Monday, June 20, 2011

476. Red-eared slider - rectal prolapse - purse string suture

Sunday's Interesting Case. Jun 19, 2011. Bright sunshine day.

A red-eared slider owner had made an appointment to see me at 9.30 am on Sunday.

5-year-old red-eared slider
"How long has the rectum come out?" I asked the owner.
"7 days," he said. "It happened some weeks ago and a vet had stitched up the rectum. After 7 days, he took the stitch out and there was no problem. What is the cause?"

"Something has irritated the rectal area," I said. "Usually it is foreign bodies, parasites or diarrhoea."

"It was due to constipation," the gentleman said he kept the slider in a tank with dry and wet areas and had fed her pork meat, chicken meat and the green sticks of commercial turtle food. "I will stop feeding the green sticks," he thought these were the ones causing constipation.

"The slider may not be drinking water in the tank if it is dirty and contaminated?"

"I change water every day," the man said.

So it is hard to know what causes this rectal prolapse as he seemed to have maintained the terrapin well for the last 5 years. The shell was in good condition with no cracks or abrasions on the shell and of good normal size. No peeling or discoloration. Active. She looked healthy.

ANAESTHESIA
Gas mask. Isoflurane gas at 5% in short duration to effect. There was some "clicking" noises of less than a second during anaesthesia. The turtle was anaesthesized just sufficient to put a purse-string suture to close up the anus after pushing back the rectum inside the anus.

PROCEDURE

1. An assistant puts the gas mask onto the turtles head and focus on her reaction.
2. A 2nd assistant holds the turtle upright but NOT upside down on her back, as the slider will suffocate.
3. I  clean the rectal prolapse with normal saline and pushed it inside the vent.  Then I insert a 2.5 ml syringe into the lumen of the rectum to prevent prolapse. The 2nd assistant held the syringe inwards as the slider may strain to cause prolapse
4. Stitch 3/0 nylon cireumference of anal opening, like a purse string.

DURATION OF STITCHING
7-10 days. The cause of the rectal prolapse must be known otherwise it will be difficult to prevent another episode.

I advised clean water (water left overnight to get rid of the chlorine and asked the owner to check whether the slider actually drinks by giving her the clean water directly.)

Antibiotics and anti-inflam oral for 7 days.

Stitches removed 7 days later. No more prolapse.  

CONCLUSION
Prompt vet treatment and slight prolapse give good chances of recovery to normal.

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