Abstract

An adult male eastern box turtle (Terrapene carolina) of unknown age presented to the North Carolina State University College of Veterinary Medicine (NCSU-CVM) in a general state of mismanagement. The patient had an overgrown and malformed tomium, overgrown toenails, malformed carapace, and a prolapsed penis. The turtle was admitted and the tomium and toenail problems were immediately addressed.

The prolapsed penis was soaked overnight in 50 percent dextrose to remove edema and reduce swelling. The prolapse was then manually reduced and a purse string suture was placed around the vent. This procedure was unsuccessful as the penis reprolapsed within seventy-two hours.

Additional diagnostics were performed to determine the cause of the prolapse. Fecal floatation and smear were negative for parasitic ova. A gastrointestinal (GI) contrast study was performed by giving 3.2 ml Renografin-76 (diatrizoate meglumine and diatrizoate sodium) (1 ml/100 gm.) per os (PO). Radiographs were taken at 0, 15, 30, 60, 75, 90, 300, 360, and 720 minutes post administration. No abnormalities were noted on the contrast study. Due to the hypertonic nature of the contrast material the turtle experienced significant GI fluid loss, which was corrected with 12 cc of lactated ringers solution administered intraperitoneally (IP) after the completion of the study.

A second surgical attempt to restore the penis to its normal position was made. Fifty percent dextrose was again applied to the penis overnight to reduce the swelling and edema. The following day, anesthesia was induced with 3.4 mg ketamine (20 mg/kg) and 16 µmedetomidine (50µg/kg) intramuscularly (IM). Induction time was approximately 1 hour. The turtle was positioned in right lateral recumbency. The prolapse was then manually reduced and a 2-0 nylon retention suture was placed across the vent to prevent reprolapsing during the procedure. A 2 cm. incision was made in the left inguinal sulcus. The cloaca was tacked to the musculature and soft tissues located on the plastron using 3, 3-0 prolene simple interrupted sutures. Four milligrams of enrofloxacin (10 mg/kg) was administered IP immediately prior to closing the incision. The muscle layers were closed using 3-0 Maxon in a simple continuous pattern and the skin was closed using 3-0 nylon in a simple interrupted pattern. The turtle was recovered from anesthesia without complications. The turtle also received 0.06 mg butorphanol (0.2 mg/kg) IM upon extubation. This procedure was also unsuccessful and the penis reprolapsed within 72 hours.

Based on our inability to reduce the penile prolapse in this box turtle, the decision was made to amputate the penis. Anesthesia was induced with 3.4 mg ketamine (20 mg/kg) and 16 µmedetomidine (50 µg/kg) IM. Induction time was approximately 1 hour. The turtle was then intubated and maintained on isoflurane. Immediately prior to intubation the turtle received 0.06 mg butorphanol (0.2 mg/kg) IM. The turtle was then positioned in ventral recumbency with his caudal aspect elevated with a foam pad. Stay sutures (3-0 nylon) were placed in the mucosa of the cloaca to prevent involution of this tissue during the procedure. A circum-penile incision was made at the dermo-mucosal junction. This incision was extended through the tissues and the penis was removed. The mucosal border was then sutured to the skin border using 4-0 prolene in a simple interrupted pattern and oversewn with 4-0 prolene in a Cushing pattern. Recovery from anesthesia was uneventful. The turtle was then given 6.5 mg ceftazidime (20 mg/kg) IM every 72 hours for 5 treatments.