Treatment of Oviductal Prolapse in a Russian Tortoise (Agrionemys horsfieldi), requiring Ovariosalpingectomy

ABSTRACT

HISTORY

A 5 year old female Russian Tortoise (Agrionems horsfieldi) with a two year history of egg laying was presented with an oviductal prolapse after a month of laying formed and unformed eggs. During this time she presented with anorexia which would be considered normal for this specie during this phase of the reproductive cycle.

CLINICAL FINDINGS

On presentation she was quiet, alert and responsive, weighed 1.38kg and showed accelerated growth for her age which was considered husbandry related, which included a diet of mainly tortoise pellets and suboptimal lighting and heating. She presented an overgrown rhamphoteca due to a low fibre diet. The carapace and plastron showed relatively good growth with only very slight pyramidism. A cloacal prolapse was noted  which was though to be an oviduct. The caudal portion was traumatised and some haemorrage was evident.

DIAGNOSTIC TECHNIQUES

Conscious dorsoventral (DV) and latero-lateral (LL) digital radiographs were taken to rule out the presence of eggs which could be the cause of straining and consequent oviductal prolapse. The x-rays did not show any formed calcified eggs.

A faecal sample was checked inhouse for the presence of any large numbers of parasites that could have contributed to the straining. The results were negative for protozoa and nematode ova.

DIAGNOSIS

Oviductal prolapse

TREATMENT

The tortoise was hospitalised in a vivarium with temperatures within the preffered optimal temperature zone (POTZ) between 26-28ºC and ultraviolet light within the UVB spectrum (considered 290-320nm), given through a 100W mercury vapour bulb (Power Sun UV; Zoo Med). Ceftazidime (Fortum® 100mg/ml; GlaxoSmithKline) was given as an intramuscular (IM) injection. Hartmann’s solution (Aquapharm 11; Animalcare Ltd) was given epicoelomically and Critical Care Formula (CCF) (Vetark) with a pinch of calcium/vitamin D  supplement (Nutrobal; Vetark) was given by stomach tube.

The options for resolution of the oviductal prolapse were limited, with the ideal solution being a ovariosalpingectomy through a central plastron osteotomy; other possible options were: resection of the oviduct through the cloaca with uncertain outcome or euthanasia.

Due to financial issues, the decision was made to perform an oviductal resection as a salvage surgical option.

Meloxicam (Metacam®; Boehringer Ingelheim) was given as an IM injection for preoperative analgesia and repeated 24 hours later.

Anaesthesia was induced and maintained with alphaxalone (Alfaxan 10mg/ml; Vetoquinol) given intravenously into the dorsal coccygeal vein.

Also, the limbs were taped in flexion in order to avoid trauma. Masks and gloves were worn throughout the procedure.

The tortoise was placed in dorsal recumbancy on a heat pad covered by towels. The area was scrubbed with very dilute povidone-iodine solution and draped for surgery. The oviduct was stretched through the cloaca in order to exteriorise the healthy oviduct remnant, clamped above the contaminated tissue and ligated using 3.0 polydioxanone (PDS II®; Ethicon), followed by resection of the oviduct and then allowed to fall back into the cloaca and returned into the coelomic cavity. Recovery from anaesthesia was uneventful and the tortoise was eating the following day.

Postoperatve treatment and care continued with meloxicam every 24h for 4 more days and daily 20min baths to enhance hydration.

After 3 weeks the tortoise started prolapsing intermitently and on presentation the oviductal stump was visualised through the cloaca. Again, she was hospitalised overnight following the treatment plan as last time.

2ND SURGERY

Urination was stimulated just prior to surgery by bathing the tortoise in an attempt to avoid iatrogenic damage during surgery (McArthur & Hernandez-Divers 2004).

Anaesthesia was induced with 10mg/kg of alphaxalone (Alfaxan 10mg/ml; Vetoquinol) given intravenously into the dorsal coccygeal vein.

The tortoise was intubated using a Cole ET tube and anaesthesia maintained with 3% isoflurane (Isoflo®; Abbott Laboratories) in oxygen. Intermittent positive pressure ventilation (IPPV) was provided using a mechanical ventilator (SAV03 ventilator; Vetronic) set at 5 breaths per minute. The pulse rate was monitored using a Doppler probe (CAT Doppler BP Kit; Thames Medical) taped over the carotid artery. Also, the limbs were taped in flexion in order to avoid trauma.

