Out of Body Experiences: A Case Series of Reptile and Amphibian Cloacal Prolapses in a Student Wildlife Rescue Organization
North Carolina State University, Department of Clinical Sciences, College of Veterinary Medicine, Raleigh, North Carolina, 27607, USA
Abstract
Prolapses through the vent in reptiles and amphibians can include reproductive, digestive, or urinary tissues, making treatment a challenge.1-4 Clinicians treating wild reptiles and amphibians may be dealing with tissues that have been out of the body for an unknown amount of time. Diagnostic tests, such as fecal examination, complete blood count, plasma biochemistry, and radiographs are indicated to look for underlying conditions such as hypocalcemia1,4 and space-occupying masses in the abdomen.1-4 Evaluating wild animals for these conditions is often limited. Cost restrictions and the need to act quickly are also of consideration. More information is needed to determine the best diagnostic and treatment strategies for wild animal prolapse cases in non-profit settings. In this report we examine four prolapse cases that presented to the North Carolina State University Turtle Rescue Team (TRT) between January 2011 and January 2013. Upon intake, each of four patients received a physical examination and the prolapsed tissues were irrigated and placed in sugar water. Cases 1 and 2 received morphine, antibiotics, and subcutaneous fluids upon initial assessment.
Case 1: A Common Snapping Turtle (Chelydra serpentina) presented for a prolapsed penis with multifocal areas of necrosis and inflammation. Successful reduction was achieved after 7 days of administering ketoprofen intramuscularly at 2 mg/kg/day.
Case 2: An Eastern Box Turtle (Terrapene carolina carolina) showed a 6 cm-long prolapse of thick necrotic tissue and wispy, white tissue. The patient's mental status declined significantly and she was euthanized. Necropsy revealed the exposed tissues were oviduct and mesometrium.
Case 3: A male Green Frog (Rana clamitans) presented for prolapse of the colon. The prolapse was reduced under anesthesia and a simple interrupted suture placed loosely across the dorsal vent. He received two doses of dilute ketoprofen at 2 mg/kg topically over the next 48 hours. The suture was removed 12 days later and the frog was released.
Case 4: A Cope's Gray Tree Frog (Hyla chrysoscelis) prolapsed tissue presumed to be rectum and intestines. Reduction was successful after two attempts but the frog died within 24 hours after the second round of anesthesia. The frog had received dilute ketoprofen at 2 mg/kg topically both days. Necropsy revealed the prolapsed tissue was oviduct.
Conclusions
Despite appearing healthy on initial assessment, systemic problems, likely related to anesthesia (Case 4) and shock (Case 2), precipitated decline leading to death or euthanasia. In cases 1, 3, and 4, the clinician's assessment of behavior and physical examination were the only criteria for evaluating anesthetic risk. Identifying the prolapsed tissue was the most problematic aspect of treatment, especially differentiating oviduct from intestine. Possible methods for differentiation include looking for fecal material to indicate colon or longitudinal striations to indicate oviduct.1 Placing patients in a sugar solution did not significantly reduce edema in prolapsed tissues, probably because the solution was too dilute. The recommended concentration for a sugar solution is at least 40%.1-3 Finally, ketoprofen seemed helpful in reducing inflammation in cases 1, 3, and 4, and may have facilitated an otherwise impossible prolapse replacement in case 1.
Acknowledgements
The authors would like to thank Bradley Waffa, Kahlina Frey, Ashley Emanuele, and Katie Leslie for their contributions in managing these cases. Thanks also to Jb Minter and Tres Clarke for their advice.
* Presenting author
+ Student presenter
Literature Cited
1. Bennett AR, Mader D. 2006. Cloacal Prolapse. In: Mader D, editor. Reptile Medicine and Surgery, 2nd ed. Philadelphia (PA): Elsevier Saunders Inc. p 751–755.
2. Clayton L, Gore SR. 2007. Amphibian Emergency Medicine. Vet Clin Exot Anim. 10: 587–620.
3. Hadfield CA, Whitaker BR. 2005. Amphibian Emergency Medicine and Care. Sem Avian and Exot Pet Med. 2: 79–89.
4. Martinez-Jimenez D, Hernandez-Divers S. 2007. Emergency Care of Reptiles. Vet Clin Exot Anim. 10: 557–585.