Use of Total Parenteral Nutrition in the Management of an Esophageal Tear Following Endoscopic Removal of Two Fishing Hooks From a Juvenile Kemp's Ridley Sea Turtle (Lepidochelys kempii)
Abstract
A juvenile Kemp's ridley sea turtle presented for rehabilitation due to two metal fishing hooks embedded in the distal esophagus.1-3 In addition to the hooks, the patient had a chronic healing boat strike injury over the left medial carapace with exposure of the left lung but no neurologic impairment. Following endoscopic4 hook removal, a tear was observed in the distal esophagus where surgical repair was difficult. An alternative wound care approach was taken where oral feedings were discontinued, and the esophagus flushed every other day with a dilute vinegar solution. Weekly endoscopic debridement of granulomatous tissue was also performed without sedation. A formulation of total parenteral nutrition (TPN) previously used in other sea turtles5,6 was administered intravenously through the cervical sinuses three times per day for 68 days. The large mucosal deficit healed though there was still a hook puncture hole associated with a small periesophageal granulomatous tract and surgical debridement and closure was necessary 57 days after hook removal.7 Oral feeding initially consisting of squid fillets was withheld for an additional 11 days following surgery to allow the esophagus to heal. Further endoscopic evaluations of the site in the weeks following surgery revealed complete closure of the surgery site with seemingly normal function of the esophagus. The support and treatment techniques used demonstrate the viability of long-term TPN therapy (68 days) to provide nutritional support for large esophageal wounds and local therapy to decrease contamination and promote mucosal healing.
Acknowledgements
The authors would like to thank Cassie Seebart, Rebecca Riley, and Lindsey Flynn as well as all of the animal care staff, interns and volunteers at the Clearwater Marine Aquarium who were instrumental in the daily care of this patient. The authors would additionally like to thank Dr. Estelle Rousselet at the University of Florida for her help in this case, and Dr. Nicole Stacy at the University of Florida for her excellent clinicopathologic work for this case.
* Presenting author
+ Student presenter
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