RESUMO
A 1.5-year-old male German Shepherd dog was referred to a Teaching Veterinary Hospital with a chronic history of regurgitation and a previous presumptive diagnosis of megaesophagus. An esophagogram showed partial esophageal dilation, suggesting one vascular ring anomaly. Computed tomography identified a persistent right aortic arch (PRAA) and an aberrant left subclavian artery (ALSA). The patient underwent thoracotomy, ligamentum arteriosum ligation, and debridement of the periesophageal region. The ligation of the ALSA was not carried out because the esophagus was observed to be released entirely during the surgical intervention. Therefore, intervention on the subclavian artery was not necessary. Clinical follow-up occurred on seven, 14, and 30 postoperative days. The dog improved, showing only sporadic regurgitations. Clinical history and complementary exams were essential to establish a diagnosis. The liberation of the esophageal transit during surgery contributed to the decision not to perform the ALSA ligation.(AU)
Um cão pastor alemão, macho, de 1,5 anos de idade, foi atendido em um Hospital Veterinário Universitário com história crônica de regurgitação e diagnóstico presuntivo prévio de megaesôfago. Um esofagograma mostrou dilatação parcial do esôfago sugerindo uma anomalia de anel vascular. A tomografia computadorizada identificou persistência do arco aórtico direito (PAAD) e artéria subclávia esquerda aberrante (ALSA). O paciente foi submetido à toracotomia, ligadura do ligamento arterioso e desbridamento da região periesofágica. A ligadura da ALSA não foi realizada, pois, durante a intervenção cirúrgica, observou-se que o esôfago estava completamente liberado, não sendo necessária intervenção na artéria subclávia. O acompanhamento clínico ocorreu aos sete, 14 e 30 dias de pós-operatório. O cão evidenciou boa recuperação, apresentando apenas regurgitações esporádicas. A história clínica associada aos exames complementares foi essencial para o diagnóstico. A liberação do trânsito esofágico durante a cirurgia contribuiu para a decisão de não realizar a ligadura da ALSA.(AU)
Assuntos
Animais , Masculino , Toracotomia/veterinária , Cães , Refluxo Laringofaríngeo/diagnóstico , Anel Vascular/diagnóstico , Artéria Subclávia/anormalidadesRESUMO
The brachiocephalic trunk and the left subclavian artery originate from the aortic arch, and both supply blood to the head, neck, and thoracic limbs. Anatomical variations, such as an aberrant right subclavian artery, are congenital conditions rarely observed in dogs, Thus, the objective of the present report was to describe a case of aberrant right subclavian artery in a 9-year-old Dalmatian. However, this anomaly was a finding in which the patient was asymptomatic during its 9 years of life and only at this age did he exhibit signs including sialorrhea, vomiting, hyporexia, and noisy deglutition. Blood count, biochemical profile, and thoracic radiography led to a diagnosis of megaesophagus and aspiration pneumonia. Despite the recommended treatment, the patient did not respond well; as such, the owner elected to euthanize the animal. On necropsy, the right subclavian artery originated directly from the aortic arch, followed a route from left to right dorsally to the esophagus, and then formed an impression of the vascular path over the muscular wall of the esophagus. The esophagus, in turn, exhibited a flaccid wall and dilation in the caudal portion to the vascular path made by the ectopic position of the right subclavian artery.(AU)
O tronco braquiocefálico e a artéria subclávia esquerda emergem do arco aórtico e são responsáveis por fazerem o suprimento sanguíneo para cabeça, pescoço e membros torácicos. Variações anatômicas, como a ectopia da artéria subclávia direita, são alterações congênitas raramente encontradas em cães, cujas alterações do sistema digestivo acontecem em pacientes recém-desmamados e não em adultos. Assim, o objetivo deste relato é descrever um caso de ectopia da artéria subclávia direita em uma cadela, Dálmata, de nove anos de idade. No entanto, essa anomalia foi um achado do qual o paciente foi assintomático durante os nove anos de vida e somente com essa idade apresentou sinais como sialorreia, vômito, hiporexia e deglutição ruidosa. O hemograma e os perfis bioquímicos, associados à radiografia torácica, levaram a um diagnóstico de megaesôfago e pneumonia aspirativa. Mesmo seguindo o tratamento recomendado, houve piora clínica do quadro e o animal foi submetido à eutanásia. À macroscopia, a artéria subclávia direita originava-se direto do arco aórtico, fazia um percurso da esquerda para a direita dorsalmente ao esôfago e, então, formava uma impressão do trajeto vascular sobre a parede muscular do esôfago. O esôfago, por sua vez, apresentava parede flácida e dilatação na porção caudal ao trajeto vascular feito pela posição ectópica da artéria subclávia direita.(AU)
