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Foreign Object in the Esophagus

A foreign body in the esophagus refers to any foreign object that gets stuck in the area between the throat and stomach after being swallowed. The esophagus is a muscular tube that transports food from the pharynx to the stomach. In dogs and cats, it initially runs along the trachea in the neck area, then enters the chest cavity, passes through the diaphragm, and finally opens into the stomach. Anatomically, the esophagus has three natural constrictions: at the transition from the pharynx to the esophagus, in the area of the heart, and at the passage through the diaphragm. These physiological constrictions are predisposed locations for foreign bodies to get stuck.

The esophageal wall consists of several layers: the inner mucous membrane (mucosa), a connective tissue layer (submucosa), a muscle layer (muscularis), and an outer connective tissue sheath (adventitia). These layers are sensitive to pressure and injury from foreign bodies, which can lead to inflammation, necrosis, or even perforation.

Unlike in humans, where foreign bodies in the esophagus are often bones or fish bones, dogs and cats swallow a wider range of objects, which is related to their different eating behaviors.

Causes

Foreign objects in the esophagus occur in dogs and cats due to various circumstances, with typical causes differing somewhat between the two species.

In dogs, hasty or greedy eating is a main cause for swallowing foreign objects. Particularly large pieces of meat or bone are often insufficiently chewed and can get stuck in the esophagus. Bone fragments pose a special danger as they can be sharp-edged and injure the esophageal wall. Toy parts, balls, stones, or other small objects are also frequently swallowed by dogs, especially by young, playful animals or those with a pronounced urge to chew and swallow.

In cats, linear foreign objects such as threads, strings, or wool remnants are particularly problematic. These can wrap around the base of the tongue and then extend into the esophagus, where they are pulled deeper with each swallow. Grass blades or small toy parts are also occasionally swallowed by cats.

For both species, certain anatomical or pathological factors can increase the risk of a foreign object in the esophagus:

Congenital narrowing of the esophagus
Acquired strictures after previous injuries or inflammations
Tumors that narrow the lumen of the esophagus
Motility disorders of the esophagus that impede normal transport

Button batteries are particularly dangerous, as they not only mechanically block the esophagus but can also cause severe burns and tissue necrosis through electrochemical reactions. Similarly problematic are sharp-edged objects such as fishhooks, needles, or bone splinters that can perforate the esophageal wall.

In cats, foreign objects in the esophagus occur less frequently overall than in dogs, which is attributed to their more selective eating behavior. However, when they do occur, they are often associated with linear foreign objects, which present specific challenges in diagnosis and treatment.

Symptoms

Gagging, retching, or gagging movements, as if the dog wants to vomit.
Increased salivation or foam formation at the mouth.
Coughing or gagging wheezing.
Swallowing difficulties (the dog tries unsuccessfully to swallow, head stretched downwards).
Restlessness or expressions of pain, possibly whining.
No food intake
Expressions of pain
Partially altered breathing

The clinical signs of a foreign object in the esophagus can vary depending on the location, type of foreign object, and duration of the obstruction. Typically, symptoms appear immediately after ingestion of the foreign object, but may also appear delayed in cases of partial obstructions.

In dogs and cats, the following symptoms are characteristic:

Increased salivation (hypersalivation) is one of the most noticeable signs. The animals cannot swallow normally, causing saliva to drip from the mouth or foamy saliva to become visible around the lips. Repeated gagging and swallowing attempts are also typical, with animals often stretching their head forward and overextending their neck to alleviate discomfort. These gagging movements can be mistaken for coughing, but are actually unsuccessful attempts to move or expel the foreign object.

Regurgitation of food and water occurs frequently, with the material being unchanged and undigested, in contrast to vomit which contains stomach acid and is partially digested. Regurgitation usually occurs immediately after food or water intake if the foreign object completely blocks the esophagus.

Anorexia (food refusal) is another common symptom, as animals experience pain when swallowing or food cannot pass the blockage. In severe cases, dysphagia (difficulty swallowing) may also be observed, where animals show interest in food but have difficulty ingesting or swallowing it.

Restlessness, discomfort, and expressions of pain are further signs. Animals may be restless, repeatedly change their position, or whine or yelp when attempting to swallow. In cats, pain may manifest as withdrawal or unusual vocalizations.

In advanced cases or with perforations of the esophagus, additional symptoms may occur:

Fever as a sign of infection or inflammation
Shortness of breath or altered breathing, especially if the foreign body is pressing on the trachea
Swelling in the neck area if inflammation or an abscess has developed
Lethargy and general deterioration of overall well-being

In cats with linear foreign bodies, a thread or string visible under the tongue can be an important diagnostic clue. These animals often show characteristic gagging with an extended tongue.

