& Management / Disease
Investigation & Management / Techniques:
||Esophagostomy tube placement
- Provide pre-emptive analgesia (buprenorphine 0.01 - 0.05 mg/kg
- Anaesthetise the rabbit.
- Place the rabbit in lateral recumbency.
- Clip and surgically prepare the left side of the neck.
- Arrange sterile drapes for surgery
- Pre-measure the tube from just below (caudal to) the pharynx to the ninth
rib space (about two thirds of the way to the stomach) and mark the
- Insert curved Kelley's forceps through the mouth and down to the
mid-cervical region, caudal to the parotid gland.
- Push the tip of the forceps laterally and palpate the tip through
the left side of the neck.
- Using a No. 10 scalpel blade, make a stab incision through the skin
and oesophagus on the left side of the
- Push the tip of the forceps out through the incision.
- Grasp the narrow end of the oesophagostomy tube with the forceps and
pull it out through the mouth.
- Turn the tip of the tube around and pass it back down through the
mouth and down the oesophagus.
- If the rabbit has not been intubated, ensure the head is
not hyperextended, to minimise the risk of the tube entering the
larynx and passing down the trachea.
- Use a laryngoscope and/or palpation with a finger to ensure that the
tube has not kinked at the pharynx.
- If kinking has occurred, manipulate the tube with a finger or
forceps as required to ensure it passes down the oesophagus and
- Note: once the tube is correctly positioned, it should be
possible to retract and insert the tube smoothly through the ostotomy
site without any obvious friction.
- Insert the tube until the mark is at the level of the incision.
- Use a Chinese finger-trap suture to hold the tube to the skin.
- Nylon or polydioxanone suture material may be used.
- For additional security, apply butterfly tape to the tube and suture
this to the skin.
- Gently bandage the tube in place on the neck.
- 5 cm (2 inch) wide padding material and 5 cm wide self-adhesive
tape (e.g. VetWrap, (3M) for a 2 kg rabbit.
- Gently coil the tube around , leaving the free end pointing
caudally, and use an additional layer of self-adhesive tape to hold it
- Take a radiograph to confirm correct placement of the tube in the
- Continue analgesia: buprenorphine 0.01 - 0.05 mg/kg intramuscularly
every eight hours for 48 hours.
- Give perioperative antibiotics: 5 mg/kg enrofloxacin twice daily
through the tube can be used.
- Feed the rabbit through the tube.
- If the rabbit has been anorectic for some time, give one third
of maintenance energy requirement (MER) on the first day (in
divided feeds), two thirds on the second day and full from the
- If the rabbit has still been eating some food, give 50% MER on
the first day and full MER from the second day.
- MER for a 2 kg adult rabbit is approximately 175 kcal per day.
- Following feeding, aspirate on the feeding syringe to draw off any
air in the stomach (stop once you get fluid).
- Flush the tube with 10 mL water to reduce the risk of blockage.
- Continue offering the rabbit fresh water, high-quality timothy or
grass hay, and other food.
Removing the tube
- Remove the tube once the rabbit is eating and drinking, and gaining
- The tube can be left for up to six weeks.
- Allow the osteotomy site to heal by granulation and
epithelialization (suturing is not necessary).
- Usually the osteotomy site heals within two weeks following removal
of the tube.
- There are no reports of oesphageal stricture or persistent
oesophagocutaneous fistula formation.
|Appropriate Use (?)
As an alternative to syringe feeding, nasogastric tube placement or
orogastric tube, for repeated feeding (where several days of force feeding are
- These tubes can be of a larger diameter than a nasogastric tube, and
thereby allow feeding with more fibrous foods. (J29.15.w2)
- An Elizabethan collar is not usually necessary. (J529.34.w1)
- These tubes do not interfere with breathing. (J29.15.w2)
- High-calorie veterinary enteral diets may be used initially to
ensure energy intake and minimise the risk of the rabbit developing
- Provide fibre to stimulate gastrointestinal motility and production
of short-chain fatty acids by the hindgut, as soon as possible. For
this, a convalescent diet designed for small herbivores should be
used, e.g. Critical Care for Herbivores (Oxbow Pet Products).
- These tubes do not interfere with normal ingestion of food. (J529.34.w1)
- Usually the rabbit starts eating after two to five days of enteral
|Complications/ Limitations / Risk
- The tube can be placed incorrectly.
- The tube can become obstructed.
- Infection may occur at the site of tube placement.
- Oedema may occur if the bandage around the neck is too tight
- The patient may be irritated by the tube.
- The rabbit may remove the tube.
|Equipment / Chemicals required and Suppliers
|Expertise level / Ease of Use
- This procedure should only be
carried out by an individual with appropriate clinical training and practical
experience. This would usually be a veterinarian.
|Legal and Ethical Considerations
In some countries there may be
legislation restricting the use of this type of technique to licensed veterinarians. For
example in the UK: "The Veterinary Surgeons Act 1966 (Section 19) provides,
subject to a number of exceptions, that only registered members of the Royal College of
Veterinary Surgeons may practice veterinary surgery." (See: LCofC1
- RCVS Guide to Professional Conduct 2000 - Treatment of
Animals by Non-Veterinary Surgeons).
||Debra Bourne MA VetMB PhD
Frances Harcourt-Brown BVSc