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Use of a carbonated beverage to disintegrate a phytobezoar obstructing the intrathoracic portion of the oesophagus of a horse

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This report describes the treatment of a 17‐year‐old American Quarter Horse gelding for an oesophageal obstruction of approximately 24 h’ duration. An intraluminal oesophageal mass resembling a phytobezoar and located close to the cardia, was observed during endoscopic examination of the oesophagus of a horse showing signs of oesophageal obstruction. An intrathoracic oesophageal diverticulum, filled with fluid, was observed about 40 cm proximal to the obstruction. The end of a nasogastric tube was guided beyond the diverticulum, using gastroscopic observation, so that its tip rested close to the obstruction. The obstruction failed to disintegrate or move into the stomach despite vigorous, prolonged lavage. With the nasogastric tube left in place, and the horse's head elevated, 0.5 L cola was administered adjacent to the obstruction through the nasogastric tube. The head was maintained in the elevated position for an hour, after which time the head was lowered and oesophageal lavage resumed. The nasogastric tube was passed into the stomach within 3 min of re‐instituting lavage. The successful use of a carbonated beverage to treat human patients for oesophageal or gastrointestinal obstruction caused by a phytobezoar is well documented. Carbonated beverages have also been reported to be effective in treating horses for gastric and enteric impactions caused by persimmon seeds. Administering cola into the oesophagus may help resolve oesophageal obstruction of horses caused by a phytobezoar or impacted feed material when horses are refractory to other treatments.
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Case Report
Use of a carbonated beverage to disintegrate a phytobezoar
obstructing the intrathoracic portion of the oesophagus of a horse
L. C. Livesey*
, E. Yorke
, A. Parra
, Q. Gray
, C. Davies
, D. Weldon
, J. Schumacher
§
,
S. Kimura
§
, C. Howard
, T. Sierra-Rodriguez
§
and M. Mora-Pereira
§
Tuskegee University College of Veterinary Medicine, Auburn, Alabama;
Southeast Equine Veterinary Services,
Phenix City, Alabama;
§
J.T. Vaughan Large Animal Teaching Hospital, Auburn University College of Veterinary
Medicine, Auburn, Alabama; and
Bluegrass Animal Clinic, Grayson, Kentucky, USA
*Corresponding author email: llivesey@tuskegee.edu
Keywords: horse; phytobezoar; carbonated beverage; oesophageal obstruction; disintegration
Summary
This report describes the treatment of a 17-year-old American
Quarter Horse gelding for an oesophageal obstruction of
approximately 24 hduration. An intraluminal oesophageal
mass resembling a phytobezoar and located close to the
cardia, was observed during endoscopic examination of the
oesophagus of a horse showing signs of oesophageal
obstruction. An intrathoracic oesophageal diverticulum, lled
with uid, was observed about 40 cm proximal to the
obstruction. The end of a nasogastric tube was guided
beyond the diverticulum, using gastroscopic observation, so
that its tip rested close to the obstruction. The obstruction
failed to disintegrate or move into the stomach despite
vigorous, prolonged lavage. With the nasogastric tube left in
place, and the horses head elevated, 0.5 L cola was
administered adjacent to the obstruction through the
nasogastric tube. The head was maintained in the elevated
position for an hour, after which time the head was lowered
and oesophageal lavage resumed. The nasogastric tube was
passed into the stomach within 3 min of re-instituting lavage.
The successful use of a carbonated beverage to treat human
patients for oesophageal or gastrointestinal obstruction
caused by a phytobezoar is well documented. Carbonated
beverages have also been reported to be effective in
treating horses for gastric and enteric impactions caused by
persimmon seeds. Administering cola into the oesophagus
may help resolve oesophageal obstruction of horses caused
by a phytobezoar or impacted feed material when horses are
refractory to other treatments.
