Gastrotomy approach for removal of an oesophageal foreign body in a dog

Abstract A 9‐year‐old castrated male Kaninchen dachshund dog weighing 4.18 kg was referred to our institution and presented with occasional vomiting and dysphagia. The radiographic examination revealed a long radiopaque foreign body located throughout the thoracic oesophagus. Endoscopic removal was attempted using laparoscopic forceps but was unsuccessful as the foreign body was too large to be grasped. A gastrotomy was therefore performed, and long paean forceps were gently and blindly inserted into the cardia of the stomach. The bone foreign body was grasped with the long paean forceps under fluoroscopy and withdrawn from the oesophagus while checking with an endoscope. A gastrotomy approach using long forceps, endoscopy and fluoroscopy should be considered for removal of oesophageal foreign bodies from patients in which an endoscopic approach has been unsuccessful.


INTRODUCTION
Oesophageal foreign bodies (EFBs) are inanimate objects that do not normally advance into the stomach after being ingested. EFBs are commonly found immediately caudal to the pharynx, thoracic inlet, heart base and distal to the oesophagus. These objects might induce oesophageal obstruction to varying degrees (Radlinsky & Fossum, 2019;Runge & Culp, 2013). The most common foreign body type in dogs is ingested bones or bone fragments (Kyles & Huck, 2018).
The usual treatment for EFBs is endoscopic removal or, if this is not possible, advancement of the foreign body into the stomach can be attempted (Runge & Culp, 2013). If neither technique is successful to facilitate anterograde removal, the use of long forceps might be performed (Yoon et al., 2009 report describes gastrotomy for retrieval of a long foreign body that occupied the full length of the thoracic oesophagus.

CASE PRESENTATION
A 9-year-old castrated male Kaninchen dachshund, weighing 4.18 kg, was referred to our institution. He presented with occasional vomiting and dysphagia. According to the owner, the dog had picked through the garbage a week earlier. Radiographic examination revealed a long, radiopaque foreign body in the thoracic oesophagus ( Figure 1). Radiographic images showed no abnormal findings other than a foreign body.
The foreign body was identified as a lamb bone. Complete blood count and routine serum biochemistry were normal. Removal of the foreign body was performed at the first visit.
F I G U R E 1 Right lateral thoracic radiography showing a radiodense oesophageal foreign body.
Therefore, laparotomy was performed. A ventral midline incision was made from the xiphoid process to the umbilicus. Then, the stomach was isolated from the surrounding organs with a moistened surgical towel. An incision was made between two stay sutures, whereas gastric contents were suctioned using an aspirator. Long paean forceps

DISCUSSION
As in the present case, most EFBs are radiopaque and easily detected by radiography. Bones are the most common cause of oesophageal obstruction ranging in incidence from 29.7% to 80% (Luthi & Neiger, 1998;Rousseau et al., 2007;Thompson et al., 2012). The owner identified the foreign body as a rib bone that they had previously thrown away. Bony EFBs are commonly found at the distal thoracic oesophagus, followed by the heart base, caudal pharynx and thoracic inlet (Thompson et al., 2012). There were few reports of foreign bodies present throughout the thoracic oesophagus.
Retrieval of ESBs is usually attempted endoscopically using grasping forceps or a balloon catheter. Success rates of endoscopic removal or dislodgement have been reported as 95%, and dislodgement was impossible in three dogs with moderate-to-severe oesophagitis induced by ESBs (Rousseau et al., 2007). In the present case, endoscopic removal was unsuccessful as the foreign body was too large to be grasped with the forceps. A gastrotomy approach was, therefore, performed using a long forceps technique under fluoroscopy.
The foreign body did not easily pass through the cardia due to its curved shape; however, successful removal was achieved under fluoroscopy by guiding the cardia to the tip of the bone with tweezers which enabled subsequent withdrawal from the oesophagus. In a previous report, EFBs were blindly palpated through the oesophageal hiatus and retrieved by gastrotomy using the long forceps technique (Yoon et al., 2009). The authors did not use an endoscope during the surgery and thus were unable to assess the oesophageal mucosa.
In this present study, the foreign body was easily grasped under fluoroscopy and concurrent endoscopic visualisation facilitated assess-ment of any oesophageal mucosal damage. Therefore, sucralfate was used only perioperatively. As no surgical complications were observed in the present case, this technique could help avoid the need for more invasive oesophageal surgery. However, complications such as iatrogenic damage or perforation caused by forceps must be considered.
Delayed complication, such as stricture, occurring a few weeks after EFB removal, may also result from damage to the deeper layers of the oesophageal wall (Rousseau et al., 2007;Kyles & Huck, 2018;Radlinsky & Fossum, 2019).

CONCLUSION
A foreign body that occupied the full length of the thoracic oesophagus was successfully removed using a gastrotomy approach aided by fluoroscopy and endoscopy. A good outcome was achieved with no complications. This technique should be considered for patients in which an endoscopic approach has been unsuccessful. The data that support the findings of this study are available from the corresponding author upon reasonable request.

ETHICS STATEMENT
Approval from the Ethics Committee was not needed for the completion of this case report.

FUNDING
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.