Esophageal and gastric bone foreign bodies

https://onlinelibrary.wiley.com/doi/epdf/10.1111/jvim.16383

Bone foreign bodies are a common emergency in small animal veterinary practice. The way the clinician chooses to deal with them depends not only on its location, but also on its material.

A recent article was published with a retrospective study using the medical records of dogs with bone esophageal foreign bodies (E-bFBs) and bone gastric foreign bodies (G-bFBs). Its aim was to describe management and outcomes for these animals.

Foreign bodies lodged in the esophagus warrant urgent/emergency intervention, whereas there are no clear guidelines for gastric foreign bodies.

In this study, all animals with E-bFBs underwent endoscopic removal with success in most cases. When endoscopy was not successful, the E-bFB was either advanced to the stomach for dissolution or surgically removed by esophagotomy. The risk factors associated with esophageal foreign bodies are a smaller body size, older age, entrapment, or having clinical signs for several days. Regarding complications such as erosions and/or esophagitis, this study found a correlation to the duration and site of entrapment. A worse prognosis is expected when the foreign body has been entrapped for more than 2 days and with location within the distal esophagus.

For approaching gastric foreign bodies, the study describes removal through emesis, endoscopy, or surgery. Emesis is not a common approach to bone foreign bodies as they can be sharp. Another thing to have in consideration when dealing with G-bFBs is that they have the potential to digest, contrary to other materials as fabric, plastic, or rocks. For this reason, a good approach to G-bFBs is to leave them in situ for digestion. In this study, the authors found no relation with adverse outcomes with this approach, neither for foreign bodies already in the stomach, nor those that were advanced from the esophagus and left to digest afterwards. When considering removing a gastric foreign body, the choice depended greatly on the presence of clinical signs, with this being the most significant decision factor.

This is a retrospective study and so it has its limitations due to its nature, more prospective studies should be done to better understand these topics. However, in conclusion, there seems to be a good decision in E-bFBs to advance them to the stomach to dissolve, when endoscopic removal is not successful. As well as leaving G-bFBs in the stomach to dissolve.

Barash, NR, Lashnits, E, Kern, ZT, Tolbert, MK, Lunn, KF, Outcomes of esophageal and gastric bone foreign bodies in dogs, 2022, Journal of Veterinary Internal Medicine, 36:500–507.

DOI: 10.1111/jvim.16383