Introduction
A bezoar is a mass of ingested, undigested material within the
alimentary tract that is resistant to disintegration (Chun and
Popachin 2017). Phytobezoars are concretions formed in the
gastrointestinal tract and are composed chiey of undigested
compacted vegetable bre. Diospyrobezoars are a type of
phytobezoar composed of persimmon seeds. Diospyrobezoars
are typically harder than other bezoars, because persimmon
seeds have a high concentration of tannins, which, in the
presence of hydrochloric acid in the stomach, form a glue-like
coagulum (Chun and Popachin 2017). Although impacted
feed material is a common cause of intraluminal oesophageal
obstruction in the horse (Hillyer 1995; Feige et al. 2000;
Chiavaccini and Hassel 2010), the presence of a concretion of
plant material (phytobezoar) is unusual.
Cola is commonly used in human patients to disintegrate
gastric and intestinal phytobezoars and diospyrobezoars
(Chung et al. 2006; Ladas et al. 2013; Iwamuro et al. 2015) and
is also widely used to resolve oesophageal obstruction caused
by any food bolus (Karanjia and Rees 1993; Cotton 1993; Ko
and Enns 2008; Ki Hoon et al. 2010; Leopard et al. 2011;
Shaque et al. 2013). Disimpaction rates of oesophageal
obstructions using carbonated beverages, or other gas forming
agents, alone have been reported in people ranging from 65%
(Zimmers et al. 1988) to 100% (Rice et al. 1983; Mohammed
and Hegedus 1986; Karanjia and Rees 1993). Gastric
phytobezoar resolution using carbonated beverages was
achieved in 91.3% of cases in human patients, either as a single
treatment, or combined with further endoscopic techniques
(Ladas et al. 2013). Cola has been administered successfully to
horses to breakup gastric diospyrobezoars (Rodriguez-Hurtado
et al. 2007; Banse et al. 2011) and enteric phytobezoars/
diospyrobezoars (Banse et al. 2011). The following report is, to
our knowledge, the rst to describe the use of cola to
disintegrate an oesophageal obstruction in a horse.
Case details
Case history
A 17-year-old, 418 kg American Quarter Horse gelding was
presented to the Tuskegee University College of Veterinary
Medicine because of signs of intraluminal oesophageal
obstruction rst observed 20 h earlier. The diet consisted of free
choice coastal bermuda hay, and 12% sweet feed twice daily.
The referring veterinarian reported that he was unable to pass
a nasogastric tube into the stomach. The horse had developed
an oesophageal obstruction 12 months previously, but on that
occasion the obstruction had resolved without treatment.
Clinical examination
The horse was obtunded, and its heart rate was elevated (68
beats/min) was elevated. The horses rectal temperature
(36.9°C), respiratory rate (20 breaths/min) and lung sounds
were normal. Saliva owed intermittently from each nostril,
and the horse periodically coughed up saliva. The horses
PCV was 40%, and its TP was 7.0 g/dL.
Diagnosis and treatment
The horse was sedated with 2.5 mg of detomidine (0.006 mg/
kg bwt i.v.). Acepromazine (0.05 mg/kg bwt i.v.) and
propantheline bromide (0.07 mg/kg bwt i.v.) were administered
©2019 EVJ Ltd
1EQUINE VETERINARY EDUCATION
Equine vet. Educ. (2019)  ()-
doi: 10.1111/eve.13082
for their spasmolytic properties. Flunixin meglumine (1.1 mg/kg
bwt i.v.) was administered as an analgesic, and crystalline
ceftiofur (6.6 mg/kg bwt i.m.) was administered because of the
likelihood of aspiration pneumonia.
A nasogastric tube passed into the oesophagus to
perform oesophageal lavage retroexed repeatedly soon
after entering the thoracic portion of the oesophagus. During
endoscopic examination of the oesophagus, a smooth-
surfaced green/brown concretion was seen after passing the
endoscope to 140 cm from the nares (Fig 1). The obstruction
completely occluded the oesophageal lumen and did not
move when gently pushed with the endoscope. As the
endoscope was retracted, a uid-lled diverticulum was
identied 40 cm cranial to the obstruction, on the ventral
aspect of the oesophagus (Fig 2). A mucosal stricture was
seen at the distal limit of the diverticulum.
