The esophagus is a muscular tube that connects the mouth to the stomach. When a dog eats, the food is swallowed and passed down into this tube, then through coordinated muscle contractions the bolus of food is passed into the stomach. If a dog has megaesophagus, this process does not occur properly and food either gets stuck passively in the esophagus or accumulates in the dilatation of the esophagus before the entrance to the stomach (near the lower esophageal sphincter). Fortunately, if you properly organize the process of feeding your puppy and select the right diet, you can relieve the symptoms of this condition.

Steps

Part 1

Feeding a dog suffering from megaesophagus

1. Feed your dog from an elevated bowl. The normal posture for a dog while feeding is to stand on all fours with his head down towards the bowl on the floor; This position is not suitable for a dog suffering from this disease. The easiest way to help your dog is to let gravity work in your favor and feed your dog by raising the bowl higher. It is optimal if the dog’s neck and body are at an angle of 45-90 ° to the surface.

   • To do this, place the food bowl on a chair or low table, depending on the size of the dog. For example, for a Labrador, place food on a surface that is 60-90 cm above the ground. In order to reach the food at such a height, the dog will need to place its front paws on the surface. This will have certain advantages because when the dog lifts his front legs, his stomach is lower than his esophagus.
   • If we talk about anatomy, then a dog that eats food in normal position, food rises up from the mouth to the stomach. In a dog with megaesophagus, the muscle contractions of the esophageal walls are too weak to allow food to rise up against gravity and past the gastric sphincter.

2. Raise your dog's paws and head after eating. In addition, after finishing eating, the dog should rest in a similar position with its paws and head raised. Food does not pass immediately into the stomach, so you need the dog to maintain this position for ten to twenty minutes after eating.

   • Make sure your dog can lean on a couple of pillows or a blanket. Over time, you can teach your animal to sit like this after eating, even if you are not around.

3. If possible, feed your dog liquid food. In a dog with a vascular ring anomaly, the lumen of the esophagus is narrow and long, but this is enough to swallow liquid food. Liquid food passes freely through the narrow esophagus, and a dense bolus of food gets stuck in the narrowed lumen and moves backward. If it is not possible to undergo surgery on the animal, such a dog should eat liquid food from a bowl that is raised up.

   • There is a special high-calorie food for dogs that is sold in canned form. In the jar it is dense, but when crushed with a fork (with or without adding water) it becomes liquid consistency. This will provide a balanced diet for your pet.
   • Alternatively, you can grind in a blender regular food, so that it acquires a mushy consistency.

4. Try to find the right consistency of food for your dog. In addition to a liquid diet, it is worth experimenting with different food textures: dry and granular feed, pieces of regular, wet food or pureed food. It is impossible to predict in advance which texture may pass better through the esophagus. Sometimes fluids pass well, but because of solid food, the muscles of the esophagus contract.

   • You can prepare “meatballs” for your dog; they are made from dry biscuits, which are crushed and rolled into balls. You need to feed by hand, giving the animal one ball of food at a time. Maybe, round form allows such food to pass down the esophagus more easily, or perhaps hand feeding allows the dog to be fed slowly. Some dogs are suited to this type of feeding.

5. Pay attention to your dog's weight. A dog with megaesophagus may lose weight without getting the required daily amount of calories. If you have changed your dog's diet and feeding method and your dog is still underweight or continues to lose weight, contact your veterinarian immediately. Proper nutrition is essential for your dog's health.

   • The main thing when caring for a dog with megaesophagus is to ensure that as much food as possible passes through the esophagus into the stomach. If this does not work for you, you need to consider the possibilities medical care animal.

Part 2

Medical Treatments for Your Dog's Disease

1. Consider surgery. Some dogs have normal motility but have an anatomical abnormality, such as a vascular ring abnormality, that interferes with the passage of food through the esophagus. An experienced thoracic surgeon can correct this disorder. Abnormal blood vessel can be surgically secured and removed to free the esophagus from the ring constricting it.

   • A vascular ring is a birth defect that occurs in a fetus when a blood vessel grows in the wrong place and compresses the esophagus. The ring prevents solid food and liquid (or just solid food) from passing through the esophagus.

2. Ask your veterinarian about the possibility of placing a gastrostomy tube. Some animals' condition is so severe that they are unable to ingest enough food to provide their body with the necessary calories and therefore lose weight. Some dogs' esophagus is so poorly functioning that it cannot pass enough fluid into the stomach, which can lead to dehydration. In these cases, the installation of a gastrostomy tube is necessary.

   • A gastrostomy tube is a feeding tube that gives direct access to the stomach. This tube is inserted into the animal under general anesthesia. In this case, a soft rubber tube is inserted into the stomach cavity. is secured there and brought out through a surgical incision in the body wall. Feeding through the tube is carried out exclusively with liquid food, but its advantage is that the food goes directly into the stomach.
     • However, the gastrostomy tube requires constant care and strict hygiene to prevent infection around its insertion site. Food should only be liquid. After each meal, the tube should be rinsed with water to remove any residue. food products which may contain bacteria. Because the tube goes directly into the stomach, it cannot be flushed disinfectants so it needs to be washed big amount water. This requires enormous responsibility on the part of the dog owner.