Meloxicam (Metacam®; Boehringer Ingelheim) was given as an IM injection for preoperative analgesia and repeated 24 hours later.

The tortoise ws positioned in dorsal recumbency and the plastron was scrubbed with dilute povidone-iodine solution and draped for surgery. A bevelled flap was made in the abdominal plastral scutes using a Dremel drill (Dremel® Multi 10000-37000) with a sterile diamond cutting disc. Care was taken to avoid the pericardium and bladder. The flap was cut full thickness on 3 sides and reflected back using a sterile orthopedic screwdriver via a hinge in order to attempt maintain flap viability (McArthur and Hernandez-Divers 2004). The coelomic membrane was dissected and incised avoiding and preserving the paired ventral abdomina. Gelpi retractors were used to maintain exposure.

Adhesions were present between the reproductive tract and other structures including the liver. The right oviduct was found intussepted as a result of the previous surgery. The ovaries and oviducts were exteriorised bilaterally, clamped and ligated using 3/0 polydioxanone (PDS II®; Ethicon). Care was taken not to rupture any follicules.

The coelomic cavity was lavaged with warm Hartmann’s solution, followed by apposition and suturing of the coelomic membrane with 3/0 polydioxanone (PDS II®; Ethicon). The plastral flap was then replaced and covered with an adhesive wound dressing (Primapore).

An oesophagostomy tube was placed at the time of surgery using an 8F feeding tube (Portex; SIMS Portex) in order to facilitate administration of nutrients and medications during the postsurgical period. The tube was measured from the entrance site on the right side of the neck to the middle of the plastron and pulled through towards the mouth with crocodile forceps, only to be reverted back down the oesophagous. Two tape strips were positioned around the tube at the exit point and sutured to the skin with 3/0 polydioxanone (PDS II®; Ethicon).

PROGRESS AND OUTCOME

The tortoises recovery was uneventful and although quiet, active and responsive over the next 2 days during hospitalisation, she was discharged 7 days after surgery, weighing 1.15kg, with a reserved prognosis based on coeliotomy findings and history. Ceftazidime and metronidazol were continued for a further 4 weeks, with nutritinal support and fluids via the oesophagostomy tube. Husbandry and dietary correction was advised and bathing was to be avoided until healing of the surgical site.

DISCUSSION

Cloacal prolapses in tortoises and turtles is not uncommon. Care must be taken to identify the prolapsed organ which could be rectum, oviduct, penis, bladder or the cloaca itself and try to establish the underlying cause.

Oviductal resection should only be used as a salvage technique as it is unclear whether oviductal resection will cause the ovary of the affected side to become atretic and inert or if there could be some health comprimise in the future (McArthur 2004c).

In this case, the period of anorexia coincided with the normal seasonal reproductive changes and the tortoise was bright and alert on presentation. Placement of an oesophagostomy tube is a useful method for mantaining hydration and nutritional status, along with fluids (McArthur 2004b, Johnson 2002), especially during the postsurgical period.

Meloxicam was used for analgesia prior to surgery and also during the postsurgery period. Although pain is difficult to assess in reptiles, it is important to assume that they would feel painafter a surgical procedure (Lawton 1999, McArthur 2004, Redrobe 2004)

 

REFERENCES

Johnson JD (2002) Esophagostomy Tube Deficiency in the Management of Ill Reptiles. Proceedings of the Association of Reptilian and Amphibian Veterinarians, pp.137-139

Lawton MPC (1999) Pain management after surgery. Proceedings of the North American Veterinary Conference p.782

McArthur S & Hernandez-Divers S (2004) Surgery. In: McArthur S, Wilkinson R & Meyer J (Eds.) Medicine and Surgery of Tortoises and Turtles. Blackwell Publishing, Oxford, UK. P.403-464

Mcarthur S (2004b) Feeding Techniques and Fluids, Medicine and Surgery of Tortoises and Turtles,  McArthur S, Wilkinson R & Meyer J (Eds.), Oxford, UK, Blackwell Publishing, pp.257-271

McArthur S (2004c) Problem-solving Approach to common diseases of Terrestrial and Semi-aquatic Chelonians. Chapter 13 in Medicine and Surgery of Tortoises and Turtles,  McArthur S, Wilkinson R & Meyer J (Eds.), Oxford, UK, Blackwell Publishing, p.310-314