Assuntos
Animais , Feminino , Cães , Artéria Subclávia/anatomia & histologia , Artéria Subclávia/anormalidades , Anormalidades Congênitas/veterinária , Acalasia Esofágica/veterináriaRESUMO
Background: Megaesophagus is a chronic dilation of the esophagus rarely found in horses. Its a non-specific disease that is associated with several causes, and esophageal hypomotility is the dysfunction that most commonly results in organ dilation. In the literature, there are few reports of megaesophagus in horses and, to date, no cases in mule have been reported. The objective of this work is to describe a case of a donkey with thoracic megaesophagus. Case: A 16 year-old donkey, castrated male, mixed breed weighing 195 kg, was referred for clinical care with a history of 5 days of anorexia. On physical examination, apathy, cachexia, 8% dehydration, moderate enophthalmos, ptialism, bilateral nasal discharge, dry and bristling hair were observed. Due to the poor general condition, a nasogastric tube was chosen to perform enteral nutrition, however, it was not possible to progress the tube to the stomach. In order to confirm the suspicion of a possible esophageal obstruction, gastroscopy was performed, where it was possible to observe an esophageal dilation filled with bulky food located in the thoracic portion of the esophagus. In an attempt to stimulate esophageal motility, in order to promote the progression of the material present in the region of dilation, intramuscular metoclopramide was administered (two applications every 6 h), however the treatment had no effect. Due to the unfavorable prognosis and financial limitations of the owner, euthanasia was performed, which was followed by autopsy and histopathological examination. At necropsy, a marked dilation of the esophagus was observed in the thoracic portion, which was filled with approximately 500 grams of bulky food (grass). In the mucosa of this area...(AU)
Assuntos
Animais , Masculino , Acalasia Esofágica/patologia , Acalasia Esofágica/veterinária , Equidae , Endoscopia/veterinária , Trato GastrointestinalRESUMO
Background: Megaesophagus is a chronic dilation of the esophagus rarely found in horses. Its a non-specific disease that is associated with several causes, and esophageal hypomotility is the dysfunction that most commonly results in organ dilation. In the literature, there are few reports of megaesophagus in horses and, to date, no cases in mule have been reported. The objective of this work is to describe a case of a donkey with thoracic megaesophagus. Case: A 16 year-old donkey, castrated male, mixed breed weighing 195 kg, was referred for clinical care with a history of 5 days of anorexia. On physical examination, apathy, cachexia, 8% dehydration, moderate enophthalmos, ptialism, bilateral nasal discharge, dry and bristling hair were observed. Due to the poor general condition, a nasogastric tube was chosen to perform enteral nutrition, however, it was not possible to progress the tube to the stomach. In order to confirm the suspicion of a possible esophageal obstruction, gastroscopy was performed, where it was possible to observe an esophageal dilation filled with bulky food located in the thoracic portion of the esophagus. In an attempt to stimulate esophageal motility, in order to promote the progression of the material present in the region of dilation, intramuscular metoclopramide was administered (two applications every 6 h), however the treatment had no effect. Due to the unfavorable prognosis and financial limitations of the owner, euthanasia was performed, which was followed by autopsy and histopathological examination. At necropsy, a marked dilation of the esophagus was observed in the thoracic portion, which was filled with approximately 500 grams of bulky food (grass). In the mucosa of this area...
