Esophagostomy Tube Placement in Tortoise
Esophagostomy tubes (E-tubes) is recommended for any chelonian patient that requires repeated oral treatments, such as nutritional support or oral medicine. Esophagostomy tubes are very well tolerated and the patient can even eat normally with the tube in place. Potential complication in E-tube placement surgery include iatrogenic damage to structure in the neck, mostly vein and carotid artery. Finally if the tube is improperly secured, it is possible that tube could be pulled out.
Anesthetic risk should be considered. Select an anesthetic and analgesic plan that allows good restraint and prevents excessive movement. Manual restraint and local anesthesia is often sufficient to allow E-tube placement in very week patients that would be considered a high anesthetic risk. Some patients may require sedation or general anesthesia but should be carefully and appropriate protocols utilized on a case-by case basis.
Esophagostomy Tube Placement: Step-by-step
First, pre-measure the catheter from the cranial rim of the plastron to the junction of the pectoral and abdominal scutes, and mark it with a non-toxic permanent marker.
Curved mosquito hemostats are inserted in the mouth and pushed on the side of the neck. Gentle pressure favors displacement of jugular vein and carotid artery.
Make small skin incision over the tip of the mosquito, exposing the external muscular layer of the esophagus. Just small enough to allow the end of the instrument to protrude through the esophageal wall and skin.
The esophageal wall is incised and the tip of the forceps is exposed. The feeding tube is grasped by hemostats, passed through the incision and directed cranially and out through the open mouth.
Once visualized through the mouth, the tube is gently curved and pushed into the esophagus toward the stomach up to the level of predetermined length of the tube.
The tube is correctly placed. A standard roman sandal suture with an optional purse-string pattern around the tube is performed.
It is important to curve the tube over the head onto the contralateral side of the carapace, preventing the creation of a loop that would allow the animal to pull the tube out with the forelimb. Once in place, radiographs can be performed to determine location of the end of the tube in the stomach. It is important to flush the tube with warm water at his stage and close the end.
References:
Girolamo, N,D., and Mans, C., 2016. Reptile Soft Tissue Surgery. Veterinary Clinics of North America Exotic Animal Practice. DOI: 10.1016/J.cvex.2015.09.010
Inzirillo, F., Giorgetta, C., Ravalli, E., and Pona, C.D., 2012. Roman Snadal modified method for securing the chest drain to the skin. Gen Thorac Cardiovasc Surg. DOI 10.1007/s1748-012-0184-2
Martinez-Silvestre, A., 2011. Massive Tachygonetria (Oxyuridae) infection in a Herman's tortoise (Testudo hermanni). CONSULT Journal, 409-412
Mansoori, M., Vosough, D., and Rezaei, M., 2018. Contrast Radiography in Zarudni's Spur-thighed Tortoises (Testudo graeca zarudnyi) by Gastrografin. IJVS, 13(1):Serial No:28
McCormack, S., 2015. A guide to esophagostomy tube placement in chelonians.
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