Twenty litres of a balanced electrolyte solution
supplemented with 500 mL 23% calcium gluconate and
160 mEq potassium chloride were administered through an
indwelling intravenous catheter to correct dehydration and
presumed electrolyte abnormalities resulting from the
longstanding duration of the intraluminal oesophageal
obstruction. Detomidine (0.01 5 mg/kg bwt i.v.) and
propantheline bromide (0.07 mg/kg bwt i.v.) were administered
for their spasmolytic properties at 3-h intervals while the horse
received uid therapy.
We observed that the obstruction of the oesophagus
persisted during endoscopic examination of the oesophagus,
performed after administering the uids and spasmolytic
drugs. The oesophagus was lavaged intermittently during the
subsequent 6 h, with the horse sedated using detomidine
(0.01 mg/kg bwt i.v.) to ensure that its head remained
lowered throughout the procedure. Lavage episodes were
prolonged, and large volumes of water were used. To ensure
the tube was placed accurately for effective lavage and to
prevent it from becoming placed inadvertently into the
diverticulum, a gastroscope inserted into the oesophagus
adjacent to the nasogastric tube was used to guide the
nasogastric tube to a position immediately proximal to the
phytobezoar (Fig 1).
Lidocaine HCl (2%) was applied to the oesophageal
mucosa, through the biopsy channel of the endoscope, to
relieve the oesophageal spasm, but despite this and
previously mentioned treatments, the appearance and
position of the obstruction remained unchanged.
One-half litre of cola was administered over a period of
3 min to the site of obstruction through the nasogastric tube,
using a funnel, with the horses head elevated and supported
by a dental stand. Detomidine HCl (0.0050.01 mg/kg bwt
i.v.) was administered to the horse periodically, to keep it
from moving. The oesophagus was again lavaged with water
1 h after cola had been administered, after conrming with
the gastroscope which was situated in the oesophagus
adjacent to the nasogastric tube, that the end of the
nasogastric tube remained situated just proximal to the
phytobezoar. By means of the endoscope, the obstruction
was observed to disintegrate approximately 180 s after
lavage using a small volume of water, allowing the end of
the nasogastric tube and gastroscope to be passed through
the cardia into the stomach. The oesophageal mucosa
at the site of the obstruction was observed to be ulcerated
circumferentially (Fig 3).
Handfuls of soaked alfalfa pellets and short grass were
offered to the horse for short periods, beginning 12 h after the
obstruction was resolved. The amount of feed offered initially
was small but was gradually increased. There were no further
episodes of oesophageal obstruction during 8 days of
hospitalisation. The horse was treated for aspiration
pneumonia with broad spectrum antimicrobial drugs and
unixin meglumine.
The horse was re-examined 60 days after discharge
because of intermittent episodes of choke that began to
occur 3 days before the horse was represented to the
hospital. Endoscopic examination revealed the formation of
a mucosal stricture at the site of the obstruction, close to the
cardiac sphincter (Fig 4). The diverticulum, although lled
with feed, was detectable during examination of a contrast
oesophagram (Fig 5). Three months after discharge, the horse
Fig 1: Endoscopic view of the phytobezoar lodged immediately
cranial to the cardiac sphincter. Correct placement of
nasogastric tube (NGT) for irrigation conrmed.
Fig 2: Endoscopic view of the intrathoracic oesophageal
diverticulum. The margins (blue arrows) of the diverticulum (D),
the distal oesophageal lumen (L) and the partial stricture (S) are
visible.
©2019 EVJ Ltd
2 Use of cola in intraluminal oesophageal obstruction
was subjected to euthanasia because of increased
frequency of oesophageal obstruction.
Discussion
The most common equine oesophageal disease is simple
obstruction (i.e. choke) (Hillyer 1995; Feige et al. 2000), which
is usually a primary problem caused by the ingestion of
inadequately masticated dry, brous material (e.g. hay) or
poorly soaked beet pulp (Hillyer 1995; Feige et al. 2000;
Chiavaccini and Hassel 2010). Oesophageal obstruction may
also be seen as a secondary feature of other structural or
functional oesophageal conditions, such as ulceration,
stricture, megaoesophagus, neoplasia, compression of the
oesophagus secondary to a space-occupying lesion,
presence of a diverticulum or an oesophageal cyst.
