Guttural pouch mycosis

Abstract

An approximately 12 year old hunter/jumper Hanoverian gelding presented to the Cornell University Equine Hospital for surgical correction of guttural pouch mycosis. The fungal plaque was identified in the medial compartment of the right guttural pouch by the referring veterinarian upon endoscopic exam. Originally the patient presented to the referring veterinarian for an episode of choke, and upon further evaluation the horse was determined to be severely dysphagic with secondary aspiration pneumonia. Surgical treatment included balloon catheter ligation of the right internal carotid artery distal to the plaque as well as ligation proximally to stop all blood flow, including retrograde flow, and prevent fatal hemorrhage while the plaque regressed. The right occipital artery was also ligated to ensure all major vessels and sources of potential hemorrhage near the fungal plaque were eliminated. The patient recovered well from surgery; however the majority of patient care post-operatively revolved around the severe dysphagia present from cranial nerve damage due to the fungal plaque, and secondary aspiration pneumonia. Medical treatment was also initiated post-operatively; topical Miconazole was applied daily for ten days via catheter and endoscopic guidance. The plaque was monitored daily via endoscopy and regressed markedly by the time of discharge. Due to the patient being dysphagic, weight loss continued, but was combatted with complete daily enteral nutrition (Platinum Performance Immunonutrition) via nasogastric tube and hand grazing. The dysphagia improved only slightly by the time of discharge, but the patient did not lose any more weight. The patient did well for approximately 2 weeks after discharge, however he became colicy and a small intestinal lesion that required surgical correction was diagnosed at Tufts University, the patient was euthanized due to poor prognosis with complicating dysphagia.