3. If possible, treat the underlying condition. Sometimes megaesophagus is a symptom of another health problem, such as a disease thyroid gland or myasthenia gravis. Treatment of the underlying condition may help improve esophageal motility.

   • However, in most cases there are no predisposing factors, so the animal needs constant monitoring rather than treatment. Unfortunately, there are no effective medications that increase contraction of the esophageal muscles.
   • The drug metoclopramide is sometimes used to increase muscle contraction in the stomach and lower esophagus. The disadvantage of this drug is that it simultaneously increases the tone of the gastric sphincter. It turns out that the esophagus effectively pushes food, but runs into a “closed door” of the gastric sphincter, thereby the problem remains unresolved.

It is difficult to differentiate between regurgitation and vomiting, but there is a fundamental difference between the two actions. Vomiting consists of food that has already entered the stomach and requires forceful muscle contractions, often involving the diaphragm and abdominal muscles, to empty the stomach of these contents. Vomit is usually partially or completely digested depending on how long the food has been in contact with digestive acid in the stomach.

Please note that secondary complications such as secondary pneumonia may develop. Your puppy is at risk of accidentally inhaling food or liquid into his lungs. This can lead to secondary pneumonia, in which case the dog will be lethargic, coughing, panting and refusing to eat. In dogs with secondary pneumonia, the condition is usually very severe, elevated temperature may last for four to five days. The cough is usually wet and severe.

• If a dog inhales at the wrong time while regurgitating food, it can cause “aspiration pneumonia,” which is very dangerous and requires treatment with antibiotics. Be alert for any cough, and always seek medical attention. veterinary care if you feel that the dog is suffocating.

• If your pet has a gastrostomy tube inserted, it is common for an infection to develop around the site where the tube passes through the skin. In this case, it is necessary to treat with antibiotics, and if the infection is serious, then it is necessary to remove the tube and then insert a new one under general anesthesia.

Esophagitis in dogs is called acute or chronic inflammatory process, affecting the esophageal mucosa. It is also possible that the submucosal and mucous layers of the organ may be involved in the pathological process. Causes of the disease: The main cause of this pathology is considered to be the reflux of gastric contents back into the lumen of the esophagus. This process helps reduce the tone of the lower esophageal sphincter. This may be due to the use of anesthetics during surgery and improper placement of the gastric tube. Also, esophagitis in dogs can develop as a result of the action of various irritants. It's about about caustic soda and some medications.

Others possible reasons diseases in animals are:

1. Constant vomiting

2. Excessive consumption of hot liquids by the dog.

3. Entry of a foreign body into the esophagus, resulting in its damage.

4. Congenital anomalies of the esophagus.

5. Infectious pathology.

When gastric contents backflow, damage to the esophagus occurs. It is associated with the action of hydrochloric acid, pepsin, trypsin, bile acids, etc. These components are found in gastric juice. As a result, an inflammatory process occurs. It leads to a deterioration in the passage of food masses through the esophagus. It must be remembered that esophagitis in dogs is characterized by a decrease in the tone of the lower esophageal sphincter. As a result, the formation occurs vicious circle. Note that saliva contains a large number of bicarbonates, which can reduce the pathogenic effect of stomach contents. Diseases and recommendations for the Rottweiler

Therefore, decreased salivation contributes to the worsening of the problem.

Clinical picture

First of all, esophagitis in dogs is manifested by impaired swallowing followed by refusal to eat. This leads to weight loss and the development of anorexia. In some cases, pain is detected when palpating the cervical portion of the esophagus.

Diagnosis of the disease

To exclude other causes of backflow of gastric contents into the lumen of the esophagus, the use of plain radiography is indicated. It is also possible to use a contrast study. With esophagitis, an uneven nature of the esophageal mucosa is detected. Endoscopy is considered the most informative way to diagnose the disease. It helps to identify redness of the mucous membrane, as well as ulcers and erosions. Esophagitis in dogs must be distinguished from narrowing or dilatation of the esophagus, a foreign body, or a tumor process.

Treatment

First of all, it is recommended to eliminate factors predisposing to the disease. We are talking about removing a foreign body, treating a hiatal hernia, etc. To reduce the pathogenicity of gastric juice, histamine receptor blockers (ranitidine) are used. IN severe cases the use of omeprazole is indicated. Metoclopramide is used to increase the tone of the lower esophageal sphincter. To prevent narrowing of the esophagus, glucocorticoid drugs (prednisolone) are prescribed. If esophagitis has developed as a result of temperature or chemical damage, the animal is not fed for 1-2 days. It is also recommended to follow a diet with reduced content fat This is necessary to speed up gastric emptying and reduce the likelihood of backflow. Severe esophagitis is considered an indication for gastrostomy tube placement. Treatment of esophagitis is stopped after a satisfactory result of repeat endoscopy. The prognosis for this disease is usually favorable.

Bulavskaya A.V.