Secondary oesophageal obstruction should be suspected in
cases of recurrent chokeand in those cases where the
affected horse responds poorly to treatment using spasmolytics
and oesophageal lavage (Hillyer 1995; Chiavaccini and Hassel
2010). Oesophageal phytobezoars of people are rare and
occur most commonly in patients with structural or functional
oesophageal abnormalities (Goel et al. 1995; Ki Hoon et al.
2010; Yaqub et al. 2012). The oesophageal diverticulum
observed in this case may have contributed to the formation
of the phytobezoar and may have reduced the efcacy of
oesophageal lavage. We are aware of only three horses
reported to have suffered from choke caused by an
oesophageal phytobezoar (MacDonald et al. 1987; Ford
et al. 1991; Orsini et al. 1991). Two of these three horses had a
phytobezoar that was associated with an oesophageal
diverticulum, similar to this case (MacDonald et al. 1987; Ford
et al. 1991).
The horse was reported to have suffered from only one
mild episode of oesophageal obstruction prior to the
presenting problem. The difculty in passing a nasogastric
tube was likely a consequence of the tube entering the
diverticulum and resulting in retroexion of the tube. The mild
stricture observed adjacent to the distal border of the
opening of the diverticulum may have contributed to the
propensity for the tube to enter the diverticulum.
Administering cola to human patients to resolve gastric
phytobezoars is an effective, noninvasive treatment and is
often the only therapeutic agent administered. Cola is
sometimes administered in conjunction with endoscopically
assisted retrieval of the mass, or mixed with cellulase or
pancreatic enzymes (Mohammed and Hegedus 1986;
Karanjia and Rees 1993; Chung et al. 2006; Ko and Enns 2008;
Coskun et al. 2011; Ladas et al. 2013; Shaque et al. 2013;
Chun and Popachin 2017). Administering cola rectally to
human patients to break down a fecolith has been reported
(Lee and Kim 2015; Ontanillo et al. 2017). Injecting the cola
directly into the phytobezoar through the endoscopic
accessory port of the endoscope, may accelerate
disintegration of the phytobezoar (Iwamuro et al. 2015). The
advantages of administering cola to cause disintegration of
a phytobezoar include the minimal mucosal damage caused
Fig 3: Endoscopic view of the oesophageal lumen after
dissolution of the phytobezoar. There is circumferential pressure
necrosis of the oesophageal mucosa at the site of the
obstruction, immediately cranial to the cardiac sphincter.
Fig 4: Endoscopic view of oesophageal stricture formation at the
site of the obstruction, 60 days after presentation.
Fig 5: Contrast oesophagram showing diverticulum (blue arrows)
and associated partial stricture (red arrow) at the level of the
heart base, 60 days after presentation.
©2019 EVJ Ltd
L. C. Livesey et al. 3
by this intervention. In many cases, the obstruction
(oesophageal, gastric or intestinal) is relieved solely by
administering the cola, thus eliminating the likelihood of
damaging the oesophageal mucosa or perforating the
oesophagus, complications that may accompany attempts
to remove the obstruction by endoscopic manipulation or by
lavage (Shaque et al. 2013). Administering cola may
eliminate the need for surgical removal of a phytobezoar
(Ladas et al. 2002). The successful treatment of equids for a
gastric diospyrobezoars (Rodriguez-Hurtado et al. 2007; Banse
et al. 2011) and enteric phytobezoars or diospyrobezoars
(Banse et al. 2011) using cola has been previously described.
To our knowledge, using cola to break down an
oesophageal obstruction in horses has not been described
prior to this case report.
Although the mechanism of action of cola has not been
fully elucidated, investigators have speculated that the
mucolytic action of sodium bicarbonate and the acidifying
action of carbonic and phosphoric acid disintegrate the
bezoar. Carbon dioxide bubbles penetrating the microscopic
pores on the surface bezoar may also assist disintegration of
the phytobezoar (Iwamuro et al. 2015). Sugar-free cola has
been reported to be successful in treatment of people with
phytobezoars (Ertugrul et al. 2012; Kramer and Popachin 2012;
Iwamuro et al. 2015), suggesting the mechanism of action is
unrelated to sugar content. Use of sugar-free formulations of
cola may be preferable if larger volumes are administered,
particularly in equids suspected of having insulin dysregulation
resulting from equine metabolic syndrome and/or pituitary
pars intermedia dysfunction.