Assuntos
Masculino , Animais , Acalasia Esofágica/patologia , Acalasia Esofágica/veterinária , Equidae , Endoscopia/veterinária , Trato GastrointestinalRESUMO
Megaesófago es un término descrito por la dilatación del esófago. Las anomalías del sistema vascular son las principales causas de la disfagia y la dilatación esofágica en los animales jóvenes. Megaesófago congénito corresponde a hipomotilidad y dilatación esofágica generalizada provoca regurgitación y el subdesarrollo del cachorro después del destete. Se concedió un perro de 40 días de edad, de sexo femenino, sin raza definida, con antecedentes de disfagia y regurgitación. El animal se sometió a un examen físico, y también se hizo un hemograma y radiografías simples de las cavidades torácica y abdominal, las posiciones de lado derecho y ventral-dorsal. En la exploración física se observó inflamación en la región del esófago cervical. En el examen radiográfico se observó un aumento de volumen en el esófago medio, cerca de la base del corazón, donde el esófago dilatado se visualizó con el contenido de los alimentos. En el hemograma se observó monocitosis, linfopenia y aumento en el número de plaquetas. Con base en los hallazgos, el animal fue diagnosticado con megaesófago y se procedió tratamiento clínico debido a la historia clínica del paciente.
Megaesophagus is a term described by the dilation of the esophagus. The abnormalities of the vascular system are the main causes of dysphagia and esophageal dilatation in young animals. Megaesophagus congenital corresponds to hypomotility and generalized esophageal dilation causes regurgitation and underdevelopment of the puppy after weaning. A dog 40 days old, female, without defined breed, with a history of dysphagia and regurgitation was granted. The animal was subjected to physical examination, and were also made a whole blood test and simple radiographs of the thoracic and abdominal cavities, the side-to-side positions right and ventral-dorsal. On physical examination it was observed swelling in the cervical esophagus region. In the radiographic examination it was observed an increase in volume in the middle esophagus, near the base of the heart, where dilated esophagus was visualized with food content. In the hemogram was observed monocytosis, lymphopenia and increase in the number of platelets. Based on the findings, the animal was diagnosed with megaesophagus and proceded to clinical treatment due to the patient"s chart.
O megaesôfago é um termo descrito para dilatação do esôfago. As anomalias do anel vascular são as principais causas de disfagia e dilatação do esôfago em animais jovens. O megaesôfago congênito corresponde à hipomotilidade e à dilatação generalizada do esôfago, provoca regurgitação e subdesenvolvimento do filhote após o desmame. Foi atendido um cão de 40 dias de idade, fêmea, sem padrão racial definido, com histórico de disfagia e regurgitação. O animal foi submetido ao exame físico, e foram realizados ainda um hemograma e exame radiográfico simples das cavidades torácica e abdominal, nas posições látero-lateral direito e ventro-dorsal. No exame físico observou-se aumento de volume na região do esôfago cervical. No exame radiográfico foi observado um aumento de volume na porção média do esôfago, próximo à base do coração, onde foi visualizado esôfago dilatado, com conteúdo alimentar. No hemograma foi observado monocitose, linfopenia e aumento no número de plaquetas. Com base nos achados, o animal foi diagnosticado com megaesôfago e procedeu-se tratamento clínico devido ao quadro do paciente.