Diverticulum esophagus limited sac-like, blind protrusion of the wall of the esophagus (usually above the site of blockage, cicatricial narrowing, tumor or at the site of injury to the muscle layer), communicating with its lumen. In this case, one should distinguish between the mouth, neck and bottom of the diverticulum. In the cavity of the diverticulum, its contents accumulate, which, when decomposed, cause inflammation of the mucous membrane of the esophagus and contribute to its further expansion.

Megaesophagus expansion of the entire esophagus and a decrease in its peristalsis due to its paresis, paralysis, as well as megaesophagus, which has a congenital, genetically determined origin. In dogs with megaesophagus, the lower esophageal sphincter is either closed, lacks an opening reflex and maintains its normal tone, or is open if it has lost its tone.

Classification of pathological dilatations of the esophagus

Classification of diverticula

Esophageal diverticula are divided into:

• congenital(terriers) rarely. Occur as a result of congenital weakness of the esophageal wall or incomplete division gastrointestinal and respiratory tract during embryonic development.
• acquired are caused by stagnation of food at the site of narrowing or at the site of a foreign body getting stuck.
• true all layers of the organ protrude.
• false only the mucous membrane protrudes through a defect in the muscle layer of the wall.

By origin:

• traction due to the formation, for example, of a scar or adhesion on the outside of an organ;
• pulsion are formed as a result of increased pressure from the inside on the wall of the organ;
• traction pulsion due to the impact on the wall of the esophagus from the outside and inside.

Classification of megaesophagus

Megaesophagus is divided clinically into:

• segmental;
• generalized;

For reasons:

• congenital puppies and young dogs(approximately 1/3 of cases).

  Congenital megaesophagus of puppies can affect the entire litter and should be considered in various breeds(wire fox terrier, miniature schnauzer, German Shepherd, Great Dane, Irish Setter) as a hereditary disease. Of the cats, Siamese and their derivative breeds are the most susceptible.

• acquired by adult dogs, which is often of a secondary nature. Acquired megaesophagus, which manifests itself in dogs of all ages, most of all in older dogs, carries for the most part the nature of the idiopathic, but possibly secondary disease.

Etiology and pathogenesis

Diseases (causes) that may be associated with dilation of the esophagus (megaesophagus):

Primary dilatation of the esophagus is characterized by motor disturbances of the latter, which leads to abnormal or unsuccessful transport of food between the pharynx and the stomach. Although a complete understanding of the pathophysiology of esophageal dilatation does not yet exist, based on most studies, primary esophageal dilatation results from dysfunction of the primary motor system with (or without) secondary dysfunction of the gastroesophageal sphincter.

Etiology of megaesophagus.

Reason type	State
1. Idiopathic M.
2. Secondary(symptomatic M.):
autoimmune inflammatory diseases:	systemic lupus erythematosus, ganglioradiculitis, polyneuritis;
infections:	toxoplasmosis, canine plague, tetanus;
endocrine diseases:	hypothyroidism, hypoadrenocorticism (Addison's disease);
muscle diseases:	hereditary myopathy, polymyositis,
toxic causes:	poisoning with lead, thallium, cholinesterase inhibitors, botulism;
neurological reasons:	pseudoparalytic myasthenia gravis (also without skeletal muscle weakness), brain stem damage, polyneuritis, polyradiculoneuritis;
other reasons:	esophagitis, mediastinitis, severe exhaustion (cachexia)

Acquired dilatation of the esophagus can occur spontaneously in young dogs and cats. In most cases the cause is unclear, but may be due to diseases affecting the nervous system and skeletal muscles.

There is also no consensus among researchers on the issue of the etiology of diverticula. One of the theories in the etiology of diverticula thoracic esophagus is the theory of anomalies in the development of the aortic arch in the process of ontogenesis. In the process of ontogenesis, the transition from gill cool blood circulation to the pulmonary in the fetus occurs with the formation of six pairs of aortic arches, which are then transformed into arteries of the small (pulmonary) and systemic (systemic) circulations. The formation of the aortic arch is normally associated with the transformation of the left fourth aortic arch. With a developmental anomaly, the aorta develops from the right fourth aortic arch. As a result, the aorta is located not to the left of the esophagus, but to the right. The ductus botallus, which runs from the aortic arch to the pulmonary artery, in this case tightens the esophagus in a ring (Fig. 1).

Rice. 1 Abnormal position aortic arch. Esophageal diverticulum:

Aa-aorta;

Ar- pulmonary artery;

DV- ligamentum arteriosus (obliterated ductus arteriosus);

Ec-diverticulum of the esophagus;

H - heart;

2-7 - ribs;

Z-aperture

When the puppy eats thick, bulky food, it will accumulate in the precordial portion of the esophagus, leading to the formation of a diverticulum.

There are also traction, pulsion and traction-pulsion mechanisms for the development of esophageal diverticula.

Traction mechanism (acts externally): a diverticulum is the result of chronic periesophageal inflammation with subsequent traction of the esophageal wall by shrinking tracheobronchial lymph nodes or scars in the area of ​​the bronchi, trachea, pleura, pericardium.

