in this case was based on the method routinely used in the small animal department of the KSVM-VTH (similar to the method described by Bisset et al. 2009, without the use of a guide wire in the filly). In the case described here, the bougienage attempts were difficult to perform. Since the stricture site was very narrow and firm, the balloon would constantly slip out orally or aborally when dilated with saline, especially in the first session. The initial dilatation attempts seemed to be painful and eventually did not result in any significant improvement, endoscopically or clinically. The second session, several days later, was performed under heavier sedation and the prophylactic use of nonsteroidal anti-inflammatory analgesia treatment. This session seemed to be more successful. Some dilatation of the stricture was achieved and marked clinical improvement was observed on the following day. Most evident was the cessation of the bruxism and foaming, which were probably related to the discomfort caused by the oesophageal dysfunction. Their cessation was related to the relief the filly must have felt when the obstruction and dysfunction had improved. The final mark of improvement was the ability of the filly to suckle without regurgitation on the day following the second bougienage. Before that day, every attempt at suckling resulted in immediate milk regurgitation and accumulation in the proximal oesophagus. On the final endoscopy, the stricture was still evident; however, the function of the proximal oesophagus and the peristalsis at the stenotic site had improved considerably. Despite the positive outcome, further bougienage sessions were not performed due to financial constraints and the owner chose to take the filly home. It is possible that more sessions would have resulted in further endoscopic improvement. Furthermore, conducting the procedure under general anaesthesia, as in dogs and cats (Bisset et al. 2009) may have been more productive, less painful and perhaps would have achieved more dilatation. The decision not to perform the dilation procedures under general anaesthesia was due to the aspiration pneumonia and indeed, the general anaesthesia that had to be used for the CT scan seemed to cause some clinical deterioration in the pneumonia. The case presented here describes an uncommon
congenital oesophageal obstruction causing milk regurgitation. Since an anatomical abnormality was not found in conjunction with the positive progression of the case, a functional stricture or stenosis accompanied by dysfunction of the proximal oesophagus were diagnosed. Pharmacological treatment alone was not successful; however, the use of balloon bougienage resulted in clinical improvement and thus may be a viable treatment option for congenital oesophageal stenosis/stricture in foals.
Authors’ declaration of interests No conflicts of interest have been declared.
Manufacturers’ addresses
1Intervet International B.V., Unterschleisheim, Germany. 2MILA International, Inc. Erlanger, Kentucky, USA. 3GE Healthcare Ireland, Cork, Ireland. 4Sandoz GmbH, Kundl, Austria. 5Bodene (PTY) Ltd, Port Elizabeth, South Africa. 6Dexcel Pharma, Or Akiva, Israel. 7Divasa-Farmavic, S.A., Gurb-Vic (Barcelona), Spain. 8Boehringer Ingelheim, Ingelheim am Rhein, Germany. 9Teva Pharmaceuticals Works Private limited Company, Debrecen,
Hungary. 10Micro-Tech (Nanjing) Co., Ltd. Nanjing, China. 11antiMedica GmbH, Senden-Bösensell, Germany. 12Norbrook, Newry, Ireland.
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