And

Welcome!!
 An assignment on:
Cloacal organ prolapse in
tortoise

SUBMITTED TO: SUBMITTED BY:

Dr Bal Ram Thapa Nabin Neupane
Chief Veterinary Officer Internee,3rd group
Central Veterinary Hospital, 2nd ,B.V.Sc and A.H
Tripureshwor , Kathmandu AFU,Rampur, Chitwan
Turtle vs Tortoise

 Tortoises and turtles are both

reptiles from the order of
Testudines, but in different
classification families.
 The major difference between
the two is that tortoises dwell
on land, while turtles live in
the water some or nearly all of
the time
 Cloaca:
This is a short large bore tube, which terminates
through the vent.
 Theoretically, the cloaca is divided into three sections, the
coprodeum, urodeum and proctodeum.
 The digestive tract empties into the coprodeum, the
proximal portion.
 The genital and urinary tracts terminate in the urodeum, the
middle portion.
 The male has a single phallus, which protrudes from the
ventral wall of the proctodeum.
 CLOACAL ORGAN PROLAPSE
Cloacal prolapse is the common disease seen in tortoise/turtle.
So, any of the organ can get prolapsed through the vent in the animals
 1st may be cloaca itself,
 2nd can be organ of digestive tract i.e colon
 3rd can be that of the urinary tract i.e bladder and
 last is the one residing in the proctodeum i.e. reproductive tract.

Reptiles are like birds they have a single chamber, which faeces and urinate are
deposited before being voided and in this same chamber sperms pass in male, egg in
female.
Fig: Prolapse of Oviduct Fig: Prolapse of PHALLUS
Fig: Prolapse of Intestinal Fig: Prolapse of Intestinal
INtussisception Colon
 The prolapsed structure can be identified on
the basis of the structure, nature and
consistency of the organs:
 Cloacal tissue- soft solid tissue, no lumen Large structure, urates often seen
coming from ureter openings
 Colon- lumen present
 Intestinal intussusception- Smooth surface faecal material and gas may be
present in lumen
 Copulatory organ - Solid mass, no lumen Median groove may be visible
More fleshy distally
 Oviduct - Longitudinal striations seen if not too devitalized Lumen present
No faecal material
 Bladder - Thin translucent wall may contain coelomic fluid
 Causes of Organ Prolapse in
tortoise
- General debility -Constipation
- Neurological dysfunction - Excessive libido
- Mating injuries/trauma - Substrate contamination
- Forced separation during copulation - Trauma during sex
determination
- Ground contact of engorged organ
- Hypocalcaemia and nutritional osteodystrophy may result in an inability
to withdraw and retain the penis
- Cystic calculi may result in tenesmus and secondary penile prolapse
- Bacterial, fungal, viral and parasitic infections of the lower genitourinary
or digestive tracts
 Predisposing factor:
Specific structures towards prolapse:
 Bladderaurolithiasis, eggs within bladder; for urolithiasis
 Shell gland/oviducta egg retention, salpingitis; for FRS
 Penis infection, mating injuries or other trauma, forced
 Separation during copulation, substrate contamination,
ground
 Contact by engorged organ.
 Clinical Signs:
Exposure of prolapse mass to the
surrounding lead to congestion, soiling and
contamination leading to irritation
resulting in
further straining and aggravation of the
condition.
 Epidemiology
 Proplapse is the common disorder seen in the reptiles. It has
been seen in snakes, lizards, chelonians, crocodilians, tortoise
and turtle.
 According to the retrospective study done by J. Hedley and K.
Eatwell the cloacal prolapse in clenoian was found to be 2.4%.
 Diagnosis
The prolapsed organ should be identified wherever possible by
endoscopy, digital examination, visual identification and
histopathology.
A full examination of the animal, including blood parameters and
radiographs should be performed, as the animal may well be
systemically ill.
 Faecal examination is also indicated.
 The history may suggest calcium metabolism problems.
 Male animals may have been sexually active in the recent past.
 Female animals warrant radiographic examination for the
presence of eggs, and ultrasonography for assessment of follicular
activity.
 Treatment
An appropriate treatment protocol depends upon the aetiology and the degree of secondary change
in the prolapsed structure. Retention of the reduced organ using a purse-string suture, and correction
of any husbandry or nutritional problems, will sometimes suffice. Knowledge of what has prolapsed is
required inorder to determine the form any necessary amputative surgery must take.
 Determine what conditions may have predisposed to the prolapse, and correct these in order to
prevent continued disease of this or other organs. Metabolic diseases will need corrective
management. Husbandry problems will need the keeper to be given appropriate advice for future
correction.
 Surgery may be necessary to reduce a prolapse, or, if it has become heavily infected or necrotic, to
remove it. It is common to amputate uterine horns and penile prolapses where trauma is
extensive. Excellent results are possible in both cases provided that the patient is appropriately
stabilised andtreatment is commenced in time. A surgical approach to the management of
cloacal-organ prolapse is given in the Surgery section of this book.
 Excessive libido in male animals may be reduced by alterations in photoperiod and temperature
provision. The use of anti-androgens and other libido-decreasing hormones has not yet been
investigated.
 Anesthetic Procedure
Preoperative
Antibiotic: Ceftriazone: ceftriazone 20mg/kg b.wt by IM in triceps muscle.
Fluid therapy: 25ml of warmed ringer lactate solution intra-coelomically through the pre-femoral fossa.
Through 23gauze needle.