The pulsation mechanism (acts from the inside) may be associated with severe degeneration of the branches vagus nerve or with an increase in intraesophageal pressure as a result of frequently repeated stretching of the walls of the esophagus by a wave of gastroesophageal reflux that occurs with a hernia hiatus diaphragm. Destructive changes in nerve trunks and cells lead to disruption of the innervation of the esophagus and disruption of the motor function of the esophagus and cardia. Weakness of the muscular wall of the esophagus, resulting from a disorder of innervation, is a condition for the development of pulsion diverticula (prolapse of the mucous membrane through a muscle defect). Weakness of the muscular wall of the esophagus can also be a congenital pathology.

Traction-pulsion mechanism (mixed): diverticula arise as a result of a traction mechanism (inflammation), and then with the long-term existence of such a diverticulum, atrophy occurs muscle fibers, a defect forms in the muscular lining of the esophagus and the mucous membrane prolapses.

Clinical symptoms

Clinical signs of both diverticula and megaesophagus are similar.

Common symptoms associated with esophageal diseases are difficulty swallowing, regurgitation of food, and increased salivation. Regurgitation is a passive, retrograde movement of swallowed food towards the upper sphincter of the esophagus; as a rule, the food does not have time to enter the stomach.

Clinical symptoms associated with esophageal dilatation usually begin when the pup becomes self-feeding. The most common type is regurgitation of food. The time intervals between eating and regurgitation depend on the degree of dilation or on the activity of the animal. Typically, both liquid and solid food are expelled equally.

Possible exhaustion, voracious appetite, general disorders due to aspiration pneumonia and esophagitis. Symptoms range from mild swallowing problems to complete paralysis with massive megaesophagus, making it impossible to eat at all.

Depending on the illness and its duration, the animal may appear quite healthy. Violations increase gradually, and the owner may not pay attention to such initial symptoms like a cough after eating or treat them as a breathing disorder. With secondary megaesophagus, dysphagia and regurgitation recede into the background compared to the symptoms of the underlying disease.

When food accumulates in diverticula or megaesophagus, disorders of the respiratory and cardiovascular systems may occur. This symptom is associated with mechanical pressure or irritation of blood vessels, nerves, and lungs due to accumulated food. This phenomenon manifests itself as follows: immediately after eating or after a short period of time, shortness of breath, anxiety, etc. occur. Moreover, these disorders disappear either after regurgitation, or disappear gradually if the food nevertheless passes into the stomach gradually. The manifestation of a particular symptom depends on the specific area of ​​the esophagus where food accumulates.

Diagnostics

A detailed medical history, as well as breed, can be very important in differentiating between surgical and non-surgical problems. If esophageal disease is suspected, an x-ray should be taken. chest. X-ray and fluoroscopy of the esophagus are two of the most useful diagnostic methods. X-rays of the esophagus can also detect the following diseases associated with it: pneumomediastinum, pneumonia, gaseous dilatation of the esophagus and mediastinum.

The diagnosis of esophageal dilatation is more than obvious if a control chest x-ray is performed. The esophageal cavity usually contains enough air and ingested food to show a couple of stripes on lateral view soft fabric, which diverge in the midthoracic region and converge in the direction of the gastroesophageal junction. In the cranial view, the dorsal wall of the esophagus merges with the longus colli muscle, forming a sharp edge. On the ventral side, the ventral wall of the esophagus forms a single silhouette with the air-filled dorsal wall of the trachea, creating a wide band of soft tissue called the tracheal stripe. When the cervical segment of the esophagus is dilated, a saber-shaped window, transparent to x-rays, is visible when viewed dorsally at the trachea and cone-shaped towards the entrance to the chest. The partially fluid-filled esophagus is visible as a uniform gray window. Noting the expansion of the esophagus, one can notice the ventral movement of the trachea and heart. In dorsoventral and ventrodorsal views, the caudal portion of the esophagus is visible as a V-shaped pair of lines on each side of the midline, converging at the junction of the stomach and esophagus.

A positive contrast esophagogram is performed if the diagnosis cannot be made on a chest radiograph and esophagoscopy cannot be performed. Barium paste and liquid barium are the most common contrast agents. However, if there is a suspicion of esophageal perforation, it is better to use barium instead water solution organic iodine to accurately eliminate perforation. Contrast radiography very clearly determines the degree of dilation of the esophagus, loss of function and the extent of the anomaly. It gives a complete picture of the size and position of the diverticulum, the patency of the esophagus, the size and condition of the neck of the diverticulum, i.e. filling and emptying of the sac, the condition of the mucous membrane. Often, weakened mobility of the esophagus is observed on esophagograms using liquid barium suspension, but this method is used primarily to confirm the contractility of the esophagus. Esophageal motility disorders are best detected by mixing barium suspension with food. An esophagus with impaired contractility is unable to move the mixture of feed and barium towards the stomach. If there is no contrast material in the stomach, as can be seen on the initial radiograph, the animal's anterior quarter should be elevated for a few minutes to allow the contrast material to enter the stomach by gravity, and then another radiograph should be taken.

