Gastrointestinal foreign body in a tortoise

16 Gastrointestinal foreign body in a tortoise




INITIAL PRESENTATION


Inappetence, reduced faecal output, hindlimb paresis in a Hermann’s tortoise.



Introduction


Pet chelonia often roam in large outdoor areas, which include access to various substrates. Ingestion of foreign material may or may not lead to gastrointestinal obstruction. A major concern in chelonia is the decision over whether medical therapy will result in a cure, or if surgical intervention (usually necessitating a trans-plastron coeliotomy) is required.



CASE PRESENTING SIGNS


A 7-year-old male Hermann’s tortoise (Testudo hermanni) was presented with inappetence, reduced faecal output and hindlimb paresis.



Husbandry


This captive-bred tortoise had been in the current owner’s possession since approximately 1 year old. He was housed on his own for most of the year in an indoor enclosure, with supplemental heating (bulb) and lighting (including UV-B), although he did roam one of the rooms periodically. During the summer months, he was permitted outdoor access in the owner’s garden – usually supervised. His diet comprised various weeds and vegetables (including clover, dandelions, cabbage, and sweetcorn), dusted with mineral supplement (Nutrobal®, Vetark, Winchester, UK; and cuttlefish). He had grown from 150 g to 1.28 kg over 6 years, and had never been hibernated.



Case History


During one of the tortoise’s outdoor excursions, 4 weeks prior to presentation at the veterinary practice, the owner temporarily left him unattended and returned to find him consuming pieces of gravel. Clinical signs were noted for a few days before presentation:


• Greatly reduced faecal output, but no straining reported

• Inappetence

• Reduced use of hindlimbs.


Clinical Examination


As tortoise clinical examinations are restricted due to anatomical constraints, findings were brief:


• Not raising plastron above ground when walking

• Body condition good, weighing 1.28 kg. Muscle mass good, with no generalized weakness noted

• Carapace showed mild pyramiding of carapacial scutes, consistent with rapid growth seen in many pet tortoises with excessive nutritional intake

• Oral mucous membranes were pink and moist (no sign of dehydration)

• No masses or foreign bodies were detected in the coelomic cavity via palpation in the pre-femoral region.


DIFFERENTIAL DIAGNOSES


Inappetence is a common presenting sign for many illnesses in reptiles, and further investigations are required to determine the disease process(es) occurring.


The differentials for reduced faecal output were:


• Secondary to reduced food intake (gastrointestinal transit time may be <20 days in chelonia)

• Systemic illness, e.g. dehydration, hypocalcaemia

• Obstruction in gastrointestinal tract, e.g. cloacolith/faecolith (often associated with dehydration), intussusception (possibly secondary to other disease, e.g. foreign body), foreign body, endoparasitism (e.g. ascarids such as Augusticaecum sp), neoplasia, volvulus

• Space-occupying lesion compressing gastrointestinal tract, e.g. cystic calculi, reproduction in female (gravidity, dystocia, pre- or post-ovulatory stasis), organomegaly (e.g. renomegaly, hepatomegaly), pelvic fracture, neoplasia, granuloma

• Poor husbandry, e.g. low environmental temperature

The differentials for hindlimb paresis were:


• Inappropriate husbandry, particularly inadequate environmental temperature

• Nutritional or renal secondary hyperparathyroidism (also known as metabolic bone disease, MBD), hypocalcaemia

• Systemic illness may result in generalized paresis, e.g. septicaemia, organ failure, end-stage starvation

• Renomegaly

• Articular gout/pseudogout

• Toxicity, e.g. ivermectin, pesticides

• Infection, e.g. abscess, cellulitis, or osteomyelitis (usually bacterial)

• Cystic calculi

• In a female, egg retention or after oviposition

• Neoplasia, in nervous or musculoskeletal systems

• Neurological, e.g. infection (bacterial, fungal, parasitic), spinal cord lesion (trauma, pathological after vertebral body collapse in MBD)

• Musculoskeletal disease (common in males if they fall off the female’s carapace after mating): tendon or ligament damage, fracture (traumatic or pathological) – less likely in this case as bilateral paresis noted

• Less commonly, flaccid paresis may result from: shock, drowning, hyperthermia or bloat.


