Small animal Review

Summary: This month's Small Animal Review summarises studies on the effect of surgical preparation solutions on body temperature in cats, the persistence of leptospires in canine urine following treatment outcomes of oesophageal stricture.

Impact of endoscopic submucosal dissection and epithelial cell sheet engraftment on systemic cytokine dynamics in patients with oesophageal cancer

The tumour microenvironment (TME) plays an important role in cancer development, progression, and metastasis. Various cytokines are present in the TME in oesophageal cancer. Oesophageal stricture is a major complication of endoscopic submucosal dissection (ESD) for oesophageal cancer, and inflammatory cytokines are closely related to its pathogenesis. However, the cytokine crosstalk involved in the oesophageal cancer TME and post-ESD stricture has not been fully elucidated. This study investigated the comprehensive cytokine dynamics following ESD in patients with oesophageal cancer. In addition, the effect of a novel preventive technique for post-ESD stricture, autologous cell sheet engraftment, on cytokine levels was evaluated. Various pro-inflammatory and anti-tumorigenic cytokines were elevated in patients with oesophageal cancer, and ESD transiently influenced cytokine concentrations. IL-1β and TNF-α, two major pro-inflammatory cytokines that induce oesophageal stricture, were significantly suppressed by cell sheet engraftment. In conclusion, this study revealed the distinct cytokine dynamics after ESD in patients with oesophageal cancer, together with the effect of autologous cell sheet engraftment on cytokine fluctuation. These results can accelerate research on the TME and therapeutic strategies for oesophageal cancer.

Post-transplant lymphoproliferative disorder as a cause of oesophageal ulceration and stricture: case report and literature review

Post-transplant lymphoproliferative disorder (PTLD) of the oesophagus is a rare complication of solid organ transplant that requires a high index of suspicion to diagnose. A literature review conducted on Ovid Medline database retrieved 24 articles, among which five previous cases of oesophageal PTLD were identified. Development of oesophageal strictures related to PTLD has not been reported in the literature. We report a case of oesophageal PTLD following lung transplant, presenting with extensive, circumferential ulceration in the oesophagus. PTLD was successfully treated with chemotherapy but subsequently, this patient developed a severe oesophageal stricture at the site of her PTLD. She presented with an episode of food bolus impaction requiring endoscopic retrieval. In the following years, our patient required multiple endoscopic dilatations of this PTLD-related oesophageal stricture.

Surgical treatment of a distal oesophageal stricture by mucosal radial incision and dilation in a kitten with secondary megaoesophagus

Case summary A 7-month-old intact female Maine Coon cat was presented with a 2-month history of regurgitations. Contrast radiographic and endoscopic examinations revealed a diffuse megaoesophagus secondary to a severe lower oesophageal stricture. An epiphrenic diverticulum was noted. Endoscopic balloon dilation was unsuccessful. Gastrotomy was thus performed in order to incise the oesophageal wall radially along the stricture site, and then to dilate the stricture. A diameter of 20 mm was reached. With the aim of preventing stricture recurrence, submucosal injections of triamcinolone acetonide were performed. An 18 Fr oesophagogastric feeding tube was placed and a left gastropexy was performed in order to exert some traction on the gastroesophageal junction, with the aim of reducing the oesophageal diverticulum. Twelve months postoperatively, clinical signs had completely resolved and follow-up radiographs revealed marked improvement of the oesophageal dilatation. Relevance and novel information Lower oesophageal strictures should be considered when evaluating regurgitations or megaoesophagus in a kitten. Surgical mucosal radial incision is a therapeutic option in cases of lower oesophageal stricture refractory to balloon dilation, and can lead to a marked improvement of clinical signs and of the oesophagus diameter leading to clinical success.

Study of definitive surgical management of patients with corrosive stricture of upper gastrointestinal tract

Background: Corrosive injury of the oesophagus and stomach is a cause of major morbidity and mortality and is usually seen in the younger age group. Although definitive surgical procedures are available, there is a considerable debate on the timing of a definitive surgery and its electiveness. This study aims to document the benefits of elective surgery and the outcomes of various surgical procedures.Methods: A retrospective observational study of 25 cases of corrosive stricture of upper gastrointestinal tract who underwent definitive surgical procedure was conducted in the department of general surgery at the new civil hospital and government medical college, Surat during a period of 60 months from July 2014 to July 2019. Patients were followed up till a period of 6 months post definitive surgical procedure and were evaluated.Results: Out of 25 patients in our study subjected to definitive surgical procedure in the form of either gastrojejunostomy (GJ) or colonic transposition, 18 patients (72%) could take fully oral and required no further intervention till 6 months post-operative follow up; 3 patients (12%) due to post-operative oesophageal stricture required serial 3 monthly oesophageal dilatation with controlled radial expansion (CRE) balloon; 4 patients (16%) had expired.Conclusions: The choice of definitive surgical procedure according to the level of oesophageal stricture and its optimal timing gives good outcomes with less morbidity and mortality in patients with corrosive substance ingestion.

Iso-peristaltic colonic loop interposition for the treatment of benign oesophageal stricture: a case report with review of literature

Corrosive oesophageal strictures are a common and debilitating condition in India. Patients generally have dysphagia, cachexia, drooling of saliva, aspiration pneumonitis, and lung abscess. Though endoscopic dilatations are done in cases of short segment strictures, surgical oesophageal by pass is the permanent solution for this condition. A 24 years female presented with complaints of dysphagia and cachexia, due to corrosive stricture. Patient had a history of poison ingestion 2 years back. Intra-operatively stricturous mucosa is excised and an iso peristaltic colonic loop by pass was carried out. Post operatively patient had a complication of anastomotic leak which was treated conservatively, excepting which patient is symptom free and gaining weight on a follow up period of 1 year. Ever since first described by Kelling and Vuillet in 1911 colonic interposition is mostly used around the globe for oesophageal bypass in both benign and malignant conditions. Stomach and jejunum are the other conduits that can be used. Iso peristaltic loop is mostly used to reduce the incidence of reflux. Right colon or transverse colon graft based on the mid colic artery or the left colic artery owing to the reliable blood supply and less diameter. This procedure has a high complication rate of around 27% most of which are due to the vascular comprise of the graft.

A rare case report of oesophagocoloplasty with distal colo-jejunal anastomosis in the management of post corrosive strictures of the oesophagus

Ingestion of corrosive substances and chronic sequelae associated with it is the major public health problem in the developing countries. The most severe forms of injury can lead to mortality; however, the major concern with this type of injury in life-long morbidity. Colonic conduit for bypassing diseased oesophagus with distal anastomosis with stomach is well documented and practiced procedure. Authors have encountered a case of 21-year-old lady with corrosive injuries to oesophagus and stomach, later developed non dilatable oesophageal stricture with completely cicatrised and adherent stomach. Due to unavailability of stomach, authors have used colon as a conduit and colo-jejunal anastomosis bypassing the oesophagus, stomach and duodenum. Colo-jejunal anastomosis for chronic corrosive oesophageal stricture is not commonly practiced procedure which makes this case a rare one.