Using cola in this case appeared to be instrumental in
disintegrating the oesophageal obstruction that had not
resolved with other forms of therapy. More aggressive
interventions have been described, including lavage using a
cuffed endotracheal tube (e.g. the Rusch oesophageal ush
probe, MEDVET, Kernen, Germany) passed intranasally into the
oesophagus (Orsini and Divers 2014). These interventions may
be attempted with the horse sedated or anaesthetised, but the
risk of oesophageal injury is increased and such injury may
result in formation of a stricture, or even perforation of the
oesophagus (Orsini and Divers 2014). If these attempts to
remove the obstruction are unsuccessful, intraluminal
obstructions in the cervical portion of the oesophagus can be
resolved by performing an oesophagotomy. Surgical treatment
should be considered a last resort, because complications
associated with oesophagotomy are common (Craig et al.
1989; Koenig et al. 2016) and include surgical site infections,
wound dehiscence and stricture formation. The surgical
approach to the intrathoracic oesophagus is complicated
(Ford et al. 1991), and likely to result in post-operative
complications (J. Schumacher, personal communication).
We suggest that administering cola to the site of
obstruction through a nasogastric tube, or through the
accessory port of an endoscope, may be helpful in
disintegrating intraluminal oesophageal obstructions. The
dramatic response shown by this horse to administration of
cola, coupled with the high incidence of success of this simple
treatment in human patients, indicates that administering a
cola to the site of an oesophageal impaction may reduce the
duration and volume of corrective oesophageal lavage, thus
potentially reducing the incidence of oesophageal trauma
and aspiration pneumonia. We recommend that the cola be
administered in a controlled manner, and that the head
remain elevated to allow time for the cola to be absorbed into
the intraluminal oesophageal obstruction. These precautions
should minimise the likelihood of cola aspiration.
Since submission of the original manuscript, four further cases
of intraluminal oesophageal obstruction that had not responded
to conventional treatment protocols were successfully resolved
using administration of a carbonated beverage, as described
in this report. Details of these cases are described in
Supplementary Item 1. We are very interested in assessing the
efcacy of this treatment protocol in a larger population of
horses and have started to collect data from practitioners using
a short questionnaire (Supplementary Item 2).
Authorsdeclaration of interests
No conicts of interest have been declared.
Ethical animal research
This was a client horse that was presented to our hospital and
treated appropriately. Extra cases described in the addendum
were client horses and treated appropriately.
Acknowledgements
The authors are very grateful to Dr Jim Schumacher for his
help in editing the manuscript.
Authorship
L. Livesey, E. Yorke, J. Schumacher, C. Howard, S. Kimura,
T. Sierra Rodriguez and M. Mora Pereira contributed to case
management and preparation of the manuscript. Q. Gray
and C. Davies contributed to case management. All authors
gave their nal approval of the manuscript.
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Supporting information
Additional Supporting Information may be found in the online
version of this article at the publishers website:
Supplementary Item 1: Additional cases.
Supplementary Item 2: Questionnaire.
©2019 EVJ Ltd
L. C. Livesey et al. 5
... Intraluminal oesophageal obstruction is the most common oesophageal disorder in the horse (Feige et al, 2000;Swain et al, 2004) and is commonly diagnosed in donkeys (unpublished data). Usually, primary oesophageal obstruction is the result of ingestion of inappropriate food such as dry sugar beet pulp, foreign bodies, or is due to rapid ingestion of fibrous food material (Swain et al, 2004;Booth et al, 2008;Livesey et al, 2019) with poor dentition considered a potential risk factor (Booth et al, 2008). Secondary oesophageal obstruction is less common and can result from structural or functional oesophageal conditions such as ulceration, stricture, megaoesophagus, neoplasia, compression secondary to space-occupying lesions such as enlarged mediastinal lymph nodes, diverticula or oesophageal cysts (Swain et al, 2004;Booth et al, 2008;Woodford et al, 2010;Livesey et al, 2019). ...
