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CASE

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R E P O R T

Abdominal Abscess in a Rabbit


David Perpin, LV, MSc
A 4-year-old male domestic rabbit (Oryctolagus cuniculus) weighing 2.7 kg was presented with a 3-day history of reduction of the size of the fecal pellets. In addition, the owners noticed 4 weeks previously that the rabbit was putting on weight and the abdominal wall was hard on palpation. The diet consisted of pellets, mixture of seeds, alfalfa hay and romaine lettuce. The owners did not notice any reduction in the amounts consumed. The rabbit was the only pet in the household, had no access to outdoors and was allowed to roam unsupervised for 1 hour every evening. No past medical problems were reported. On physical examination, the rabbit was bright, alert and responsive. The heart rate was 240 beats per minute, respiratory rate was 52 breaths per minute and rectal temperature was 39.3C (102.7F). Palpation revealed a hard and rounded abdomen, and no discernible internal organs upon palpation. Gut sounds were reduced. Dental examination with an otoscope while the animal was awake showed no abnormalities. Fecal pellets were present in the cage and were considered reduced in size (Fig 1).

David Perpin, LV, MSc Zoological Medicine Resident Department of Small Animal Medicine & Surgery College of Veterinary Medicine University of Georgia Athens, Georgia david1@uga.edu

David Perpin graduated in 2000 from the College of Veterinary Science at University of Barcelona, Spain. He obtained a masters degree working with wildlife and then moved to private practice to work with exotics and small animals in Spain and England. He completed an internship at the Henry Doorly Zoo in Omaha in 2008 and is currently the Zoological Medicine Resident at the University of Georgia, College of Veterinary Medicine.

Fig 1. Fecal pellets at the initial examination were small and dry.

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A radiograph taken under physical restraint showed an image compatible with a large fluid-filled mass containing a central gas bubble, which was displacing the intestines dorsally. In addition, small, linear radiodense particles were seen in stomach and cecum (Fig 2). A presumptive diagnosis of a large mass displacing and compressing the intestines was made. No organ was believed to be seriously compromised as the rabbit was bright, alert and responsive. Upon further questioning, the owners admitted seeing their rabbit chewing on cables, which could explain the radiodense particles seen radiographically. Bloodwork, ultrasonography and biopsy were offered but declined by the owners. They

elected exploratory laparotomy. Butorphanol (0.3 mg/kg) was administered 10 minutes prior to induction. The rabbit was anesthetized with isoflurane via face mask and prepared for surgery. A routine ventral midline incision was made with the animal in dorsal recumbency. The mass was identified as a large abscess (19 20 cm) (Fig 3) with multiple attachments to several portions of intestinal wall and mesenterium. The rabbit was euthanized intra-operatively at the owner's request. Necropsy did not show any other abnormality. Further opening of the abscess obtained 1.5 L of pus (Fig 4). No histopathology or cultures were allowed.

Intestines displaced Mass outline

Fig 2. Lateral radiograph shows a mass displacing the intestines dorsally.

Fig 3. Shown is an intraoperative image of the abdominal abscess.

Fig 4. A large amount of pus was recovered from the abdominal abscess.

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Abdominal Abscess in a Rabbit D. Perpin

Discussion
Slow growing, well encapsulated and seemingly painless abscesses develop readily in rabbits.1 Abdominal abscesses are not uncommon in rabbits, and theoretically they can be primary or secondary to hematogenous spread. Although the small pieces of cable ingested by this rabbit may have perforated the intestine and originated the abscess, all cases seen by the author have had an uncertain origin and were not related to abscesses in other parts of the body. However, initiating causes, such as foreign body penetration from the intestine, hematogenous spread or underlying tumors, should be considered. Abdominal abscesses are difficult to remove due to adhesion formation with surrounding structures,1 and incomplete removal usually results in relapse of the abscess. Antibiotic therapy is challenging in rabbits due to the fact that abscesses contain thick pus and are well encapsulated. Pasteurella multocida, a gram-negative bacterium and Staphylococcus aureus, a gram-positive bacterium, are commonly isolated.1,2 Depending on the location, anaerobes may also be present; therefore, aerobic and anaerobic cultures and sensitivities are necessary to establish an appropriate antibiotic therapy. If culture and sensitivity are not available, administration of injectable penicillins is a good empiric initial option.3 It should be remembered that oral penicillins are contraindicated in rabbits due to the risk of intestinal dysbiosis.4 A combination of aggressive surgical removal and long-term antibiotic treatment (based on culture and sensitivity results) seem the best therapeutic approach for abdominal abscesses in rabbits. As demonstrated in this case and other similar cases, such as the one depicted in Figs 5 and 6 (Case 2), abdominal abscesses can develop to a considerable size before production of obvious clinical signs. However, such large abscesses are usually associated with inexperienced owners who are unable to recognize early findings, such as a hard abdominal wall or gastrointestinal disturbances. Case 2 had a similar account and outcome as Case 1: This 3-year-old male rabbit was not handled much by the owners, who noticed a hard abdomen without any other clinical sign. They decided euthanasia after the radiograph, and gross necropsy revealed the abscess was extensively attached to mesentery and intestine. No other gross lesions were found, and no histopathology or cultures were allowed. These cases demonstrate that early recognition of abdominal abscesses is vital to improving the chances of a successful outcome following treatment.

Abscess outline

Fig 5. The rabbit in Case 2 also had a large abdominal abscess.

Fig 6. Lateral radiograph of the rabbit in Case 2 revealed severe displacement of all abdominal organs.

References and Further Reading


1. Harcourt-Brown F: Textbook of Rabbit Medicine. Edinburgh, UK, Butterworth Heinemann, 2002. 2. Segura P , Martnez J, Peris B, et al: Staphylococcal infections in rabbits does on two industrial farms. Vet Rec 160:869-873, 2007. 3. Gaertner DJ: Comparison of penicillin and gentamicin for treatment of pasteurellosis in rabbits. Lab Anim Sci 41:78-80, 1991. 4. Jenkins JR: Gastrointestinal diseases. In Quesenberry KE, Carpenter JE (eds): Ferrets, Rabbits, and Rodents: Clinical Medicine and Surgery. Saunders, 2003, pp 161-171.

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