FINAL
VIDEO – SURGERY OF THE EVERTED CHEEK POUCH
2011
case study
The dwarf hamster is stressed out by an everted gangrenous cheek pouch. It required surgical removal (amputation) of the exposed pouch. However, the family vet did not do hamster surgery. What to do? The young lady researched the internet and came to Toa Payoh Vets which does hamster cheek pouch amputations under anaesthesia. The pouch was excised using electricity. The hamster returns to a happy owner and leads a normal life able to eat and drink as usual. Cheek pouch eversion is an emergency.
In
some early cases, no surgical amputation is required as the vet can
push it back. Consult a hamster vet
early.
#evertedcheekpouch
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UPDATES
AT:
https://2010vets.blogspot.com/2022/10/a-dwarf-hamster-tries-to-pull-off-big.html
2011 CASE STUDY by Dr Sing Kong Yuen, BVMS (Glasgow).
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.
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 had 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 by amputation of the cheek pouch in
this case. Everted cheek pouch surgery is best seen early as it may
be pushed back and there is no need for surgery. The risk is not
surgery but anaesthesia.
Isoflurane gas was used. The
assistant must focus on this. "It is a simple surgery compared
to Caesarean section or spay. Clamp the pouch first," I said to
my assistant. "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.
Anaesthesia again. Stitched cut end of pouch with 6/0 absorbable
sutures x 3 in pattern of simple interrupted sutures.
"Don't
stress the hamster," I gave this advice to my lady assistant.
"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. "Use
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 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.
INSTAGRAM:
https://www.instagram.com/toapayohvets/
UPDATES
AT:
https://2010vets.blogspot.com/2011/10/update-on-blog-no-648-everted-cheek.html
2. SCRIPT FOR VIDEO PRODUCTION
HOOK
CONSULTATION AT TOA PAYOH VETS VIDEO
https://www.youtube.com/watch?v=r8ft7CKTg5w
DRAFT TEXT AS FOLLOWS:
CASE STUDY IN 2011. The
young lady's dwarf hamster has a pink mass
Her vet
had prescribed baytril oral antibiotic 2 days ago, "My vet 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.) Not for video production.
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 dried yellow pus settled 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 life-threatening operation, the hamster would die
from infections and malnutrition. If she consented, the hamster had a chance of a normal
life eating and drinking normally, with a painful septic pouch which would turn gangrenous.
(See case in
2022.
https://2010vets.blogspot.com/2022/10/4121-dwarf-hamster-is-emaciated-and-has.html)
Cheek pouch surgery is best treated early. The
risk of death will be anaesthesia, not surgical procedures.
Isoflurane gas was
used. "It is a simple surgery
compared to Caesarean section or spay. Clamp the pouch first," I
explain to my young vet assistant. "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 electro-surgery. Anaesthesia gas was given on and off
again, based on effect. I stitched the cut end with three 6/0 absorbable sutures in an interrupted pattern.
"Don't
stress the hamster," I gave this advice to my assistant.
"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."
When the forceps was unclamped for inspection, the inner side of the cheek pouch shrank inwards. "No problem with that," I said to my assistant. "Use
the artery forceps to pull out the cut ends to complete the 3 simple interrupted
stitches".
As long as the hamster is anaesthesized
adequately, the stitching is easy. 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," 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 available for storing food.
3. What if she did not get
surgery done?
Pus and infection is already
present in the pouch. The tip of the pouch is gangrenous as it has no
more blood supply. The gangrene will spread to the whole pouch. The
hamster will die from infections and malnutrition as she will not be
able to eat and drink normally.
See case in
2022.
https://2010vets.blogspot.com/2022/10/4121-dwarf-hamster-is-emaciated-and-has.html
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 no news is good
news as I did not see her 7 days after surgery nor hear from her by
phone.
UPDATES AT:
https://2010vets.blogspot.com/2022/10/a-dwarf-hamster-tries-to-pull-off-big.html
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