UNSEDATED COMPUTED TOMOGRAPHY FOR

DIAGNOSIS OF PELVIC CANAL OBSTRUCTION IN A

LEOPARD GECKO (EUBLEPHARIS MACULARIUS)
Author(s): Kelly DeCourcy, D.V.M., B.S., Eric T. Hostnik, D.V.M., M.S., Dipl.
A.C.V.R., Josh Lorbach, D.V.M., and Sue Knoblaugh, D.V.M., Dipl. A.C.V.P.
Source: Journal of Zoo and Wildlife Medicine, 47(4):1073-1076.
Published By: American Association of Zoo Veterinarians
DOI: http://dx.doi.org/10.1638/2016-0040.1
URL: http://www.bioone.org/doi/full/10.1638/2016-0040.1

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 Journal of Zoo and Wildlife Medicine 47(4): 1073–1076, 2016
Copyright 2016 by American Association of Zoo Veterinarians

UNSEDATED COMPUTED TOMOGRAPHY FOR DIAGNOSIS OF

PELVIC CANAL OBSTRUCTION IN A LEOPARD GECKO (Eublepharis
macularius)

Kelly DeCourcy, D.V.M., B.S., Eric T. Hostnik, D.V.M., M.S., Dipl. A.C.V.R., Josh Lorbach, D.V.M.,
and Sue Knoblaugh, D.V.M., Dipl. A.C.V.P.

Abstract: An adult leopard gecko (Eublepharis macularius) presented for lethargy, hyporexia, weight loss,
decreased passage of waste, and a palpable caudal coelomic mass. Computed tomography showed a
heterogeneous hyperattenuating (;143 Hounsfield units) structure within the right caudal coelom. The distal
colon-coprodeum lumen or urinary bladder was hypothesized as the most likely location for the heterogeneous
structure. Medical support consisted of warm water and lubricant enema, as well as a heated environment.
Medical intervention aided the passage of a plug comprised centrally of cholesterol and urates with peripheral
stratified layers of fibrin, macrophages, heterophils, and bacteria. Within 24 hr, a follow-up computed tomography
scan showed resolution of the pelvic canal plug.
Key words: Cloaca calculus, computed tomography, inflammation, leopard gecko, pelvic canal obstruction,
urolith.

BRIEF COMMUNICATION dehydration. A large firm mass was palpated

A 2-yr-old leopard gecko (Eublepharis macular-
ius) of unknown sex presented to The Ohio State
University College of Veterinary Medicine for
lethargy, hyporexia, decreased passage of waste,
and weight loss of ;1-mo duration. The gecko
was typically housed in a large cage (36 3 18 3 12
inch), but was recently maintained in a smaller
cage (18 3 12 3 12 inch) because the owner was
traveling with the gecko. The travel enclosure
included an under tank heater, ultraviolet lighting,
moist and dry hide, water bowel, and felt sub-
strate. The gecko was previously housed on a clay
burrowing substrate, but this substrate was re-
moved because of inappropriate consumption of
the substrate. The diet consisted primarily of
mealworms, with occasional waxworms, super-
worms, and crickets, all of which were dusted with
calcium supplement. Upon scrutiny of husbandry,
it was determined the under tank heater of the
gecko’s smaller enclosure had malfunctioned and
failed to provide an external heat source for an
undetermined time.
On the initial examination, the leopard gecko
was quiet, but responsive. The gecko had a body
condition score (BCS) of 1 (1–5 scale) and mild
From The Ohio State University College of Veterinary
Medicine, 601 Vernon L. Tharp Street, Columbus, Ohio
43210, USA (DeCourcy, Hostnik, Lorbach, Knoblaugh).
Correspondence should be directed to Dr. Hostnik
(ericthostnik@gmail.com).
within the right caudal coelom.
Computed tomography (CT) was performed
without sedation to characterize the coelomic
mass. Radiography with contrast medium and
ultrasound were not performed. The leopard
gecko was placed prone within a vented plastic
Tupperware container with foam blocks to limit
motion. The CT scan was performed using an 8-
detector helical CT scanner (GE LightSpeed Ultra
8-slice, GE Healthcare, Waukesha, Wisconsin
53188, USA) with the settings 80 kV, 130 mA, 1-
sec tube rotation time, 0.625-mm slice thickness,
and 0.875 pitch. The acquisition time of the scan
lasted ;5 sec. Data were acquired in helical mode,
and images were reconstructed with a standard
soft tissue filter algorithm (window level [WL] ¼
40 and window width [WW] ¼ 400) and bone filter
algorithm (WW ¼ 250, WL ¼ 2,500).
CT showed a well-defined, ovoid (1.5 3 0.7 3 0.7
cm), heterogeneous, hyperattenuating structure
(Hounsfield unit [HU] of 143.1) within the caudal
coelom (Fig. 1A, B). The structure was longest in
the craniocaudal plane. The structure had a
central hypoattenuating (13.3 HU) portion within
the cranial aspect. The caudal margin of the
structure tapered as it entered into the pelvic
canal. Intravenous contrast medium was not
administered. Upper gastrointestinal series with
positive contrast was not performed because of
concerns of dehydration.11 Based on the location,
tubular shape, and tapering of the caudal margin
into the pelvic canal, the structure was suspected
to be within the distal descending colon-copro-