The normal dog esophagus has linear bands of mucous membrane along its entire length, while the normal cat esophagus has circular mucous folds that, after the injection of a contrast agent, look like a fish skeleton.

Diagnostic tests

Esophagoscopy is very convenient in order to detect morphological abnormalities: the condition of the mucous membrane (esophagitis), the size and content in the lumen of the esophagus, neoplasms, and also for carrying out full examination. But, at the same time, megaesophagia cannot always be detected using this method(this is likely due to anesthesia, which can change the diameter of the esophagus): upon careful examination, we can see a significantly relaxed esophageal wall. In the diagnosis of diverticula, esophagoscopy is of auxiliary value, since X-ray examination provides, as a rule, comprehensive data.

Differential diagnosis

An enlarged esophagus can be observed in brachycephalic breeds, which is not a pathology and must be distinguished from congenital anomalies, a similar condition is often found in Shar Peis. They have a diverticulum-like loop of the esophagus before the entrance to the chest.

Dilatation of the esophagus on chest x-rays is not always a pathological finding. Transient dilatation of the esophagus is often due to the following reasons:

• aerophagia;
• animal anxiety;
• breathing problems (shortness of breath);

  Anesthesia;

• vomit.

Forecast

The prognosis depends on the severity and size, volume of the diverticulum or megaesophagus, as well as the ability to influence the underlying disease and its complications. The prognosis is more favorable in cases where the pathology is detected in puppies than in adult dogs.

The best prognosis will be the early detection of these pathologies and the use of an appropriate nutritional system. Dilatation of the esophagus in puppies and kittens can be diagnosed at the time of weaning, and if treatment is started at this time, the prognosis will be much better than for those pups whose treatment began later at 4-6 months. But if the animal already has an enlarged esophagus, then a complete non-surgical cure is impossible. Retention of food in the diverticulum sac leads to the development of chronic diverticulitis (inflammation of the mucous membrane of the diverticulum), sometimes with ulceration of the mucous membrane and subsequent perforation into the mediastinum, pleural cavity or light.

In the case of acquired enlargement of the esophagus, treatment can be successful. However, if the dilation of the esophagus was a consequence of some systemic diseases, then the treatment gives a very weak result. Death due to pneumonia, gastroesophageal retraction, cachexia and other diseases.

Treatment

The choice of one or another method and method of treatment depends on a number of reasons: the individual characteristics of the pathology, the age of the animal, the degree of neglect of the disease, as well as the presence of the necessary experience in thoracic operations by the surgeon. It should be noted that only radical surgical treatment can completely or partially eliminate the pathology. Conservative treatment is the treatment of choice for mild cases and only in young animals. IN advanced cases, with significant disturbances in esophageal motility, non-surgical treatment plays only a palliative role, or will be carried out after surgical intervention.

Surgical treatment

Methods and principles of surgical operationson the esophagusBasic principles

The esophagus is predisposed to postoperative dilatation due to several inherent characteristic features, including a segmental blood supply and the absence of a serous covering to facilitate plug formation.

Constant movement of the esophagus and irritation of the lumen by food and saliva also plays a role in the development of postoperative complications.

Excessive tension on the anastomotic suture line after resection can also lead to rupture, so tension should be avoided. Careful, non-traumatic handling of tissues is very important.

Preoperative antibiotics are indicated, because the operation is classified as “clean contaminated,” and if there is perforation, it will already be “dirty.”

Indications for surgery:

with megaesophagus, when solid food does not enter the stomach of an adult dog sitting or standing on its hind legs;

with large and small diverticula with retention of contrast suspension in the bag;

in the presence of diverticulitis;

with pronounced clinical picture diseases (dysphagia, regurgitation, vomiting after each meal) regardless of the size of the diverticula;

for complications of the diverticulum (esophagobronchial or esophagotracheal fistula, ulceration and necrosis of the diverticulum, bleeding, neoplasm).

Contraindications:

old animals;

animals with diseases of cardio-vascular system; animals with diseases respiratory system; severe dysfunction of the liver and kidneys.

In these cases, the risk from carrying out general anesthesia And artificial ventilation the lungs are very large.

Surgical treatment of megaesophagus

Myotomy of the distal circular muscles of the esophagus (Geller myotomy) is performed. This surgery is not recommended for young dogs as it may promote reflux esophagitis or intussusception of the stomach into the esophagus when reduced closing tone of the lower esophageal sphincter is already present.

Left thoracotomy in the 9th or 10th intercostal space. A napkin soaked in warm saline is placed on the cranial lobe of the lung and moved cranially. The pleura is then incised and the esophagus is carefully separated from the diaphragm at the hiatus. After this, the cardia can be slowly pulled out to a sufficient distance.

Using a longitudinal incision caudal to the dilated portion of the esophagus, the mediastinum and longitudinal muscles of the esophagus are dissected to the cardia. Using small Metzenbaum scissors (with notches on the cutting edge), carefully cut the circular layer of the muscular layer (circular muscles). When the fibers of the circular layer of the muscular layer are pulled apart, the mucous membrane protruding forward becomes visible.