Assuntos
Animais , Cães , Acalasia Esofágica/veterinária , Refluxo Laringofaríngeo/veterinária , Doenças do Esôfago/veterináriaRESUMO
Megaesófago es un término descrito por la dilatación del esófago. Las anomalías del sistema vascular son las principales causas de la disfagia y la dilatación esofágica en los animales jóvenes. Megaesófago congénito corresponde a hipomotilidad y dilatación esofágica generalizada provoca regurgitación y el subdesarrollo del cachorro después del destete. Se concedió un perro de 40 días de edad, de sexo femenino, sin raza definida, con antecedentes de disfagia y regurgitación. El animal se sometió a un examen físico, y también se hizo un hemograma y radiografías simples de las cavidades torácica y abdominal, las posiciones de lado derecho y ventral-dorsal. En la exploración física se observó inflamación en la región del esófago cervical. En el examen radiográfico se observó un aumento de volumen en el esófago medio, cerca de la base del corazón, donde el esófago dilatado se visualizó con el contenido de los alimentos. En el hemograma se observó monocitosis, linfopenia y aumento en el número de plaquetas. Con base en los hallazgos, el animal fue diagnosticado con megaesófago y se procedió tratamiento clínico debido a la historia clínica del paciente.(AU)
Megaesophagus is a term described by the dilation of the esophagus. The abnormalities of the vascular system are the main causes of dysphagia and esophageal dilatation in young animals. Megaesophagus congenital corresponds to hypomotility and generalized esophageal dilation causes regurgitation and underdevelopment of the puppy after weaning. A dog 40 days old, female, without defined breed, with a history of dysphagia and regurgitation was granted. The animal was subjected to physical examination, and were also made a whole blood test and simple radiographs of the thoracic and abdominal cavities, the side-to-side positions right and ventral-dorsal. On physical examination it was observed swelling in the cervical esophagus region. In the radiographic examination it was observed an increase in volume in the middle esophagus, near the base of the heart, where dilated esophagus was visualized with food content. In the hemogram was observed monocytosis, lymphopenia and increase in the number of platelets. Based on the findings, the animal was diagnosed with megaesophagus and proceded to clinical treatment due to the patient"s chart.(AU)
O megaesôfago é um termo descrito para dilatação do esôfago. As anomalias do anel vascular são as principais causas de disfagia e dilatação do esôfago em animais jovens. O megaesôfago congênito corresponde à hipomotilidade e à dilatação generalizada do esôfago, provoca regurgitação e subdesenvolvimento do filhote após o desmame. Foi atendido um cão de 40 dias de idade, fêmea, sem padrão racial definido, com histórico de disfagia e regurgitação. O animal foi submetido ao exame físico, e foram realizados ainda um hemograma e exame radiográfico simples das cavidades torácica e abdominal, nas posições látero-lateral direito e ventro-dorsal. No exame físico observou-se aumento de volume na região do esôfago cervical. No exame radiográfico foi observado um aumento de volume na porção média do esôfago, próximo à base do coração, onde foi visualizado esôfago dilatado, com conteúdo alimentar. No hemograma foi observado monocitose, linfopenia e aumento no número de plaquetas. Com base nos achados, o animal foi diagnosticado com megaesôfago e procedeu-se tratamento clínico devido ao quadro do paciente.(AU)
Assuntos
Animais , Cães , Acalasia Esofágica/veterinária , Refluxo Laringofaríngeo/veterinária , Doenças do Esôfago/veterináriaRESUMO
BACKGROUND: Esophageal stricture due to caustic ingestion is one of the most difficult problems to manage. Esophageal dilations are the usual treatment and they require a great number of sessions in the majority of cases. This implies time, risks for the patient, anguish for the relatives, and very often, frustration for the physician. OBJECTIVES: To evaluate the efficacy of the application of topical mitomycin C and intralesional triamcinolone in the prevention of post-dilation esophageal stricture recurrence. MATERIAL AND METHODS: A prospective, comparative, nonrandomized, and longitudinal study was conducted that compared a cohort of 16 patients treated with mitomycin C (2009-2012) with a retrospective cohort of 34 patients treated with triamcinolone (2002-2009). RESULTS: The patients treated with intralesional triamcinolone had a median of 11 dilations (minimum 4 and maximum 24), whereas the median in the patients treated with topical mitomycin C was 4.5 (minimum 3 and maximum 8). The groups were compared using the Mann-Whitney U test, finding a statistically significant difference of a two-tailed P<.001. In the multiple linear regression model, the dependent variable was the number of dilations and the independent variables were the type of lesion and treatment. The result was an R(2) .676 with a significance level of P<.001, in which the regression coefficient for treatment was B -.682 (95% CI -8.286 to -5.025) and the lesion grade was B .435 (95% CI 2.043- 4.573). The ANOVA result was an F 49.08 and a P<.001 and showed that the independent variables of type of lesion and treatment had a linear relation with the number of dilations, reinforcing the fact that our results were not due to chance. CONCLUSIONS: Topical mitomycin C considerably reduced the number of esophageal dilations compared with the use of intralesional triamcinolone to alleviate dysphagia, and therefore we suggest it as a treatment option in strictures due to caustic ingestion.