The symptoms may be less pronounced in partial obstruction, with animals possibly only gagging occasionally or refusing certain types of food (e.g., solid food, while liquid food can still pass).

First Aid

Stay Calm and Secure the Dog
- Keep the dog as calm as possible and avoid unnecessary stress. Excited or panicked movements can further shift the foreign object or lead to injuries.
- If possible, let the dog sit or lie down in a safe place and keep it under observation.
No Forceful Attempts to Remove the Foreign Object
- There is a risk of pushing the foreign object further into the esophagus or even causing injuries.
- Only attempt to remove the object if it is clearly visible and easily accessible (e.g., in the throat area).
- Be careful not to injure yourself or stress the dog.
Do Not Induce Vomiting
- Do not try to make the dog vomit (for example, using salt water or other home remedies). This can lead to additional injuries, especially if the foreign object is angular or sharp.
Veterinary Help as Quickly as Possible
- A foreign object in the esophagus can quickly lead to serious complications such as perforations (puncture of the esophageal wall) or tissue damage.
- Contact your veterinarian or a veterinary hospital immediately and notify them of your arrival so the team is prepared.
- At the veterinary practice, an X-ray examination or endoscopy (esophageal examination) is usually performed first to determine the position and size of the foreign object. Removal can be done endoscopically or surgically.
Transport your dog carefully. If possible, do not let it walk over a long distance.

Diagnosis

The diagnosis of a foreign body in the esophagus is based on a combination of medical history, clinical examination, and imaging techniques. The diagnostic process must be carried out quickly, as delays increase the risk of complications.

During the medical history, the veterinarian collects important information such as the time of onset of symptoms, possible observed ingestion of a foreign body, and the animal’s eating behavior. During the clinical examination, particular attention is paid to the pharyngeal area, the neck region, and the abdomen. In cats, the underside of the tongue is carefully inspected to identify possible linear foreign bodies.

Imaging diagnostics play a central role. X-rays of the neck and chest in two planes (lateral and ventrodorsal) are usually the first step. Radiopaque foreign bodies such as bones, metal objects, or stones are directly visible. Non-radiopaque objects such as wood, plastic, or textiles can be indirectly recognized by air accumulations, fluid levels, or soft tissue swelling. In some cases, a contrast study is helpful, in which a water-soluble contrast agent is administered to visualize the course of the esophagus and identify obstructions. However, this method must be used with caution, as complications can occur in cases of complete obstruction or suspected perforation.

Ultrasound examination can be particularly helpful in the neck area and cranial thorax to identify foreign bodies and assess accompanying inflammation or fluid accumulations. In complex cases, advanced imaging techniques such as computed tomography (CT) or magnetic resonance imaging (MRI) can be used, which allow a more detailed visualization of the esophagus and surrounding structures.

Esophagoscopy (esophageal endoscopy) is both a diagnostic and therapeutic procedure. With a flexible or rigid endoscope, the entire esophagus can be directly visualized, allowing precise localization and characterization of the foreign body. At the same time, in many cases, the foreign body can be directly removed. Esophagoscopy requires general anesthesia and should be performed by an experienced veterinarian.

Laboratory tests such as complete blood count and blood chemistry are not specific for the diagnosis of a foreign body but can provide important information about the general condition of the animal and detect complications such as dehydration, electrolyte imbalances, or infections.

If perforation of the esophagus is suspected, additional examinations such as chest X-rays may be necessary to detect mediastinitis, pneumomediastinum, or pleural effusion. In such cases, thoracocentesis to obtain and analyze pleural fluid may also be indicated.

Further veterinary measures

The treatment of a foreign body in the esophagus usually requires immediate intervention, as prolonged presence of the foreign body can lead to serious complications. The choice of treatment method depends on various factors, including the type and location of the foreign body, duration of obstruction, clinical condition of the animal, and existing complications.

Endoscopic removal is the method of choice and is performed under general anesthesia. Using a flexible or rigid endoscope, the foreign body is visualized and then grasped and removed with special instruments such as forceps, snares, or baskets. This method is particularly advantageous as it is minimally invasive and simultaneously allows assessment of the esophageal mucosa for injuries. Special care must be taken with linear foreign bodies in cats to avoid injuries. Here, the part wrapped around the base of the tongue is often loosened first before removing the part located in the esophagus.

In some cases, careful advancement of the foreign body into the stomach may be considered if direct removal is not possible. However, this technique is only used if the foreign body has no sharp edges and there are no injuries to the esophagus. Subsequently, the foreign body can either be excreted naturally or removed by gastrotomy if necessary.