The bleeding is minor; it is stopped with gauze soaked in warm saline. In the area of ​​the submucosa and mucous membrane, the use of coagulation, ligation, pinching or suturing methods to stop bleeding is not allowed, as this can cause tissue necrosis.

The esophagus and diaphragm are connected and secured with several interrupted stitches. To do this, the diaphragm can be sutured to the spread edges of the incision made during myotomy in the area of ​​the cardia. The esophagus is sutured in such a way as to prevent narrowing of the esophageal opening of the diaphragm. A strongly dilated esophagus can be “picked up” in the longitudinal direction, thereby narrowing it, and then sutured. If necessary, install a suction drain (due to the risk of aspiration).

Follow-up treatment. The suction drain is removed after breathing normalizes. During feeding for 4 weeks, the dog must sit or stand on its hind legs. Food should be given several times a day in small portions. During the first days after surgery it should be liquid and then mushy. Starting around the 10th day, the dog can be gradually given more solid food.

Surgical treatment of diverticula

There are three main methods of operation:

Method 1. For small diverticula, surgery is performed using the intussusception method. After operational access to the esophagus and the presence of a limited unilateral protrusion of the mucous membrane, the latter is set into the lumen of the esophagus without opening its walls. 3-4 loop-shaped sutures are applied to the resulting longitudinal surface, in the transverse direction of the esophagus, piercing only the adventitial and muscular layers (according to Lambert or Plakhotin). The submerged fold of the esophageal wall in its lumen gradually atrophies and does not interfere with the passage of food through the esophagus.

Method 2.IN in cases where the diverticulum has big sizes and it cannot be sutured; it is cut open. It is advisable to excise only the adventitial muscular part of the esophageal wall in the form of an elliptical flap without opening the mucous membrane. The latter is set into the lumen of the esophagus, and the adventitial muscular wound of the esophagus is sutured with interrupted knotted sutures.

Method 3. If below the diverticulum there is an area of ​​sharp narrowing of the esophagus (which caused the development of a diverticulum), no more than 3-4 cm long, a completely narrowed section of the organ is cut out and the esophagus is connected end to end with a two-story suture in the same way as the two ends of the intestine are sutured. In the surgical area, the esophagus is sutured to the visceral fascia. This method is used in extreme cases.

Sutures on the esophagus

Closure of the esophagus is best accomplished using a two-story, simple interrupted suture. This method provides greater strength, better tissue registration (without crushing the edges by gently closing them) and healing than a single-story suture. The first floor of sutures connects the mucosa and submucosa using knots tied inside the esophageal lumen. The second floor of sutures connects the muscles and the adventitia, and on it the knots are tied from the outside. Sutures are placed very carefully at a distance of 2 mm from each other. Continuous sutures should be avoided as they do not provide the same degree of healing and result in less satisfactory tissue closure (Figs. 2, 3).

Rice. 2 Stitching of the mucous membrane and submucosal layer (invaginating interrupted suture).

Rice. 3 Stitching the muscular membrane (interrupted suture).

For surgical operations on the esophagus, an inert, absorbable, monofilament suture material(size 3-0 and 4-0) with high tensile strength, such as polydioxanone and polyglecaprone 25, as well as small diameter round and ribbon needles, as they penetrate the submucosa more easily.

Plastic and strengthening of seams.

Without the use of plastic surgery, the possibility of divergence of the sutures of the esophagus and the occurrence of relapse is quite real, since the use of the muscular membrane itself (multi-row sutures) in some cases can lead to a narrowing of the lumen of the esophagus, and in others this technique may be insufficient due to atrophy of the muscle bundles, due to How does relapse of diverticulum occur? Therefore, the outcomes of surgical treatment of esophageal diverticula depend mainly on how reliably the muscle layer of its wall is strengthened.

Plastic surgery of the esophagus is used with a flap of the parietal pleura and pericardium, and a pedicled omentum. All these tissues have good adherence to the esophagus. Sutures in the esophagus can also be reinforced with a pedicled diaphragm flap in the form of a cuff.

A flap of the diaphragm, cut to preserve blood circulation in it, adapts perfectly to the esophagus, completely replacing its wall even when large penetrating defects are created in the esophagus. The diaphragm differs from other tissues in its great strength, elasticity and excellent regeneration capabilities. Long flaps should be cut from the costal part of the diaphragm with the base at the posterior edge of the left lateral part of the tendon center. When cutting out a flap in this way, the muscle part is used for plastic surgery, and the tendon part is like a leg. A shorter flap can be cut from the costal part of the diaphragm with the base facing the esophagus. Considering that in the muscular part of the diaphragm the distribution of vessels and nerves corresponds mainly to the course of the muscle bundles, it is better to make incisions for cutting out flaps, orienting themselves in their direction. At the same time, the blood supply and innervation of the flaps is preserved, which creates Better conditions their engraftment and regeneration.

There are also other methods of esophageal plastic surgery that use gastric and intestinal autografts.

In the absence of indications for surgical treatment or if there are contraindications to surgical intervention there is a need for conservative treatment.

