Question of the Day

The most appropriate initial therapy for this systemically stable horse with an acute esophageal obstruction (also incorrectly called “choke”) is to withhold food and water, give sedatives and oxytocin (and n-butylscopolammonium bromide) to relax the esophagus, and recheck in a couple hours.

This is often successful in uncomplicated cases.

If obstruction has not resolved within two to four hours, sedate to lower the head, pass a nasogastric tube to the level of the obstruction, and GENTLY lavage the esophagus with water. This is typically successful.

In cases that do not resolve with this Tx, refer for ultrasound, esophageal endoscopy, and/or general anesthesia with esophageal lavage at a referral center.

Click here to see an endoscopic image of an esophagus after resolution of a 12-hour obstruction.

Obstructions lasting more than several hours require IV fluids and electrolytes, anti-inflammatories, and antimicrobials (for secondary aspiration pneumonia). Complications include aspiration pneumonia, repeat obstruction, and esophageal stricture.

Image courtesy of Nora Grenager, VMD, DACVIM.