Something stuck in a dog's oesophagus – signs and treatment

Overview

Bones are the objects most commonly lodged in the oesophagus, but chews, wood, needles and fishing tackle can also cause obstruction. Oesophageal foreign bodies are identified more often in dogs than cats.

With a partial obstruction, liquid may pass even when solid food cannot. Swallowing water therefore does not rule out oesophageal obstruction.

One study from northern Europe included 69 dogs treated for oesophageal foreign bodies during 2006–2012. Of these, 68, or 98.6%, were discharged home, but that figure does not mean all were free of later problems.

Post-discharge information was missing for 42 dogs, leaving long-term outcomes unconfirmed for many. Survival rates of 75–95% have also been reported in different groups of treated dogs, so case severity influences the outlook.

Causes

Lodging and pressure damage the lining

An object often stops where the oesophagus cannot stretch as readily as elsewhere. Common sites are the entrance to the chest, the heart-base region and the lower oesophagus just before the diaphragm.

The upper oesophagus immediately behind the throat can also become obstructed. Prolonged pressure can reduce blood flow to the wall and cause tissue death.

A rigid bony object in particular can cause death of the lining after remaining in place for more than 24 hours. A sharp object can perforate the oesophageal wall.

A fish hook may attach to the lining at several points, making safe removal harder. Mechanical rubbing and backflow of stomach acid can together cause oesophagitis, or inflammation of the oesophagus.

Inflammation can impair oesophageal movement and lower sphincter function, further increasing acid reflux.

Risk factors

Small dogs and terriers have been over-represented among oesophageal foreign-body patients. In the northern European study group, 42% of dogs were terriers.

The group's most common breeds were West Highland White Terriers and Cairn Terriers. Patients ranged from a 6-week-old puppy to a 16-year-old dog.

The mean age in the same group was 5.1 years, so this was not solely a puppy problem. Gulping food and swallowing poorly chewed pieces can predispose to objects becoming lodged.

In the northern European group, bone or cartilage accounted for 70% of the 67 objects whose material was known. In a Thai group of 111 oesophageal cases, bones accounted for 61.26% of findings.

Dried chews accounted for 23.42% there, showing that items intended to be eaten can also become lodged.

Typical symptoms

The signs depend on the object's location, how complete the obstruction is and how long it has been present.

• Your dog drools or produces more foam from the mouth than usual.

• Your dog gags or tries to swallow repeatedly.

• Food returns to the mouth without obvious abdominal effort.

• Eating or swallowing is painful, and food is left untouched.

• Your dog changes its head or neck position because of pain.

• Coughing and faster breathing may be associated with food or liquid entering the airways.

A prolonged obstruction can cause weight loss, refusal to eat and tiredness. Regurgitation differs from vomiting, which usually involves active abdominal muscle contractions.

However, not all dogs show signs immediately: 4 dogs in the northern European group had no symptoms after an observed ingestion. If a dog stops eating entirely, regurgitation may decrease even though pain and oesophageal damage continue.

Complications and consequences

Oesophagitis is a common consequence of damage to the lining from both the object and its removal. Some form of complication was recorded in 87% of patients in the northern European study.

Oesophagitis was identified in 78%, with severity ranging from mild to severe. This inflammation figure does not mean the same proportion of cases were fatal.

Regurgitated food or liquid may enter the airways and cause aspiration pneumonia. A perforation within the chest can cause pneumothorax, a collection of pus in the chest or mediastinal inflammation.

A perforation in the neck may be associated with an abscess or air accumulating beneath the skin. Scar tissue forming during healing can narrow the oesophagus and make eating difficult later.

Reported rates of scar-related stricture are 1–24% of treated dogs. Stricture signs often begin within 2 weeks of foreign-body removal.

Diagnosis at the vet

Imaging looks for the object and the damage it has caused

The vet needs to know about any observed swallowing and when signs began. In the northern European group, 46 dogs had a normal general examination despite an oesophageal foreign body.

Radiographs cover both the neck and chest portions of the oesophagus so that an object in the upper part is not missed. Bone and metal are usually visible on plain radiographs.

In the same treatment group, radiography was diagnostic in 64 of 65 examinations, or 99% of imaged cases. An object that shows poorly on radiographs may be revealed by surrounding air or accumulated food.

Images are also checked for pneumonia, fluid in the chest and free air. However, plain radiography may miss a perforation if the object covers the leak.

If needed, contrast imaging helps identify an object or oesophageal injury. An iodine-based contrast medium replaces barium when perforation is suspected.

Barium can interfere with endoscopy, so the order of investigations is planned before contrast is given. Endoscopy shows the object and the condition of the oesophageal lining at the same time.