1073
1074 JOURNAL OF ZOO AND WILDLIFE MEDICINE
Figure 1. Dorsal plane computed tomography of
leopard gecko in standard soft tissue algorithm (win-
dow width [WW] ¼ 400, window level [WL] ¼ 40). The
heterogeneous mineral-attenuating structure within the
right caudal coelom entering the pelvic canal was later
defecated after medical management and submitted for
histopathology.
deum or the urinary bladder. Factors considered
to potentially contributing to the pelvic canal
obstructive disease included inappropriate tem-
peratures, inappropriate or insufficient water,
insufficient space, indigestible food parts (hard-
shelled insect prey), and consumption of indigest-
ible cage substrates such as sand. Gastrointestinal
parasitism may also contribute to constipation.8
Intussusception or inflammation of the cloaca
may cause physical obstruction of the gastroin-
testinal tract.14
Medical management was discussed based on
the findings of the CT scan. A warm water and
lubricant enema was administered using a 20-ga
venous catheter with the stylet removed. The tip
of the catheter was lubricated and then inserted
into the cloaca directed cranially. The mixture of
warm water and lubricant was administered until
resistance was met. The gecko was then placed
back into a warm enclosure. Approximately 6 hr
after administration of the enema, a firm, formed,
cream-colored concretion (1.7 3 1 3 0.5 cm) with a
waxy texture was found in the gecko’s enclosure.
The plug was ovoid and soft with a tan, shiny,
waxy outer surface (Fig. 2A). On cut section, this
waxy outer layer was ;0.5 mm in thickness. The
plug contained multifocal, large, gritty, white,
hard nodules admixed with multifocal, yellow,
soft, crumbly material. The contents crumbled
upon sectioning.
Histologically, the plug was composed of
densely packed macrophages, scattered hetero-
phils, amorphous, eosinophilic cellular debris,
and abundant fibrin admixed with many colonies
of intracellular and extracellular bacteria (Fig.
2B). Bacterial colonies were composed of Gram-
negative coccobacilli and occasional Gram-posi-
Figure 2. A. Macroscopic appearance of the plug.
Bar ¼ 1 cm. B. The plug is composed of layers of fibrin;
macrophages, with few heterophils (asterisk) admixed
with cholesterol clefts; bacterial colonies; and a central
core of urate crystals (arrows). Bar ¼ 100 lm. C. High-
magnification urate crystals (arrows) surrounded by
cholesterol clefts, fibrin, and macrophages. Bar ¼ 50
lm. D. Urate crystals are birefringent under polarized
light. Bar ¼ 50 lm.
tive cocci with Twort Gram staining (Fig. 3).
Multifocally, inflammatory cells and bacteria
surround acicular cholesterol clefts and acicular
crystals consistent with urate tophi (Fig. 2C).
Urate tophi were birefringent when polarized
(Fig. 2D).
Urate calculi form as a consequence of super-
saturated solutions. The formation process is also
influenced by temperature and pH.5 The super-
saturation of a solute can be perpetuated by
chronic dehydration in captive reptiles.8 Solutes,
such as uric acid, continue to be produced despite
dehydration, thereby further increasing the con-
centration of the solute. Crystals and uroliths can
form around a nidus such as bacteria and
inflammatory cells.8 Environmental temperature
contributes significantly to behavior and water
homeostasis in reptiles.15
Figure 3. Left. Higher magnification of the plug
layers. There are cholesterol clefts (arrows) surrounded
by macrophages, heterophils, and bacterial colonies.
Hematoxylin and eosin, 403 . Bar ¼ 20 lm. Right.
Bacterial colonies (arrows) are predominately Gram-
negative (–) rods. Twort Gram stain, 603 . Bar ¼ 20 lm.
 DECOURCY ET AL.—CT OF PELVIC CANAL OBSTRUCTION IN LEOPARD GECKO
To the authors’ knowledge, this is the first study
using unsedated CT to diagnose and guide
treatment of a urolith in a Squamata. Transloca-
tion of urinary calculi into the distal cloaca has
been described in African spurred tortoises (Geo-
chelone sulcata), supporting the concerns that the
urolith may be within the cloaca or urinary
bladder.9 Uroliths are a common finding in
reptiles, with reports that include lizards, turtles,
and snakes.8 Rarely, cloacoliths are reported in
birds seen as a consequence of reflux of urates
from the urinary tract into the coprodeum. A