Assuntos
Anti-Inflamatórios/administração & dosagem , Antibióticos Antineoplásicos/administração & dosagem , Queimaduras Químicas/complicações , Estenose Esofágica/tratamento farmacológico , Mitomicina/administração & dosagem , Triancinolona/administração & dosagem , Administração Tópica , Anti-Inflamatórios/uso terapêutico , Antibióticos Antineoplásicos/uso terapêutico , Cáusticos/toxicidade , Criança , Pré-Escolar , Terapia Combinada , Dilatação , Estenose Esofágica/induzido quimicamente , Estenose Esofágica/terapia , Esofagoscopia , Feminino , Humanos , Lactente , Injeções Intralesionais , Estudos Longitudinais , Masculino , Mitomicina/uso terapêutico , Estudos Prospectivos , Recidiva , Estudos Retrospectivos , Resultado do Tratamento , Triancinolona/uso terapêuticoRESUMO
Introducción: La disfagia puede ser a nivel orofaríngeo o esofágico debido a trastornos estructurales o funcionales. Su abordaje diagnóstico y tratamiento evita la desnutrición y el riesgo de aspiración. Objetivo: reportar la experiencia en la evaluación diagnóstica y tratamiento en niños con disfagia orofaríngea y esofágica. Pacientes y método: estudio descriptivo y transversal, de 49 niños con disfagia, durante dos años. Protocolo de estudio: historia clínica, patologías asociadas, estudio radiológico, endoscopia, nasolaringoscopia-videodeglutoscopia, terapia deglutoria, videofluoroscopia, manometría y ph-metría esofágica y tratamiento indicado. Resultados: 20(40,82%) hembras y 29(59,18%) varones. Edad promedio 2,56 años (rango: 1m-16 años). El 46,93% presentó trastornos neurológicos como patología asociada. El 65,31% con disfagia a sólidos y 34,69% a líquidos, otros síntomas: vómitos, regurgitaciones y reflujo faringo-nasal. Posterior a la evaluación y estudios se encontró: disfagia orofaríngea 25/49(51,02%), de origen funcional en 22/25(88%) y mecánica 3(12%); disfagia esofágica 13/49(26,53%), mecánica en 1/13(7,69%) y funcional en 12/13(92,30%) de los cuales 6 con dismotilidad inespecífica y 4 asociada a esofagitis; disfagia mixta 11(22,44%). Evaluación nutricional fue requerida en 65,30%, se indicó nutrición por sonda de alimentación en 21 niños, por gastrostomía endoscópica en 4 y cambio en la consistencia de los alimentos en 7. Dilatación esofágica por estenosis congénita en un caso y por acalasia esofágica en 2. Terapia deglutoria en 71,42%. Conclusiones: la evaluación integral del niño con disfagia orofaríngea y esofágica es fundamental para identificar la causa e indicar el tratamiento específico con apoyo nutricional, procedimientos endoscópicos y terapia deglutoria.