Radiographs may be repeated immediately before endoscopy in case the object has moved into the stomach. A blood count, blood biochemistry and electrolytes help assess dehydration, infection and the dog's condition before anaesthesia.

Treatment

The dog's condition is stabilised before removal

Your vet prescribes treatment according to the object, damage and your dog's condition. Fluid therapy corrects dehydration and electrolyte disturbances.

Adequate pain relief forms part of initial treatment. Removal or movement of the object is performed under general anaesthesia.

If the object presses on the windpipe and impairs breathing, securing breathing determines the urgency of treatment.

Endoscopy removes the object and shows the lining

A flexible endoscope is passed through the mouth into the oesophagus, and the object is grasped with an instrument guided through it. Direct vision helps controlled removal, particularly of sharp objects or those attached to the lining.

In the northern European group, endoscopic treatment succeeded in 94% of cases: 61 successes in 65 attempts. In some dogs, the object is pulled out through the mouth; some objects can instead be moved into the stomach.

An object moved into the stomach is surgically removed if needed when it cannot dissolve or pass onwards safely. Removing a hook attached to the lining requires identification of its attachment points and precisely directed movements.

Surgical removal is needed when endoscopy fails or the oesophageal wall has perforated. An oesophageal surgical wound heals less readily than other parts of the digestive tract, so aftercare considers leakage and stricture risks.

Inflammation, nutrition and scar-related narrowing need specific aftercare

An acid-suppressing medicine such as omeprazole may reduce additional damage from refluxing stomach acid.

Sucralfate may be used to protect the lining.

An antibiotic is needed for conditions such as aspiration pneumonia or bacterial infection in the chest, rather than as a substitute for object removal. When to restart eating depends on the damage: early swallowing may help function but can also increase pain and inflammation.

In one historical northern European clinical series, food was often offered around 12 hours after removal, but strong research evidence for that timing was lacking. Prolonged refusal to eat or severe swallowing pain may require a feeding tube to ensure adequate nutrition.

A feeding tube can be selected to bypass the damaged oesophageal area so nutrition does not depend on painful swallowing. Extensive damage encircling the oesophageal lining may require repeat endoscopy after 1–2 weeks.

A confirmed scar-related stricture can be treated by veterinary balloon dilation. A success rate of around 85% has been described for balloon dilation of strictures.

Successful stricture treatment usually requires 2–4 procedures.

Prevention

Keep bones and large chews away from a dog that swallows them in chunks without chewing. Even a chew sold to be eaten can become lodged in the oesophagus, so do not leave swallowable pieces unsupervised.

Store needles, fish hooks and sharp rubbish out of reach. When your dog cannot be supervised, keep its room or a secure confined area free of objects it could swallow.

A basket muzzle may be considered for a dog that repeatedly swallows objects to prevent further ingestion. Do not try to remove an object by inducing vomiting yourself at home: sharp edges can tear the oesophagus on the way back.

Important for dog owners

Record the possible time of swallowing, the object's material and size, and whether someone definitely witnessed it. Bring a similar object or packaging if this helps identification. Immediately mention any fishing line attached to a hook or any sharp component.

Film regurgitation or unusual swallowing movements only if this does not delay leaving for treatment. Explain whether your dog has already received medicines or food in an attempt to address the situation. Telephone instructions from the veterinary practice determine whether water or food can be offered during the journey.

After discharge, monitor breathing, eating, pain and any return of regurgitation. Follow the feeding and medication instructions given specifically for this dog. Confirm the follow-up date before leaving and seek reassessment if swallowing becomes difficult or food starts returning to the mouth.

Frequently asked questions

Can there be an obstruction even if water goes down?

A partial obstruction that prevents solid food passing may still allow water and other liquids through. A dog may then have signs for a long time despite drinking. A confirmed oesophageal foreign body is still removed promptly before more serious wall damage develops.

Is regurgitation the same as vomiting?

In regurgitation, undigested food returns passively to the mouth, whereas vomiting involves active abdominal muscle contractions. Oesophageal obstruction can cause regurgitation, but vomiting may also occur in the same dog. Describing the event therefore helps locate the problem.

Does removing a foreign body always require surgery?

An object can often be removed endoscopically or moved into the stomach under controlled conditions. Surgery is needed if this fails or the wall has perforated. An indigestible object moved into the stomach may also need removal through a separate abdominal operation.

Can I make my dog vomit after it swallows a bone?

Do not induce vomiting yourself, as a sharp piece can damage the oesophagus on its way back up. Salt used at home can also cause poisoning. An object already lodged in the oesophagus requires veterinary examination and urgent removal.

Why does swallowing become difficult again after removal?

Scar tissue during healing can narrow the oesophagus and cause regurgitation to return. Stricture signs usually begin within 2 weeks of removal. New swallowing difficulty is investigated promptly because a stricture may progress and become harder to treat.