Conservative treatment

Treatment is based on the assumption that any retention of fluid or solid food in the esophagus increases esophageal dilatation and aggravates aspiration pneumonia. When treating a dilated esophagus, a targeted diet is necessary. It is necessary to frequently provide nutritious food of the appropriate composition for each animal (one needs a large volume, the other semi-liquid food such as porridge) in correct position. In most cases, this leads to spontaneous improvement if the abnormality is detected immediately. In addition to eating nutritious food, you should avoid heavy loads and stretching of the esophagus until its normal motor function develops. However, stagnation of the contents of the esophagus can lead to gradual expansion and atony.

For idiopathic megaesophagus in adult dogs, in addition to ensuring nutrition in the correct position ( alternative way gastrostomy tube feeding), symptomatic improvement can be achieved by parenteral antibiotics to treat aspiration pneumonia. If polymyositis is suspected or immune diseases You can try giving 2 mg/kg prednisolone daily initially, then every other day. If myasthenia gravis is suspected, based on evidence of the presence of acetylcholine antibodies in the serum, treatment with neostigmine (0.5 mg/kg) should be tried.

Principles of treatment of megaesophagus:

1. Eliminate the cause, if possible.

2. Reduce the likelihood of aspiration of esophageal contents (feed the animal in vertical position, When top part body above the bottom at least at 45°). The animal must remain in this position for at least 10 minutes. after meals and before bed.

3. Increasing the amount received from food nutrients(if possible, feed the animal 2-4 times a day).

Clinical manifestations of the disease with small diverticula are associated mainly with diverticulitis, which very often causes inflammatory changes in the mucous membrane of the esophagus at the level of the diverticulum, i.e. segmental esophagitis. Due to this conservative treatment diverticula should be aimed at eliminating or reducing these inflammatory changes. Diet and diet therapy are of great importance. Prohibition has a certain meaning medicines irritating the mucous membrane of the esophagus and stomach (drugs salicylic acid), as well as drugs that enhance gastric secretion (caffeine, corticosteroids, etc.).

Dilatation of the esophagus in dogs - pathological condition arising due to impaired motor skills. It is caused by various reasons and is divided into megaesophagus and esophageal diverticulum.

Megaesophagus in dogs is characterized by severe diffuse disturbance of esophageal peristalsis, as a result of which the esophagus expands and becomes atonic (deprived of normal tone).

By origin they are divided into congenital and acquired. The causes of the congenital type are myasthenia gravis, neuropathy, and hiatal hernia. The German Shepherd, Great Dane, Irish Setter, Wire Fox Terrier, Miniature Schnauzer, Labrador Retriever and Newfoundland are predisposed to it. Acquired megaesophagus, in turn, is divided into idiopathic (due to neuropathy) and secondary. Acquired secondary megaesophagus is a consequence of the main (primary) disease of the animal, which may be: myasthenia gravis, autoimmune diseases, polymyositis, hypoadrenocorticism (Addison's disease), hypothyroidism, hiatal hernia, malignant myasthenia gravis, heavy metal poisoning, polyradiculoneuritis, esophagitis, canine distemper, tetanus.

The following are distinguished: Clinical signs:

• regurgitation - backflow of stomach contents into the esophagus and oral cavity;
• salivation (salivation);
• cachexia (exhaustion);
• polyphagia (increased appetite);
• aspiration pneumonia – shortness of breath, cough, hyperthermia and lethargy;
• infection of the upper respiratory tract and mucopurulent discharge from the nasal openings.

The necessary examinations include the following: laboratory research: general clinical and biochemical blood tests, thyroid function testing, ACTH stimulation test and other methods to identify the primary (main) disease. In addition, visual diagnostics are required - radiography and endoscopy. Plain radiography reveals dilation of the thoracic esophagus. Contrast radiography, in turn, colors contrast agent the lumen of the dilated esophagus and reveals the lack of evacuation of the contents of the esophagus further into the stomach.

To treat megaesophagus, special feeding conditions are required: frequent, fractional, liquid high-calorie food from high-standing bowls or vertically from the hand. Prokinetic drugs (cerucal, bethanechol), antacids, antibiotics, etc. are used. Both complications of esophageal dilatation (eg, aspiration pneumonia) and its underlying cause must be treated.

The prognosis for congenital and acquired megaesophagus is unfavorable.

Diverticulum in dogs- This is a localized pouch-like protrusion of the wall of the esophagus, interfering with its normal motility. The pathology can be congenital (muscle tissue defect) or acquired. In the second case, it occurs as a result of inflammation of adjacent tissues, due to increased pressure in the lumen of the esophagus or when obstacles arise to normal peristalsis ( foreign body in the esophagus, anomaly of the vascular ring, stricture, neoplasm).

Clinical signs the same as with megaesophagus.

Diagnosis is carried out using radiography. Plain radiography is not always informative and may not reveal dilated areas of the esophagus, especially in the anterior thoracic part. Therefore, contrast radiography helps to identify a locally enlarged esophageal cavity, which is partially or completely filled with a contrast agent. The endoscopic examination is also very informative.