Introduction: Dysphagia can be oropharyngeal or esophageal level due to structural or functional disorders. Its diagnosis and treatment approach prevents malnutrition and the risk of aspiration. Objective: To report our experience in the diagnostic evaluation and treatment for children with oropharyngeal and esophageal dysphagia. Patients and methods: Descriptive, cross-sectional, 49 children with dysphagia, for two years. Study protocol: clinical history, associated diseases, radiographs, endoscopy, Nasolaryngoscopy-videodeglutoscopia therapy, swallowing, videofl uoroscopy, manometry and esophageal pHmetry and appropriate treatment. Results: 20 (40.82%) females and 29 (59.18%) males. Average age 2.56 years (range: 1m-16 years). The 46.93% had neurological disorders and associated diseases. The 65.31% with dysphagia to solids and 34.69% for liquids, other symptoms: vomiting, regurgitation and nasal pharyngeal reflux. After the evaluation and studies found: Oropharyngeal Dysphagia 25/49 (51.02%) of functional origin in 22/25 (88%) and mechanical 3 (12%) Esophageal Dysphagia 13/49 (26.53% ) mechanical 1/13 (7.69%) and functional in 12/13 (92.30%) of which 6 and 4 with dysmotility associated nonspecifi c oesophagitis Mixed Dysphagia 11 (22.44%). Nutritional assessment was required to 65.30%, is indicated feeding tube 21 feeding children endoscopic gastrostomy 4 and change in the consistency of food at 7. Dilatation Congenital esophageal stenosis in one case and two esophageal achalasia. Swallowing therapy in 71.42%. Conclusions: The evaluation of the child with oropharyngeal and esophageal dysphagia is essential to identify the cause and indicate the specifi c treatment with nutritional support and therapeutic endoscopic procedures swallowing.
RESUMO
Introdução: estenose péptica de esôfago resulta da inflamação crônica da mucosa, causada pela doença do refluxo gastroesofágico. O objetivo deste estudo é apresentar a experiência com estenose péptica de esôfago, em um serviço de endoscopia digestiva pediátrica, analisando os achados clínicos e, principalmente, a diminuição da incidência dessa entidade nos dias atuais. Métodos: estudo retrospectivo de janeiro de 1996 a setembro de 2002. As dilatações foram realizadas com velas de Savary-Gilliard. O número de estenoses por ano, relativo ao número de endoscopias, foi avaliado através dos testes do qui-quadrado e da tendência linear. Resultados: no período de 6,5 anos, 1.636 crianças e adolescentes foram submetidos a endoscopia digestiva alta. Desses, 26 eram portadores de estenose péptica. As idades desses pacientes variaram de 10 meses a 16 anos, com uma média de 6,5 anos, sendo que 69% eram meninos.Treze pacientes eram portadores de condições predisponentes ou associadas a refluxo mais grave. Nenhum era portador de esôfago de Barrett. Foram realizadas 69 sessões de dilatação (2,65/paciente). Um paciente apresentou pneumomediastino, após a dilatação. Todos os outros apresentaram boa resposta às dilatações. O número de estenoses pépticas diminuiu com o passar dos anos, embora o número total de endoscopias tivesse aumentado. Conclusões: as dilatações com velas de Savary foram eficazes em diminuir a disfagia dos pacientes portadores de estenose péptica. Houve uma diminuição da incidência de estenose péptica, apesar do aumento do número de endoscopias nesse serviço pediátrico (AU)
Introduction: esophageal peptic stricture results of chronic mucosal inflammation caused by gastroesophageal reflux disease. The aim of this study is to present the experience with esophageal peptic strictures in a pediatric gastrointestinal endoscopy unit showing clinical aspects and mainly the decreasing incidence of this entity nowadays. Methods:retrospective study from January 1996 to September 2002. The esophageal dilations were performed with Savary-Gilliard bougies. The number of the strictures per year, relatively to endoscopies number, was evaluated by qui-square test and linear tendency. Results: in the period of 6.5 years 1,636 children and adolescents were submitted to upper digestive endoscopy. Twenty-six individuals had a peptic esophageal stricture. The ages varied between 10 months and 16 years with a mean age of 6.5 years and 69% were male patients. Thirteen patients had an associated or predisposing condition to more severe gastroesophageal reflux. There was no Barrett esophagus. We have done 69 esophageal dilations sessions (2.65/patient). One patient presented with pneumomediastine post-dilation. All the others presented a good outcome. The total number of strictures decreased with time although total number of endoscopic procedures increased. Conclusions: dilations with Savary-Gilliard bougies were efficacious to decrease the disphagia of the esophageal peptic strictures in children. There was a decreasing incidence of peptic strictures although the increasing incidence of endoscopic examinations performed in this pediatric endoscopy unit (AU)