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Friday, January 9, 2009
Solution for case 10

Radiographs show radiopaque foreign body (FB) in pharyngeal region (indicated by green lined boxes/areas).

Differentials for the signs presented:

  • Rabies
  • FB
  • Toxin ingestion
  • Esophageal stricture
  • Laryngitis
  • Congential/Acquired esophageal weakness
  • Cricopharyngeal Achalasia
  • Pharyngeal Dysphagia
  • Esophageal neoplasia
Rabies should always be suspected in all the cases of hypersalivation, dyaphagia and FB.

Esophageal stricture (cicatrix) can form from a prior esophagitis (e.g., subsequent to foreign bodies or severe gastroesophageal reflux) of any cause.

Laryngitis was ruled out due to lack of cough on palpation.

Congenital/Acquired esophageal weakness usually present with regurgitation with or without weight loss and were ruled out from the radiographic findings.

Cricopharyngeal achalasia is usually congenital and there is an incoordination between the cricopharyngeus muscle and the rest of the swallowing reflex which produces an obstruction at the cricopharngeal sphincter during swallowing.

Pharyngeal dysphagia is an acquired disorder related to myopathies, neuropathies and junctionopathies and the inability to form a normal food bolus. This would present most often in an older animal with regurgitation associated with swallowing.

Esophageal neoplasia such as primary sarcomas (due to Spirocerca lupi), primary carcinomas, leiomyomas/sarcomas were ruled out due to the age of the patient and toxin was ruled out due to the absence of more severe clinical signs.

Treatment and Management:
Surgical removal of the bone foreign body was decided to be the best treatment for this patient. The patient was sedated with 3mg/kg Propofol intravenously. Her oral cavity was evaluated with a laryngoscope and the FB was removed with alligator forceps. The FB was positively identified as fish bone vertebrae. The patient was given 2mg/kg ketoprofen subcutaneously for pain management and to reduce esophageal inflammation. After recovering from anesthesia puppy was offered some soft food which she ate immediately.

The patient was given Clavamox 15 mg/kg bid for 7 days and advised the owner to feed the puppy soft diet for 2 weeks. The patient has now made a full recovery.

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posted by Dr Banga's Websites @ 12:00 AM  
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