... Usually, primary oesophageal obstruction is the result of ingestion of inappropriate food such as dry sugar beet pulp, foreign bodies, or is due to rapid ingestion of fibrous food material (Swain et al, 2004;Booth et al, 2008;Livesey et al, 2019) with poor dentition considered a potential risk factor (Booth et al, 2008). Secondary oesophageal obstruction is less common and can result from structural or functional oesophageal conditions such as ulceration, stricture, megaoesophagus, neoplasia, compression secondary to space-occupying lesions such as enlarged mediastinal lymph nodes, diverticula or oesophageal cysts (Swain et al, 2004;Booth et al, 2008;Woodford et al, 2010;Livesey et al, 2019). ...
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Mycobacterial infections are rare in horses, donkeys and mules. Although there are a few reports in horses, mycobacterial disease is poorly documented in the donkey. Mycobacterial infection of equine species typically affects the alimentary tract, causing granulomatous enterocolitis resulting in diarrhoea and chronic weight loss, while lymph nodes and liver may also be affected. We now document recurrent oesophageal obstruction, secondary to cranial mediastinal lymphadenitis caused by Mycobacterium avium complex (MAC). To the best of our knowledge, this is the first report of MAC infection in a donkey in the UK.
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Diospyrobezoars are a subtype of phytobezoars caused by excessive consumption of persimmons, which contain large amounts of tannins. In contrast to phytobezoars, diospyrobezoars have a harder consistency than other bezoars, making them more difficult to break up both chemically and endoscopically. We have previously reported successful dissolution of phytobezoars with diet soda and cellulase. A review of the literature found low efficacy of soda in dissolving diospyrobezoars compared to other phytobezoars. We report a case of successful dissolution of a diospyrobezoar after a failed attempt with diet soda alone.
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Colorectal fecaloma is hardening of feces into lumps of varying size that is much harder in consistency than a fecal impaction. Complications of colorectal fecaloma include ulceration, bleeding, perforation and obstruction of the colon. Most fecalomas are successfully removed by conservative treatment with laxatives, enemas and rectal evacuation to relieve fecal impaction. When conservative treatments have failed, a surgical intervention may be needed. Herein, we report a case of 4.7 cm sized sigmoid fecaloma showing no response to conservative treatments that was successfully removed by endoscopic fragmentation with Coca-Cola injection instead of surgery.
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Aim. Large food bits can get stuck in the esophagus and must be removed by endoscopy. In some cases, this can be difficult or unsafe. We describe a new and safe treatment for such patients. Materials and Methods. 100 consecutive patients were referred to Akershus University Hospital with impacted food in the esophagus. In 36 patients (36%), the food passed spontaneously. In 59 (92%) of the remaining 64 patients, the food was removed by endoscopic intervention. In the last five patients, endoscopic removal was judged difficult or unsafe. These patients received the new treatment: one capsule Creon 10000 IU dissolved in 30 mL of Coca-Cola administered by a nasooesophageal tube four times daily for 2-3 days. Results. Of the 59 patients treated with endoscopic procedure, complications occurred in four (7%): three bleedings and one perforation of the esophagus. In five patients treated with Coca-Cola and Creon, the food had either passed or was soft after 2-3 days and could easily be removed. Conclusion. The treatment of choice of impacted food in the esophagus is endoscopic removal. In cases where this is difficult, we recommend treatment with Coca-Cola and Creon for 2-3 days before complications occur.
