Dog coughing and vomiting after bone removal surgery

Abstract

BACKGROUND: Esophagorespiratory fistulae are rare pathological communications between the esophagus and the respiratory tract. While acquired bronchoesophageal fistulae have been sporadically documented in dogs, tracheoesophageal fistulae, particularly in the cervical region, are exceptionally rare. This case report is the first to describe an acquired cervical tracheoesophageal fistula in a dog following esophageal foreign body retention. The case highlights the clinical course, diagnostic challenges, and successful surgical management, expanding the current understanding of this uncommon condition in veterinary medicine. CASE PRESENTATION: A 6.5-year-old male Shih Tzu was referred for persistent hyporexia, vomiting, and moist cough following endoscopic removal of a bone lodged at the thoracic inlet. Despite medical management for esophagitis and aspiration pneumonia, the dog exhibited progressive respiratory signs and recurrent pneumonia. An esophagorespiratory fistula was suspected based on the ability to provoke coughing by liquid ingestion and tracheal palpation. Endoscopic examination confirmed a defect in the esophageal wall with direct communication to the tracheal lumen, consistent with a cervical tracheoesophageal fistula. Surgical repair was performed via a cervical ventral midline approach, involving separate closure of the tracheal and esophageal defects and reinforcement using a bipedicle sternohyoid muscle flap. Recovery was uneventful, and the dog remains asymptomatic at 12-month follow-up. CONCLUSIONS: This case underscores the importance of considering a tracheoesophageal fistula in dogs presenting with persistent or recurrent gastrorespiratory signs following esophageal foreign body removal. Diagnosis can be challenging due to the rarity of the condition and its non-specific clinical presentation. Endoscopy proved to be a safe and effective diagnostic tool and avoided the risk of aspiration associated with contrast studies. The surgical technique, including muscle flap interposition, mirrors approaches used in human medicine, where similar strategies are applied to prevent recurrence. Comparative insights with human cases highlight the translational value of interspecies knowledge, especially in understanding pathogenesis, refining diagnostics, and optimizing treatment. Continued reporting and awareness of tracheoesophageal fistula in veterinary patients are essential to improve outcomes and explore minimally invasive alternatives.