Veterinary Medicine - November 2008 - (Page 610)

A challenging case PEER-REVIEWED extramucosal enucleation of the mass. Enucleation involves separating the overlying adventitia and muscle longitudinally and performing blunt dissection, avoiding damage to the submucosa and mucosal layers.6,17 If necessary, visualization can be improved by injecting saline solution under the serosal and muscular layer to separate the planes and create a cushion between the lesion and the muscle layer.12 It is important to repair the mucosa if it is injured during dissection, as well as to close the myotomy after mass removal. Postoperative diverticula have been reported in people possible postoperative complications in dogs. In general, esophageal surgery is prone to serious complications, including infection, regurgitation, esophagitis, dehiscence, stula formation, stricture, and disease recurrence. The high complication rate associated with esophageal surgery has been attributed to many factors, including esophageal movement during swallowing, high wound tension, lack of a serosal layer as present in the small and large intestinal tract and omentum to help provide an early seal and promote vascularization to a CONCLUSION Because tumor enucleation avoids esophageal resection and spares the mucosal surface, this technique should be considered for symptomatic esophageal leiomyomas in dogs, as expected complications would be minimal. In people, a low incidence of complications and recurrence is reported with enucleation of leiomyomas. REFERENCES 1. Ridgway RL, Suter PF. Clinical and radiographic signs in primary and metastatic esophageal neoplasms of the dog. J Am Vet Med Assoc 1979;174(7):700-704. 2. Withrow SJ. Esophageal cancer. In: Withrow SJ, Vail DM, eds. Withrow and MacEwen’s small animal clinical oncology. 4th ed. St. Louis, Mo: Saunders, 2007;477-478. 3. Ranen E, Shamir MH, Shahar R, et al. Partial esophagectomy with single layer closure for treatment of esophageal sarcomas in 6 dogs. Vet Surg 2004;33(4):428-434. 4. Gualtieri M, Monzeglio MG, Di Giancamillo M. Oesophageal squamous cell carcinoma in two cats. J Small Anim Pract 1999;40(2):79-83. 5. Culbertson R, Branam JE, Rosenblatt LS. Esophageal/gastric leiomyoma in the laboratory Beagle. J Am Vet Med Assoc 1983;183(11):1168-1171. 6. Lee LS, Singhal S, Brinster CJ, et al. Current management of esophageal leiomyoma. J Am Coll Surg 2004;198(1):136-146. 7. Kim TI, Park YS, Choi EH, et al. Endoscopic resection of a large leiomyoma of the esophagus. Gastrointest Endosc 2004;59(1):129-133. 8. Farese JP, Bacon NJ, Ehrhart NP, et al. Oesophageal leiomyosarcoma in dogs: surgical management and clinical outcome of four cases. Vet Comp Oncol 2008;6(1):31-38. 9. Matros L, Jergens AE, Miles KG, et al. Megaesophagus and hypomotility associated with esophageal leiomyoma in a dog. J Am Anim Hosp Assoc 1994;30:15-19. 10. Head KW. Tumors of the alimentary tract. In: Moulten JE, ed. Tumors in domestic animals. 3rd ed. Berkely, Calif: University California Press, 1990;347-428. 11. Bagley RS, Levy JK, Malarkey, DE. Hypoglycemia associated with intra-abdominal leiomyoma and leiomyosarcoma in six dogs. J Am Vet Med Assoc 1996;208(1):69-71. 12. Wehrmann T, Martchenko K, Nakamura M, et al. Endoscopic resection of submucosal esophageal tumors: a prospective case series. Endoscopy 2004;36(9):802-807. 13. Rolfe DS, Twedt DC, Seim HB. Chronic regurgitation or vomiting caused by esophageal leiomyoma in three dogs. J Am Anim Hosp Assoc 1994;30:425-430. 14. Kerpsack SJ, Birchard SJ. Removal of leiomyomas and other noninvasive masses from the cardiac region of the canine stomach. J Am Anim Hosp Assoc 1994;30:500-504. 