Treatment:

• conservative. Includes feeding with liquid and semi-liquid food, fractional feeding and antibiotic therapy.
• operational. It is mainly used for anomalies of the vascular ring.

The prognosis for esophageal diverticulum in dogs is poor. An exception is an anomaly of the vascular ring, when due to congenital feature The vessels of the chest are compressed by the esophageal tube. The operation to eliminate this pathology is successful in most cases.

If you notice the clinical symptoms described above in your pet, immediately contact veterinary clinic for diagnosing and treating the disease of your four-legged friend.

If you have had an attack of gastritis or another disease at least once in your life gastrointestinal tract, you yourself can imagine the meaning digestive system and the consequences arising from its “problems”. In animals, everything is exactly the same, except that they cannot see a doctor on their own, and therefore their illnesses can go undetected for a long time. Especially such as megaesophagus in dogs.

The name of the pathology consists of two Latin terms. The first means “large”, the second means “esophagus”. True, the length of the organ does not change in any way. It grows in width. More precisely, the lumen of the esophagus greatly increases, inside which a kind of “pocket” is formed. In particularly advanced cases x-rays such a picture as if a dog swallowed balloon. At the same time, the lumen of the esophagus increases so that even a full stomach can be smaller in size.

Pathology can be divided into four main types: primary and secondary megaesophagus, congenital and acquired. In the first case, the “Megaesophagus” exists on its own, being the only disease. In the second, it is only a consequence of the pet’s existing pathology. Accordingly, the congenital variety is present in the dog from its very birth, in most cases being a consequence of disorders of intrauterine development and/or a genetic or autoimmune disease of the mother. Dogs become ill with acquired megaesophagus as a result of some acute or chronic diseases gastrointestinal tract.

But it is not always possible to draw an exact line between these types of ailments. Thus, esophagitis, that is, inflammation of the esophagus, can be both a consequence and a cause of dilatation (expansion) of the organ. And finding out what exactly appeared first is not possible in all cases.

The following signs may indicate that your pet has this disease:

• and/or . These are very bad effects, as they may indicate the development of inflammation in the organs of the respiratory system.
• , that is, increased salivation.
• Strong , Moreover, mucopurulent exudate is released from the pet’s nostrils.
• Decreased appetite.

Vomiting that occurs shortly after feeding is considered specific. But! Unlike other diseases of the gastrointestinal tract, the pet vomits after drinking or eating semi-liquid food. However, not all pets develop this symptom. Sometimes the disease is almost asymptomatic.

The danger of a “mega-esophagus”

What does enlargement of the esophagus entail, and why does it pose a danger to the health and even life of your pet? It's simple - in normal conditions this organ, which many see as a sort of analogue of a “garbage chute,” is actively involved in the assimilation of ingested food. When a food bolus, soaked in saliva and partially chewed, enters the esophagus, the latter begins to contract. This occurs due to the presence of striated muscles in its walls. If the walls of the esophagus are stretched to the point of a tightly stretched ball, there is no talk of any contractions.

What does this mean? Nothing good. Food that has entered the dilatation of the esophagus cannot move further. Since this organ lacks secretory glands that secrete digestive secretions, it simply is rotting. The dog also suffers from inflammation of the esophagus, which inevitably occurs against the background of the action of putrefactive microflora. Interestingly, one of the consequences of megaesophagus is: rhinitis, sinusitis, and even.

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However, there is nothing strange in such a “bouquet”: putrefactive microflora from the esophagus can (for example, with vomit) enter the lumens of the respiratory system. This ends sadly, since such a “spillover” is fraught with the development of aspiration pneumonia. Information about reverse process, when pathogenic microflora from the nose or bronchi could contribute to the appearance of a “mega-esophagus”, no.

Predisposing factors

Why can this even happen? There are many reasons. “Megaesophagus” is described by modern veterinarians as a disease specific to dogs. They also have a breed predisposition. Thus, miniature schnauzers and many types of “pocket” terriers get sick much more often, and their disease is often congenital. Because of this, breeders (conscientious, of course) try to exclude from the reproduction process those animals that had at least one ancestor with this disease in their family. However, this does not always work out.

For reasons that have not yet been clarified, there is a definite connection between the pathologies endocrine glands and an increase in the lumen of the esophagus. In particular, with diseases of the thyroid gland and pituitary gland, the frequency of esophageal pathologies increases by 11-16%. Most likely, an excess or lack of hormones leads to degradation of the muscle tissue of the esophagus. But why exactly this organ reacts so sharply to endocrine disorders is unclear.

Diagnostics

It is impossible to determine megaesophagus by eye. That’s why the doctor resorts to using several diagnostic techniques:

• Ultrasound examination easily helps to detect dilation of the esophagus. Difficulties can arise only in cases where the enlarged area is located in the chest.

• X-rays are much more reliable when the organ cavity is first filled with a contrast solution of barium sulfate. Because of the risk of aspiration pneumonia, contrast fluoroscopy is not recommended in all cases unless a definitive diagnosis is otherwise possible.