Induction of anaesthesia:
Anaesthesia can be induced with ketamine 20mg/Kg b.wt. and midazolam 1mg/kg b.wt IM. Or slow
intravenous through the right jugular vein.

Suture material:
Suture material used can be PDS as the absorbable suture material, given invertingly.
Polypropylene as non absorbable external suture.

Post operative care:

The post operative care includes the use of ceftriazone 20mg/kg b.wt and prednisolone .2ml IM. For five
days.
In case of the unnecrotized case, the purse string suture can be removed after 10-15 days.
 Surgical technique
Replacement of normal prolapsed structure (applying lignocain jelly)
a. In order to preserve viability, a contaminated prolapse should be cleaned,
examined and where possible reduced at the earliest opportunity.
b. Blunt instruments, digits, rubber stomach tubes and gentle water pressure can
be used to invaginate or invert structures such as oviduct, bladder or rectum
that have become intussuscepted or everted.
c. Using retractors to increase the size of the cloacal orifice is helpful.
d. A temporary purse-string suture can be used to retain the cleaned and
replaced prolapse.(It is important that a purse-string suture allows elimination
of urine and faeces, but ensures that the prolapse is retained.
 Removal of a necrotic penile prolapse.
a. The organ is pulled forward until healthy tissue is revealed. A mattress suture (PDS,
Ethicon) is placed through healthy proximal penile material to achieve
haemostasis.
b. Devitalised tissue distal to the suture is then removed surgically. Post-operative
analgesia and antibiosis are normally provided.
 Management of a necrotic oviductal
prolapse.
a. Application of paired haemostats at the base of a necrotic and traumatised
chronic oviductal prolapse. The clamps were placed as proximal as possible in
order to ensure removal of all devitalised tissue.
b. A transfixed crushing suture was placed around the base of the prolapse
which was then removed with scissors.
c. After the contaminated prolapsed material was removed and discarded, it was
possible to exteriorise the healthy oviduct remnant to allow suture placement.
d. The stump is over-sewn using PDS. Before being allowed to fall back into the
cloaca and returned into the coelomic cavity.
e. The other oviduct, the remnants of the oviduct in question, and the two ovaries
were removed through a coeliotomy. It would be unwise to leave such material
within the animal.
 Sequelae of disease
At the site of anastomosis, stricture can be
formed and it can be another cause of
obstruction.
 REFERENCES:
1. Essentials of Tortoise Medicine and Surgery
2. Medicine and Surgery of Tortoises and Turtles by
Stuart McArthur, Roger WilkinsoN & Jean Meyer
for listening