Pouch-like sacs on the Esophageal Wall in Cats

Esophageal Diverticula in Cats

Pulsion diverticula is a pushing outward of the wall of an internal, hollow organ, in this case, the esophagus. It is caused by increased pressure from within the esophageal cavity (intraluminal). This is directly related to esophageal diverticula, which is characterized by large, pouch-like sacs on the esophageal wall. Traction diverticula occurs secondary to inflammation, where fibrosis and contraction pull the wall of the esophagus out into a pouch, resulting in obstruction or failure of the esophageal muscles to move food through to the stomach.

Diverticula most commonly occurs at the inlet to the esophagus or near the diaphragm, with food being taken into the mouth and getting caught in a pouch as it travels down the esophagus toward the stomach. Organ systems affected include the gastrointestinal, musculoskeletal, and respiratory. Although no genetic basis has been proven, it may be congenital (present at birth), or acquired. There is no specific breed or gender predisposition for this disease.

Symptoms and Types

• Regurgitation following eating, difficult swallowing, lack of appetite, coughing
• Weight loss, respiratory distress (aspiration pneumonia)

Causes

• Pulsion Diverticulum
• Embryonic developmental disorders of the esophageal wall
• Esophageal foreign body or failure of the muscles to move food through
• Traction Diverticulum
• Inflammatory process associated with the trachea, lungs, lymph nodes, or lining of the stomach; causes fibrous tissue formation around the esophagus

Diagnosis

Your veterinarian will conduct an esophagram, or an esophagoscopy to examine the diverticula in order to determine whether there is a related mass. An X-ray of the chest area, and a fluoroscopal examination to evaluate the movement of food through the esophagus will give your doctor a better idea of where the diverticula is placed in the esophageal wall. An injection of a radiocontrasting agent into the esophageal passage may be used to improve visibility on an X-ray so that an exact determination can be made, as the substance flows down the esophagus, filling the pouches as is does.

Treatment

If the diverticulum is small and is not causing significant clinical signs, your veterinarian may only recommend a change in diet for your cat. A soft, bland diet, given frequently and followed by copious liquids, will most likely travel through the esophagus to the stomach unhindered. If the diverticulum is large, or is associated with significant clinical signs, surgical resection will probably be recommended. The potential for food being drawn into the lungs, and leading to aspiration pneumonia makes the importance of dietary management key to avoiding fatal complications. Fluid therapy, antibiotics, and aggressive care will be called for if aspiration pneumonia is present. Nutrition given via tube will also be necessary. Your veterinarian will prescribe medications for your cat on the basis of the diagnosis.

Living and Management

Your doctor will want to monitor your cat for evidence and prevention of infection or aspiration pneumonia. You will need to maintain a positive nutritional balance throughout the disease process. Cats with diverticula and impaction (i.e., food material that is packed tightly) are predisposed to perforation, fistula, stricture, and postoperative rupturing of the incision. For this reason, your veterinarian will want to revisit your cat on a regular schedule. Prognosis is guarded in patients with large diverticula and overt clinical signs.