A ‘megaesophagus’ and ‘persistent right aortic arch’ successfully corrected by veterinary surgeon.
Recently, a three-month-old mixed-breed puppy named Kim was brought to the University of Illinois Veterinary Teaching Hospital in Urbana for persistent regurgitation, meaning that Kim would spit up her meals shortly after eating. Dr. Evelyn Caporali, a surgery resident, and Dr. Laura Selmic, a veterinarian with board certification in small animal surgery, handled the case and Dr. Selmic explains Kim’s condition and its treatment.
“After giving Kim a thorough physical examination, her local veterinarians took x-rays to get a good look at her esophagus,” says Dr. Selmic.
The x-rays revealed that the esophagus, the tube that carries food from the mouth to the stomach, was enlarged, a condition called a “megaesophagus.” With Kim being so young her veterinarians suspected a rare condition called persistent right aortic arch.
“This is a condition where the aorta, the large vessel that carries oxygen-rich blood from the heart to the rest of the body, forms on the right side of the animal’s body, instead of the left, where it normally is,” explains Dr. Selmic. “A small fibrous band runs between the aorta on the right and another major vessel on the left, squashing the esophagus, causing it to pouch out, and therefore food can’t move through normally.”
Kim was referred by her veterinarians to the University of Illinois for more tests and possible surgery. To characterize Kim’s problem better, a computed tomography (CT) scan was performed to see Kim’s blood vessels and confirm the suspicion that Kim had been born with a persistent right aortic arch.
Dr. Selmic says any breed of dog can be born with a persistent right aortic arch, but the condition is uncommon.
“It is not entirely understood why an animal’s vessels may develop abnormally, causing constriction of the esophagus,” says Dr. Selmic. “This condition is suspected when a young pup has been able to drink milk but, when it starts weaning, it has trouble eating solid food and regurgitates immediately after eating.”
To correct Kim’s constricted esophagus, Dr. Caporali and Dr. Selmic performed a chest surgery called an “intercostal thoracotomy.”
“We made an incision in her chest between two ribs and found the fibrous band, called the ‘ligamentum arteriosum,’ that was constricting Kim’s esophagus,” explains Dr. Selmic. “The bands were cut to allow her esophagus to open up and then we sutured her chest wall closed.”
After surgery, Kim stayed overnight in the hospital and was given pain medication. She was kept on a liquid diet for the first few days. In addition, Kim was kept in an elevated position for 10 to 15 minutes after she ate to ease passage of food to her stomach and try to prevent food or water from accidentally getting drawn into her lungs, which would cause pneumonia.
Eventually Kim was allowed to eat wet puppy food, and after a couple of weeks dry food was introduced.
“Dogs tend to do well after chest surgery and most have a good quality of life,” says Dr. Selmic. “Kim came back for a check-up two weeks after surgery and was doing very well.”
If you have questions about megaesophagus or persistent right aortic arch, ask your local veterinarian.
By Sarah Netherton