Surgical intervention (esophagotomy) is necessary if endoscopic removal is not successful or if complications such as perforations already exist. Access to the esophagus is achieved through the neck, chest, or diaphragm, depending on the location of the foreign body. Esophagotomy is a challenging procedure with an increased risk of complications, especially in the chest area where a thoracotomy is required.

After removal of the foreign body, medical therapy usually includes:

Antibiotics to prevent or treat infections, especially in cases of injuries to the esophageal wall
Pain medication to control pain and inflammation
Proton pump inhibitors or H2 receptor antagonists to reduce gastric acid production and protect the damaged esophageal mucosa
In severe cases, intravenous fluid therapy to correct dehydration and electrolyte imbalances

Feeding management after the removal of a foreign body is crucial for the healing of the esophagus. Depending on the severity of the injuries, temporary food restriction with parenteral nutrition or the placement of a gastric tube may be necessary. In less severe cases, a gradual reintroduction of feeding with soft, easily digestible food is recommended.

In cases of complications such as strictures (narrowing) of the esophagus, repeated balloon dilatations may be necessary to restore normal function. In particularly severe cases with extensive necrosis or non-healing perforations, partial resection of the esophagus with subsequent anastomosis may be necessary, which is associated with increased morbidity and mortality.

Prognosis and aftercare

The prognosis for foreign bodies in the esophagus depends significantly on several factors: the duration the foreign body remains in place, the extent of tissue damage caused, the type of foreign body, and the timing of intervention. Generally, the earlier the diagnosis and treatment, the better the prognosis.

In uncomplicated cases where the foreign body can be removed endoscopically within 24 hours of ingestion and there are no or only minimal mucosal lesions, the prognosis is good to excellent. Most animals recover completely without long-term consequences. If the foreign body remains in place longer (more than 24-48 hours), the risk of deeper tissue damage, necrosis, and perforations increases significantly, worsening the prognosis.

Foreign bodies with sharp edges or corrosive properties (such as button batteries) cause more severe damage more quickly and are associated with a worse prognosis. Similarly, an already occurred perforation with mediastinitis or pleuritis significantly reduces the chances of survival.

Aftercare plays a crucial role in complete recovery. In the first few days after removing the foreign body, the animal should be closely monitored to detect complications early. Feeding is gradually adjusted: With mild mucosal lesions, soft, mushy food can be started after 12-24 hours. In more severe injuries, a longer food withdrawal with parenteral nutrition or feeding via a gastric tube is necessary to promote healing of the esophagus.

The medical aftercare typically includes:

Continuation of antibiotic therapy for 7-14 days, depending on the severity of the lesions
Pain management for 3-7 days
Gastric protection with proton pump inhibitors for 2-4 weeks to reduce reflux and promote mucosal healing

Follow-up examinations are important to monitor the healing process. A control endoscopy can be performed 2-4 weeks after the procedure to assess mucosal healing and detect possible strictures early. Contrast studies may be helpful if strictures are suspected.

One of the most common long-term complications is the development of strictures (narrowing) of the esophagus, which can lead to recurrent regurgitation. These typically occur 1-4 weeks after the injury and often require repeated balloon dilations. In severe cases, strictures can be therapy-resistant and permanently impair the animal’s quality of life.

To prevent further foreign body episodes, owners should be educated about appropriate toys and feeding practices. For dogs with voracious eating behavior, special slow-feeder bowls or dividing meals into smaller portions can be helpful. Cat owners should be particularly careful with linear objects such as threads, strings, or wool remnants and keep these out of reach.

Summary

Foreign bodies in the esophagus represent a medical emergency in dogs and cats that requires prompt diagnosis and treatment. The esophagus, a muscular tube between the pharynx and stomach, has natural narrowings where foreign bodies are particularly likely to get stuck. While dogs often swallow bones, toys, or other objects due to hasty eating, linear foreign bodies such as threads or strings are characteristic in cats.

Clinical symptoms include increased salivation, repeated gagging, regurgitation, food refusal, and pain expressions. Diagnosis is made through a combination of clinical examination, X-rays, and endoscopy, with the latter often used simultaneously for treatment.

Treatment aims at removing the foreign body as quickly as possible, preferably through endoscopic procedures. In more complicated cases, surgical intervention may be necessary. Subsequent therapy includes antibiotics, pain medication, gastric protection, and adjusted feeding management.

The prognosis depends largely on how long the foreign body has been in place, the extent of tissue damage, and the timing of intervention. Early treated, uncomplicated cases have an excellent prognosis, while delayed treatment or severe complications such as perforations can significantly reduce the chances of survival.

