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

Abstract

Summary 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.

Management of phytobezoars

“…However, administration of cola into the oesophagus carries the additional risk of aspiration pneumonia. Using small volumes (500 mL) and elevating the head during and after the procedure, as described in the present case report, (Livesey et al 2020) may help minimise this risk. In the future, consideration of other carbonated beverages (i.e.…”

“…However, due to the risk of complications with oesophageal (Craig et al 1990;Koenig et al 2016) or gastric (Freeman 2011) surgery, investigation of other treatment options is warranted. The present report 'Use of a carbonated beverage to disintegrate a phytobezoar obstructing the intrathoracic portion of the oesophagus of a horse' by Livesey et al (2020), is the first to use cola to resolve an episode of oesophageal obstruction from a phytobezoar that was unresponsive to standard medical management. In this report, a dose of 0.5 L of cola was used effectively to promote dissolution.…”

The use of cola for the treatment of gastric impactions in equids

“…Gastric impaction is a rare and poorly defined disease in horses and ponies, characterised by persistent and progressive accumulation of dehydrated ingesta in the stomach (Freeman 2011, Bird et al 2012). A plant-based concretion can also be referred to as a phytobezoar (Naramore et al 2015, Livesey et al 2020. These impactions can be either primary or secondary in nature, although the distinction is not always clear and this classification is somewhat controversial, as it is often not possible to rule out all possible primary causes (Bird et al 2012).…”

“…Similarly, Tallon et al (2020) distinguished lone gastric impactions and those associated with other gastrointestinal (GI) disturbances, such as grass sickness, strangulating obstructions, peritonitis and ileus, but indicate that it is very hard to diagnose lone GI definitively without additional diagnostics, such as exploratory laparotomy. Rapid eating, overeating, poor dentition, improper mastication, feed that swells or forms a coagulum after consumption, coarse roughage, high fibre diets and inadequate water consumption are considered to play a role in the development of gastric impactions (Boswinkel et al 2007, Sutton 2014, Sanchez 2018, Livesey et al 2020. Foreign bodies and indigestible objects can also cause a gastric impaction but almost never occur in horses.…”

“…Cola, or other carbonated beverages, are now commonly used in human patients to disintegrate gastric and intestinal phytobezoars and diospyrobezoars (Chung et al 2006, Lee et al 2006, Ladas et al 2013, Iwamuro et al 2015, with gastric phytobezoar resolution using carbonated beverages being achieved in 91.3 % of cases in human patients, either as a single treatment, or combined with further endoscopic techniques (Ladas et al 2013). Livesey et al (2020) reported the successful treatment of an oesophageal obstruction in a horse by a phytobezoar using cola, which has also been used successfully to break up gastric and enteric diospyrobezoars in horses caused by persimmon fruits (Rodriguez-Hurtado et al 2007, Banse et al 2011. Bird et al (2012) also used diet cola in some cases of gastric impaction.…”