Saturday, October 8, 2011

Update on blog no. 648. Everted cheek pouch

The young lady's vet gave a baytril 1% oral antibiotic 2 days ago. He said he would not operate as he was not able to do so.


So the young lady must have had surfed the net and brought her hamster to me. I did not ask her. Nowadays, young people are "google" people and they sometimes know more than the vet regarding specific niche conditions of their pets! A vet has to know everything in the hamster from nose to toe and that is only one species. How about dogs, cats, terrapins, guinea pigs, birds and fishes, iguanas and others? This comes from time in practice. Vets are not Gods and will need time to become experienced. Pet owners need to understand this.

She knew that her hamster's left pouch had turned inside out and needed to get a vet to operate. A pink mass dangled from the left cheek. One end had become black, a sign of gangrene. Blood supply has been cut off. The surrounding part had turned yellow due to bacterial infection. A speck of yellow pus dried on the upper eyelid.

"Antibiotics will not shrink the dwarf hamster's cheek pouch inwards," I said. "Your hamster needs surgery and the end of the infected pouch needs to be cut away. There is anaesthetic risk. Will you accept the risk?"

The young lady had no choice. If she did not consent to the operation, the hamster will die from infections. If she consented, the hamster may return to a normal life.

I would operate together with Dr Vanessa. Everted cheek pouch surgery is best seen once. The risk is not surgery but anaesthesia.

Isoflurane gas was used. The assistant must focus on this. Dr Vanessa operated with me. "It is a simple surgery compared to Caesarean section or spay. Clamp the pouch first," I said. "Cut and stitch".

It is easy to lecture. The hamster woke up from the gas anaesthesia and needed to be given the gas again. The necrotic end was excised with scalpel. Anesthesia again. Stitch 6/0 absorbable x 3 interrupted.

"Don't stress the hamster," I gave this advice to Dr Vanessa. "Unclamp as the hamster had woken up and may die of fright struggling with a clamp. The correct way is to give the gas anaesthesia again."

On unclamping, the cut end of the pouch shrank inwards. "No problem with that," I said. "Used the forceps to pull out the cut ends to give 3 simple interrupted stitches".

As long as the hamster is anaesthesized adequately without killing him, the stitching is not a problem. The pouch was thus stitched with 6/0 absorbable sutures. The hamster went home to a happy young lady. There was slight bleeding and she would take care of it. "Use the other vet's antibiotics to save you some money," I said. "Do you want to take the excised pouch home with you?"

She shook her head. I showed her the illustration of how the pouch was excised. She seemed to be in a hurry and so I did not detain her. Overall, this was a satisfactory outcome. As long as the hamster survives the anaesthesia, the surgery is not complicated and the hamster owner is usually very delighted with the surgical outcome.

Questions asked by owner:
1. Feed liquid food? No need.
2. Can she store food? Not much as 80% had been cut off in the left cheek pouch. The right cheek pouch is still there.
3. What if she did not get surgery done?
Pus already in pouch. Gangrene tip. Hamster will die from infections.
4. "The hamster had pulled out a stitch," she phoned me later. "The stitch could have been cut longer and therefore looked loose," I said. But she did not turn up for a check up. I presumed all are well as I did not see her 7 days after surgery nor hear from her by phone.

"Warts seen in right ear," I had said to the young lady. "If they grow bigger or the hamster feels itchy, they need to be excised." Presently her vet had give some anti-fungal wash to the other hamster with similar problem. Both hamsters live by themselves.

How an everted cheek pouch is operated at Toa Payoh Vets
Isoflurane + oxygen gas anaesthesia was used in this case










A gentle hamster. Does not squeak or bite the vet! But my assistant Min does not take chances. He wears the hand grove when handling this hamster!

More images at:
http://www.sinpets.com/F6/20111017everted-cheek-pouch-gangrenous-surgery-singapore_ToaPayohVets.htm

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