Case Study - Choke

In this case study we encounter a senior aged mare who presented for acute onset of coughing and nasal discharge, shortly after eating a mixed feed of pelleted concentrate and chaff.

Clinical Signs

 

  • Acutely distressed.

  • Coughing.

  • Neck extended abnormally.

  • Green foam-like discharge from nostrils + mouth. This is typical of a choke reflux caused by mixed saliva and feed.

 

 

Physical exam

  • Cervical oesophagus distended with palpable mass in oesophageal lumen.

  • Nasogastric tube unable to be passed beyond the pharynx.

  • Not performed in this case, but endoscopy may be used to visualise blockage if clinical exam does not confirm diagnosis — material and size of bolus forming obstruction.

Treatment

 

  • Horse sedated — intravenous detomidine and acepromazine combination.

  • Anti-inflammatory (flunixin)and smooth muscle relaxant (buscopan) also administered intravenously.

  • Nasogastric tube used to push food bolus down the oesophagus toward stomach.

 

Ongoing Management

 

  • No food to be given for 12-24 hours as some degree of oesophagitis, and decreased motility will likely be present. Soft food (e.g. bran mash) + fresh grass to be fed from 24-72 hours post-choke episode to reduce risk of recurrence, or oesophageal stricture formation.

  • Rectal temperature to be taken once daily for the following 5-7 days. Fever may indicate aspiration pneumonia.

  • If aspiration pneumonia is suspected, broad-spectrum antimicrobials may be indicated. Recheck with vet required.

 

Prognosis

  • Good but recurrence is possible.

 

Risk Factors

  • Commonly associated with sugar-beet pulp, chaff or hay. The dry material expands when mixed with saliva, causing obstruction in the oesophageal lumen.