cloacolith composed of 100% uric acid salts in a
blue fronted Amazon parrot (Amazona aestiva)
was diagnosed by radiographs and endoscopy; the
cloacolith formed an obstruction at the rectal
opening, producing clinical signs associated with
constipation (e.g., straining to defecate, blood in
feces, automutilation).2 In an African black-foot-
ed penguin (Spheniscus demersus), chronic cloaco-
lithiasis with gastrointestinal obstruction was
associated with intestinal lymphosarcoma with
hepatic and renal metastatic disease.6
A follow-up CT of the leopard gecko was
performed within 24 hr after the passage of the
plug. The heterogeneous, hyperattenuating struc-
ture was no longer within the caudal coelom on
the CT images. A small amount of residual
hyperattenuating material remained within the
pelvic canal. The hyporexia continued for 24 days.
Nine months after the passage of the plug, the
gecko gained weight, with a BCS improvement to
4–5. On the last examination, the gecko was
bright, alert, and responsive with a good body
condition and normal appetite.
The urolith was the likely cause of the pelvic
canal obstructive clinical signs because the animal
showed improvement after its passage. Contrast
radiography is an established tool for diagnosis of
intestinal obstructive disease. Gastrointestinal
transit times are relatively long and may vary
depending on hydration status of the patient.11
Iodinated contrast media, such as Gastrografin
(diatrizoate meglumine and diatrizoate sodium
solution), typically have a faster gastrointestinal
transit time in reptiles than barium. The average
time for iodinated contrast medium to reach the
large intestine varies between species, ranging
from 2.6 hr in Greek tortoise (Testudo graeca) up
to 288 hr in loggerhead sea turtle (Caretta care-
tta).4,10 One study of two leopard geckos found
that contrast medium was excreted between 18
and 45 hr.1 At this time, a comprehensive study
examining the gastrointestinal transit time of a
1075
large sample population of leopard geckos has not
been performed.
The urolith is postulated to have formed as a
consequence of multiple contributing causes. The
decreased enclosure temperature as a result of the
malfunction of the external heat source may have
initiated or complicated dehydration of the gecko.
Underlying renal pathology may have changed the
animal’s hydration, causing an increased satura-
tion of waste and potentially a change in the pH of
the urinary tract. However, markers for renal
disease were not investigated. Inflammation in
the colon, coprodeum, or urinary bladder may
have potentiated the formation of the urolith.8
Because of the improved clinical status, tissue
histopathology was not performed to assess for
possible underlying renal or gastrointestinal pa-
thology. Gram-negative bacteria, macrophages,
and cholesterol clefts were also found as part of
the cloacolith, suggesting that physiologic and
environmental changes due to stress, temperature
change, pathology, or a combination could have
led to a shift in the microenvironment of this
gecko, further predisposing it to urolith formation.
CT provided a quick and efficient method for
diagnosis of pelvic canal obstructive disease in a
Leopard gecko without the need for sedation. CT
imaging is a noninvasive imaging modality that
uses contiguous cross-sectional images to allow
interpretation of a study in multiple planes.12
Radiography with contrast and ultrasonography
are alternative techniques to evaluate for coelo-
mic disease. Screen film mammography film,
screen film radiography, and digital radiography
have better spatial resolution compared to CT;
thus, all are valuable for small structures such as
the anatomy of a gecko.3 However, unlike screen
radiography or digital radiography, CT overcomes
the superimposition of structures that occurs
when converting a three-dimensional animal in a
two-dimensional image.13 The variety of filter
algorithms and intricacy of back projection for
attenuation profiles help to distinguish between
soft tissue structures on CT that may have similar
opacities on radiography.7 CT is an advanced
imaging tool that will have an increased number
of applications within zoo and exotics medicine as
accessibility increases.
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Received for publication 28 February 2016