ENDOSCOPIC RETRIEVAL OF PIPER BETEL IN A DOG WITH HYPOTHYROIDISM ASSOCIATED MEGAOESOPHAGUS

K. Sasikala1 and G. Vijayakumar2 1M.V.Sc Student, 2Professor and Head, Department of Veterinary Clinical Medicine, Veterinary College and Research Institute, TANUVAS, Namakkal – 637 002(T.N.). [Received: 28.4.2018; Accepted: 29.10.2018] {DOI 10.29005/IJCP.2018.10.2.112-113}

A seven year old non descriptive dog weighing about 22 kg was presented to Veterinary College and Research
Institute, Namakkal hospital with the history of anorexia for 3 days. On clinical examination animal was dull with
exaggerated lung sounds on auscultation. Haematobiochemical values were within the normal range except for reduced total thyroxine level. Chest and abdominal survey radiography did not show any abnormality. Animal was subjected to video endoscopy under general anesthesia. On oesophagoscopy oesophagus was packed with Piper betel leaves with dilatation of cervical and thoracic oesophagus. Around 18 betel leaves were removed by using endoscopic snare. The owner was advised to follow elevated feeding with semisolid diet. Thyroxine @ 20μg /kg was administered twice daily for hypothyroidism. The animal showed clinical improvement after 20 days.
Keywords: Dog, Endoscopy, Hypothyroidism, Megaesophagus, Retrieval.

Megaesophagus is a condition where there is a decreased or absent motility (movement, muscular contractions) of the oesophagus (Tams, 2003). This syndrome may occur as a congenital disorder (uncommon), or it may manifest in adult animals as an idiopathic (common) or acquired lesion (Jergens, 2010). Megaoesophagus is an important cause of regurgitation, may be associated with hypothyroidism (Huber et al., 2001). Aspiration pneumonia is a common complication of megaesophagus (Tams, 2003). Fracassi and Tamborini (2011) reported high concentration of cTSH associated with low basal TT4 in a dog with megaoesophagus. Esophagoscopy is rarely required for diagnosis of megaesophagus, except when obstructive disease (neoplasia) or reflux esophagitis are suspected. However, a definitive association between hypothyroidism and megaoesophagus has not been proved (Johnson et al., 2009). Endoscopy is a minimally invasive tool that can be used for retrieval of foreign bodies. When compared with surgery, endoscopy offers a less invasive and less expensive option. Elevated feeding with semi solid food
and antibiotics for aspiration pneumonia should be followed for dogs with megaoesophagus (Jergens, 2010). The present article describes endoscopic retrieval of Piper betel leaves in a non descriptive dog with
hypothyroidism associated megaoesophagus.

Case History and Observations A seven year old non descriptive dog weighing about 22 kg was presented to
Teaching Veterinary Clinical Complex, Veterinary College and Research Institute, Namakkal with the history of anorexia for 3 days. On clinical examination animal had dullness, exaggerated lung sounds on auscultation, dull and dry skin with patchy alopecia. Haemato-biochemistry revealed normal haemoglobin (13.8 g/dl), packed cell
volume (42.17%), red blood cells (6.23×106/cumm), white blood cells (7.07 ×103/cumm), blood urea nitrogen (24 mg/dl) and creatinine (0.7 mg/dl) levels. Total T4 level on serum was 0.5μg/dl. No foreign body
/ abnormality could be detected on lateral chest and abdominal plain radiography. Ultrasonographic findings were normal.

Treatment and Discussion
Oesophagoscopy was carried out using atropine (@ 0.04 mg/kg b.wt as preanaesthesia), xylazine (@ 0.5 mg/kg b.wt IM) and propofol (@ 4 mg/kg b.wt IV as anaesthetic). Piper betel leaves obstructing the oesophagus with dilatation of cervical and thoracic oesophagus was noticed on oesophagoscopy (Fig. 1). Around 18 betel leaves were removed by using endoscopic snare (Fig. 2). Animal was administered with Ringer’s lactate (@ 20ml/kg I/V),
amoxicillin-cloxacillin (@ 20mg/kg I/V BID) and pantoprazole (@ 1mg/kg I/V) for 3 days. Levothyroxine (@ 20μg/kg BID) was advised for 1 month. The owner was advised to follow elevated feeding with semisolid diet.
TT4 level was normal after 1 month of therapy. Animal recovered uneventfully following treatment.

Levothyroxine (@ 20μg/kg) followed in the present case was in concurrence with Fracassi and Tamborini (2011). In conclusion betel leaves were removed successfully by using endoscope in a non-discript dog with
hypothyroidism associated megaoesophagus. Elevated feeding with levothyroxine (@ 20μg/kg) gave excellent recovery in the present case.

References
Fracassi, F and Tamborini, A. (2011). Reversible megaoesophagus associated with primary hypothyroidism in a dog.
Vet. Rec., 168: 329.

Huber, E., Armbrust, W., Forster, J.L., Ribiere, T and Grosclaude, P. (2001). Resolution of megaesophagus after
treatment of concurrent hypothyroidism in a dog. Schweizer Archiv für Tierkeilkunde, 143: 512-514.

Jergens, A.E. (2010). Diseases of the oesophagus. In: Textbook of Veterinary internal medicine, Diseases of dog and
cat. S.J. Ettinger and E.C. Feldman (Eds.), 7th edn., Saunders Elsevier, St. Louis, Missouri, U.S.A. Pp. 1487-1499.

Tams, T.R. (2003). Diseases of the esophagus. In Tams TR, Eds.: Handbook of Small Animal Gastroenterology, 2nd
edn., WB Saunders, Philadelphia, U.S.A. Pp. 119-134.

Johnson, B.M., Denovo, R.C and Mears, E.A. (2009). Canine megaesophagus. In Kirk’s Current Veterinary Therapy. J.D. Bonagura, D.C. Twedt (Eds.) 14th edn., WB Saunders, Philadelphia, U.S.A. Pp. 486-492.

Leave a comment

Your email address will not be published. Required fields are marked *

RSS
Follow by Email
Facebook
Twitter
error: Content is protected !!