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Background: Colonic obstruction is a relatively common condition in emergency care, with a mortality rate of up to 20%. In 90% of cases it results from colonic or rectal adenocarcinoma, volvulus, or stenosis secondary to diverticular disease. When fecal impaction is the underlying cause, the condition is usually managed conservatively, but may on occasion become complicated and even require surgical intervention. Based on the proven efficacy of Coca-Cola® to dissolve gastric phytobezoars, we report a case of colonic obstruction secondary to sigmoid fecaloma. Case report: A 58 years old woman arrived at the Emergency Room (ER) with persistent constipation for the last six days. An abdominal CT scan showed a large fecal mass at the sigmoid colon with retrograde dilated colonic loops. Cleansing enemas and oral lactulose were administered, which failed to resolve the clinical presentation, so we then proceeded to inject Coca-Cola® within the fecaloma using a sclerosing needle, and then washed the fecaloma surface also with Coca-Cola®. After a few minutes we started to fragment the fecalith, the consistency of which had been notably decreased. Discussion: The use of Coca-Cola® for gastric washes in the management of phytobezoars is well established. Since fecaliths are partly composed of these same substances than phytobezoars, the use of Coca-Cola® might well be warranted against them as in our patient, without surgery. Our case report is the second one published in the literature, in which Coca-Cola® helped solve colonic obstruction secondary to fecaloma.
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The main objective of this retrospective study was to describe clinical findings, management, and short- and long-term outcome in 27 horses that underwent various surgical techniques for esophageal disease. Surgical techniques (sometimes concurrently) performed were: esophagostomy (n = 14), esophagotomy with primary closure (n = 6), esophagomyotomy (n = 3), and esophagoplasty (n = 2). Esophageal perforation in 5 horses was treated by ventral drainage; 3 horses had the esophageal defect sutured (n = 3). Feeding tubes were placed in 15 horses. Postoperative complications occurred in 52% (14/27) with a median of 3 complications/horse (range: 1 to 7). Significantly more complications occurred in horses with a perforated esophagus. Eighteen horses (18/27; 67%) were discharged. Most horses (8/9; 89%) with a lesion located in the proximal esophagus were discharged. Horses with a higher number of postoperative complications, particularly postoperative infection, were more likely to be euthanized. One year after surgery, 41% of the horses were alive and free of complications.
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Respond quickly and confidently to emergency situations with the only text dedicated entirely to equine emergency treatment. The latest edition of this reliable manual is vastly expanded to encompass a wide range of new and evolving topics in horse care, with thorough, step-by-step procedures for the most effective emergency treatment. Portable for use in the clinic or in the field and presented for the first time in full color, its your one-source guide for complete equine emergency support. Unique focus provides your only single-source guide devoted to equine emergency management. Bulleted format makes information easily retrievable, presenting detailed procedures in concise, step-by-step outlines. 12 new chapters help you ensure biosecurity and treat a variety of increasingly common emergency conditions, including diarrheal, infectious, and zoonotic diseases. Revised Organ Systems section presents content in a more user-friendly, timesaving format. What to Do and What Not to Do headings identify proper care techniques and alert you to steps you should avoid. Updated drug dosage table improves treatment with accurate dosage information for many recently approved drugs. Full-color design distinguishes specific features within the text for quick reference in critical situations.
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The formation of a bezoar is a relatively infrequent disorder that affects the gastrointestinal system. Bezoars are mainly classified into four types depending on the material constituting the indigestible mass of the bezoar: phytobezoars, trichobezoars, pharmacobezoars, and lactobezoars. Gastric bezoars often cause ulcerative lesions in the stomach and subsequent bleeding, whereas small intestinal bezoars present with small bowel obstruction and ileus. A number of articles have emphasized the usefulness of Coca-Cola(®) administration for the dissolution of phytobezoars. However, persimmon phytobezoars may be resistant to such dissolution treatment because of their harder consistency compared to other types of phytobezoars. Better understanding of the etiology and epidemiology of each type of bezoar will facilitate prompt diagnosis and management. Here we provide an overview of the prevalence, classification, predisposing factors, and manifestations of bezoars. Diagnosis and management strategies are also discussed, reviewing mainly our own case series. Recent progress in basic research regarding persimmon phytobezoars is also briefly reviewed.
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The findings of this case series support the combined use of cellulase and Diet Coke as a simple, noninvasive, and effective treatment for gastric phytobezoars. Future evaluation is necessary to assess and compare the efficacy of each agent as monotherapy as well as to evaluate the combination therapy in more patients.
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OESOPHAGEAL disorders are relatively uncommon in the horse in comparison with other domesticated species. However, because of their dramatic and acute presentation, they often cause the owner considerable concern and anxiety. This article outlines the aetiology, diagnosis and treatment of oesophageal obstructions in horses.