Case Work-Up



Radiography


Three views were taken of the conscious tortoise – dorso-ventral (Fig. 16.1) using a vertical beam, and cranio-caudal and lateral using a horizontal beam. These orthogonal views outlined the presence of foreign material within the gastrointestinal tract. The object was less dense than bone but more radiodense than soft tissue, and its shape was consistent with a piece of gravel. The absence of gas near the mass suggested that it was not completely obstructing the gastrointestinal tract. No musculoskeletal pathology was detected on the radiographs.


image

Figure 16.1 Dorso-ventral radiograph of the tortoise, showing radiodense foreign body within the gastrointestinal tract. (Lateral and cranio-caudal views were also taken, using a horizontal beam.)



Haematology and biochemistry


Financial consideration may preclude blood analysis in practice, and the clinician should be aware that analysis is not sensitive in reptiles. In this case, results showed mild dehydration (haematocrit and total protein were slightly elevated). There was no evidence of systemic infection (total white cell count normal, and no ‘toxic’ or ‘reactive’ white blood cells were seen on microscopy). Biochemical parameters (including renal parameters (uric acid), hepatic enzymes (AST, LDH, CK), and ionized calcium, and calcium to phosphorus ratio (1.85)) were within reported ranges – reducing the likelihood of metabolic bone disease or other metabolic derangement (Table 16.1).



Table 16.1 Hermann tortoise blood results (with reference ranges for comparison)

image


Other diagnostic tests which could have been performed


Cloacal swabs or wash for microscopy/culture (for endoparasites, enteric infection), ultrasound, coelioscopy.


The history was suggestive of a gastrointestinal foreign body, although other pathological processes could also be concurrent. The diagnosis was supported by the positive radiographic findings.



Diagnosis


The diagnosis in this case was that of gastrointestinal foreign body. The clinical signs of inappetence and hindlimb paresis were attributed to intestinal discomfort. Dehydration likely developed with the reduced appetite.


Radiodense foreign bodies are relatively easy to detect on radiography. Obstruction is often accompanied by an enlargement of the intestinal diameter. Obstructive ileus presents as gas-distended portions of intestine, which can usually be seen on both the dorso-ventral and lateral (impinging the lung region dorsally) radiographs. Contrast studies (e.g. barium sulphate, water-soluble iodinated media, or barium-impregnated polyethylene spheres, BIPS) may be required to outline a non-radiodense object. Other imaging techniques may be useful, for example ultrasound and MRI.



Anatomy and Physiology Refresher



Gastrointestinal tract


The chelonian oesophagus passes on the left-hand side of the neck (Fig. 16.2). The stomach is simple and fusiform, positioned caudal to the liver on the left with the pylorus centrally or to the right. Thick folds at the cardia in Testudo spp act like a sphincter; there may be a muscular sphincter at the pylorus. The small intestine is not well divided into sections, and lies caudally in the coelom. There is a muscular valve between the duodenum and caecum, caudally on the right. The large intestine consists of ascending, transverse and descending colon. The colon empties into the coprodeum of the cloaca, and thence material is voided via the vent. Various membranes and ligaments suspend the intestines, restricting movement of some parts of the gastrointestinal tract and permitting others to move more freely (e.g. the transverse colon can move dorso-ventrally, and heavy ingested material commonly becomes trapped in this region owing to gravity).


image

Figure 16.2 The ventral view of viscera within the chelonian coelomic cavity.

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Sep 3, 2016 | Posted by in SMALL ANIMAL | Comments Off on Gastrointestinal foreign body in a tortoise

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