Fatal aortic hemorrhage subsequent to esophageal-aortic fishhook extraction in a dog.

Abstract

A 3.5-year-old castrated male toy poodle dog weighing 4.9 kg was evaluated for an esophageal fishhook foreign body previously diagnosed by the referring veterinarians. Repeat radiographs at the Western College of Veterinary Medicine (Saskatoon, Saskatchewan) confirmed a single fishhook located in the middorsal thorax, spanning the 3rd to 6th intercostal spaces with an esophageal location prioritized. Concurrent pleural effusion, later identified as frank blood, made endoscopic retrieval unsafe due to possible great vessel involvement, necessitating surgical intervention. We decided to carry out a lateral thoracotomy with assisted esophageal endoscopy to aid fishhook extraction. We discovered that the "bend" portion of the fishhook - the curved section between the barb and the shank - penetrated the esophagus and was lodged in the lumen of the descending aorta. Although the fishhook was successfully extracted manually, it caused severe hemorrhage, requiring multiple blood transfusions during surgery. Aortic hemostasis was achieved using hemoclips and the esophageal defect repaired under endoscopic assistance. After surgery, a large quantity of blood was suctioned from the chest, raising concerns for potential hemoclip displacement and progressive aortic hemorrhage. Despite the administration of tranexamic acid and a plasma transfusion, stabilization efforts failed. Humane euthanasia was ultimately elected but the dog died before euthanasia could be undertaken. Postmortem examination confirmed the dislodgement of the hemoclips from the aorta led to exsanguination and the dog's death. Key clinical message: This case demonstrates that relying solely on smooth hemoclips to control hemorrhage in the descending thoracic aorta of a dog may be insufficient. Successful management of esophageal-aortic fishhook injuries depends upon the sequence and direction of hook extraction, with normograde removal recommended to minimize aortic wall injury and better facilitate primary sutured repair.