Pre-Ovulatory Follicular Stasis and Hepatitis in a Spur-Thighed Tortoise

PATIENT DETAILS

A fifty year old female Spur Thighed tortoise (Testudo graeca) presented in June 2012. Husbandry was considered to be good for this specie.

PRESENTATION/CLINICAL SIGNS

She presented with bilateral hind leg weakness and anorexia that had been going on for a couple of weeks.

INVESTIGATION

Based on the clinical signs she was admitted for stabilisation and a full blood panel including biochemistry and haematology. The biochemistry results revealed hyperproteinaemia and hypercalcaemia (total calcium). Marked leucopenia was also evident on haematology. Different phases of follicular development (newly formed follicles and also atretic follicles) were noted on ultrasound.

DIAGNOSIS

Pre-ovulatory follicular stasis was confirmed and septicaemia or coelomitis was suspected.

TREATMENT/PROCEDURE

She was hospitalised for stabilisation in view of performing an ovariectomy and exploratory laparotomy for three days. In this time she was administered fluidtherapy (2% bodyweight daily) through the epicoelomic route and also daily baths. Intramuscular (IM) Ceftazidime (Fortum® 100mg/ml; Glaxosmithkline) 20mg/kg was administered every 3 days.

After 3 days she was considered fit for surgery. A central plastral osteotomy was performed. On exploration of the coelomic cavity the liver seemed to have a mottled appearance and a wedge biopsy was taken. This revealed moderate diffuse hepatic lipidosis and multifocal heterophilic hepatitis. Bilateral ovariectomy was also performed, removing numerous follicles. An oesophageal tube was placed at the time of surgery. A fibre glass plastral patch was applied 48h post surgery.

Ceftazidime (Fortum® 100mg/ml; Glaxosmithkline) was continued along with Meloxicam (Metacam 1.5mg/ml; Boehringer Ingelheim) and Metronidazole (Flagyl® 40mg/ml; Sanofi-Aventis)

OUTCOME

She recovered from anaesthesia and was managed as an inpatient for a further 5 days. She was sent home to be managed as an outpatient every 3 days to administer Ceftazidime (q 3 days) and to perform a clinical examination including checking the plastrotomy site for any signs of infection or septicaemia.

COMPLICATIONS

After 12 days, despite the optimised husbandry and medications she presented with a foul odour coming through the plastral flap along with fluid retention. Uric acid was measured to assess kidney function to be found within normal limits. A poor prognosis was given at this stage and the owner opted for euthanasia.