The most common long-term complication is the development of strictures, which may require further treatment. Preventive measures such as adapted feeding practices and avoidance of dangerous toys are important to prevent recurrence.

Overall, this clinical picture underscores the importance of prompt veterinary care when a foreign body in the esophagus is suspected, as well as the need for careful aftercare to ensure complete recovery.

Outlook on current research

Research in the field of foreign body diseases of the esophagus in small animals is continuously evolving, with the aim of improving diagnostic and treatment methods and reducing complications.

An important research focus is on improving endoscopic techniques and instruments. Newer flexible endoscopes with higher resolution and improved maneuverability allow for more precise visualization and manipulation of foreign bodies. Innovative grasping tools and extraction devices are being developed to remove even complex foreign bodies more safely. Particularly promising are advances in removing linear foreign bodies in cats, which traditionally pose a special challenge.

Diagnostic imaging is also experiencing significant advancements. High-resolution CT and MRI procedures are becoming increasingly available and affordable in veterinary medicine. These technologies provide more detailed information about the exact location of the foreign body, the extent of tissue damage, and possible complications such as small perforations that might be overlooked with conventional X-rays.

In the area of treating esophageal strictures, a common complication after foreign body removal, new therapeutic approaches are being researched. In addition to established balloon dilation, biodegradable stents and local injections of medications such as corticosteroids or mitomycin C are being investigated to reduce scar formation. Initial studies show promising results in preventing recurrent strictures.

Esophageal wound healing is another active area of research. New biomaterials and tissue adhesives are being developed to better seal perforations or surgical wounds of the esophagus and promote healing. These could reduce the complication rate after surgical procedures on the esophagus in the future.

Research into the esophageal microbiome is gaining increasing importance. Studies are examining how changes in microbial colonization after foreign body injuries affect healing and whether probiotic therapies can support recovery.

In the area of prevention, innovative feeding systems and toy designs are being researched to reduce the risk of swallowing foreign bodies. At the same time, educational programs for pet owners are being developed to raise awareness of potential dangers.

Telemedicine and digital image analysis could play a more important role in the early detection of foreign bodies in the future. Algorithms for automated evaluation of X-rays or endoscopy images are being developed to help veterinarians in rapid and precise diagnosis.

Although these areas of research are promising, early detection and treatment by an experienced veterinarian remains the most important factor for a good

Frequently asked questions (FAQs)

What Objects Do Dogs and Cats Most Frequently Swallow?
Dogs often swallow bone pieces, toy parts, stones, balls, and socks. For cats, it’s mainly threads, strings, wool remnants, blades of grass, and small toy parts.
How Can I Tell if My Pet Has a Foreign Object in Its Esophagus?
Typical signs include increased salivation, repeated gagging without vomiting, difficulty swallowing, refusal to eat, restlessness, and expressions of pain. In cats, a thread may sometimes be visible under the tongue.
What Should I Do if I Suspect My Pet Has Swallowed a Foreign Object?
Seek veterinary care immediately. Do not attempt to remove the foreign object yourself or induce vomiting, as this can lead to further injuries.
How Are Foreign Objects Removed from the Esophagus?
The preferred method is endoscopic removal under general anesthesia. In more complicated cases, surgical intervention may be necessary.
How Long Does Recovery Take After Removing a Foreign Object?
In uncomplicated cases, recovery time is about 7-14 days. If the esophagus is injured, healing can take several weeks. In severe cases with complications, recovery can take months.
What Long-Term Complications Can Occur After a Foreign Object in the Esophagus?
The most common long-term complication is the formation of strictures (narrowing) of the esophagus, which can lead to chronic swallowing difficulties and regurgitation. Less common are chronic inflammations or motility disorders.
Are There Breeds That Are Particularly Susceptible to Foreign Objects in the Esophagus?
Yes, dog breeds with greedy eating behaviors such as Labrador Retrievers, Golden Retrievers, and Beagles have an increased risk. In cats, there is no clear breed predisposition.
How Can I Prevent My Pet from Swallowing Foreign Objects?
Keep small objects out of reach, use only suitable toys of appropriate size, supervise your pet while playing and eating, and use special slow-feeder bowls for greedy eaters.
Can a Foreign Object in the Esophagus Move On Its Own?
In rare cases, small, smooth foreign objects can slip into the stomach on their own. However, this is unpredictable and should not be waited for, as any delay increases the risk of complications.
How high are the treatment costs for a foreign object in the esophagus?
The costs vary depending on the required diagnostics and treatment. Endoscopic removal is usually less expensive than surgical intervention. The total costs can range from a few hundred to several thousand euros, depending on the complexity of the case and possible complications.

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