15. Grooters AM, Johnson SE. Canine gastric leiomyoma. Compend Contin Educ Pract Vet 1995;17:1485-1491. 16. McPherron MA, Withrow SJ, Seim HB, et al. Colorectal leiomyomas in 7 dogs. J Am Anim Hosp Assoc 1992;28:43-46. 17. Bonavina L, Segalin A, Rosati R, et al. Surgical therapy of esophageal leiomyoma. J Am Coll Surg 1995;181(3):257-262. 18. Moore TC, Goldstein J. Use of intact omentum for closure of full-thickness esophageal defects. Surgery 1959;45(6): 899-904. 19. Shamier MH, Shahar R, Johnston DE, et al. Approaches to esophageal sutures. Compend Contin Educ Pract Vet 1999;21(5): 414-421. 20. Kyles AE. Esophagus. In: Slatter D, ed. Textbook of small animal surgery. 3rd ed. Philadelphia, Pa: Saunders, 2003;573-592. 21. Saint JH, Mann FC. Experimental surgery of the esophagus. Arch Surg 1929;18:2324-2338. 22. Muangsombut J, Hankins JR, Mason GR, et al. The use of circular myotomy to facilitate resection and end-to-end anastomosis of the esophagus. J Thorac Cardiovasc Surg 1974;68(4):522-529. Esophageal resection of more than 3 to 5 cm increases the risk of dehiscence. if the muscle layer is not reapposed.6 Tumors up to 8 cm are easily enucleated in people. Those greater than 8 cm can be removed, but the remaining muscle defect may be too large to easily close.6 If the tumor has a broad base and is tightly adherent, complete removal may not be possible by enucleation.7 Without complete removal, recurrence is likely, so debulking alone is unlikely to provide long-term relief. Esophageal resection may be required in about 10% of people. Human mortality rates are reported from 0% to 1.3% for leiomyomas. Most patients have complete resolution of symptoms, with 89% to 94% of patients symptom-free ve years later. Complications after leiomyoma enucleation in people are rare, but include diverticula, stula, re ux esophagitis, stenosis, ulceration, and, rarely, recurrence.6 The incidence of esophagitis can increase after excision because of decreased propulsive activity and acid clearing mechanism impairment, especially in patients with a previous history of re ux. All of these complications should be considered as repair, and the presence of a segmental blood supply to the esophagus.18,19 After esophageal surgery, particularly in cases involving resection and anastomosis or mucosal penetration or damage, use of a gastrostomy tube is recommended to decrease the amount of motion occurring at the surgical site and facilitate mucosal healing.20 In this case, esophageal resection and anastomosis were initially considered but would have required resecting 6 cm of thoracic esophagus to provide a 1-cm margin around the neoplasm. Experimentally, resection and primary anastomosis of up to 20% of the cervical esophagus and 50% of the thoracic esophagus have been reported in dogs.21 Clinically, resection of more than 3 to 5 cm increases the risk of dehiscence.20 Circumferential partial myotomy can reduce anastomotic tension and decrease the risk of dehiscence in dogs.22 Partial esophagectomy has also been reported for malignant esophageal neoplasms in dogs, with resection of the mass and then longitudinal closure of the resulting defect.3 610 November 2008 VETERINARY MEDICINE

Table of Contents Feed for the Digital Edition of Veterinary Medicine - November 2008

Veterinary Medicine - November 2008 Contents Leading Off Editors' Guest Just Ask the Expert Letters Practice Makes Perfect Clinical Exposures Practice Matters Idea Exchange Author Guidelines A Challenging Case: Esophageal Leiomyoma in a Dog Osteoarthritis in Cats: What We Now Know About Recognition and Treatment Product Preview CE Form/Advertiser Index Marketplace/Classifieds Mind Over Miller

Veterinary Medicine - November 2008

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.