Abstract
Gastrointestinal impaction is a nonspecific disease condition commonly affecting Asian elephants (Elephas maximus) in captivity in India. Clinical management of three elephants in captivity aged 35, 57 and 45 years which had suffered from gastrointestinal impaction is discussed. Clinical signs were: reduced appetite in all three cases, dyspepsia in animal I and III, progressive bilateral flatulence of abdomen in case II, and presence of colic of varying degrees in all three. All three animals were not voiding feces. The physical examination and laboratory investigation revealed reduced to absence intestinal peristalsis. The recto-colonoscopy revealed the presence of cyanotic patches in the intestinal mucosa suggestive of inflammatory reaction. Treatment protocol included improvement of the hydration status using maintenance and replacement fluids intravenously, ensuring antibiotic coverage, parenteral supplementation of vitamins and minerals, administering agents to modify the rate of gastric emptying, warm enema with isotonic solutions, mineral oil and surfactants. Antacids, proton pump inhibitors and H2 antagonists were used in animals with progressive flatulence. All the elephants responded to the above line of treatment and started defecation in varying durations from 5 to 40 days. The impacted fecal bolus were of different confirmation - elongated, hard and fibrous (animal I), hard and massive followed by small boluses (animal II) and small soft normal textured (animal III). It can be concluded that successful management of gastrointestinal impaction in captive Asian elephants depends on adoption of the protocol including specific diagnosis, supportive therapy, and administration of enema and maintaining the animal in a physiologically stable condition.
Introduction
Kerala state has a large number of captive Asian elephants compared to any other state in India and forms an inevitable part of its rich cultural and traditional life. Gastrointestinal impaction is one of the fatal, nonspecific diseases of elephants and is commonly affecting the elephants in captivity in India.1,10 Lack of exercise, feeding of excessive fibrous diet and poor nutritional management are the predisposing factors leading to this condition. The present paper discusses the occurrence of gastrointestinal impaction in three captive Asian elephants in the state during a period of 2 years which were managed successfully using a suitable clinical protocol.
Case History and Observations
The captive animal I (male, ∼35 years) was reported to have a heavy intake of raw fibrous diet, showed signs of anorexia and dyspepsia along with abdominal pain and was dull and lethargic in appearance. The animal was unable to void the faeces. On observation, the animal was showing intermittent signs of varying degrees of colic. Upon clinical examination, all vital parameters were normal. The animal II (male tusker, ∼57 years) was transported for a long distance after a heavy intake of food and water. Upon reaching the destination, it started showing the signs of anorexia dyspepsia and severe abdominal pain. Clinical examination revealed normal respiration, temperature and heart rate. Physical examination revealed that the animal was not voiding faeces and exhibited signs of colic. Mild bilateral flatulence was also noticed. The animal III, similar to animal I, had a history of heavy intake of high fibrous diet leading to slow development of anorexia and colic. Consequently, food and water intake reduced. Clinical examination revealed normal respiration, temperature and heart rate.
Haemato-Biochemical Observations
In all the cases, haemoglobin level was within the normal range.5 Interestingly, there was an elevated level of neutrophils and basophils in all the cases, suggestive of inflammatory changes.2,6,7 Blood gas analysis was performed and the level of lactate was fairly high in all the cases, 4.5 mmol/L, 4.9 mmol/L, and 5.1 mmol/L, respectively.2 Hypokalaemia was noticed in animal II and III.7 The level of bicarbonate ions were lower in animal I and II.
Physical Examination
Rectal examination and abdominal palpation were performed in all the cases. Bilateral flatulence was observed in animal II suggestive of gas formation in the anterior segments of intestine and stomach, which was absent in animal I and III. Abdominal palpation and auscultation revealed the complete absence of gut motility in all the cases, and intestinal oedema in animal I and II. Rectal examination was performed in all animals to assess the viability of the gut mucosa. There was evidence of primary intestinal torsion in animal II and the mucosa had inflammatory changes. Recto-colonoscopy was performed in all the cases using a modified wire camera. Cyanotic and greyish patches were noticed on the mucosa in animal I and II, suggestive of inflammatory changes.4
Diagnosis and Treatment
From the history, physical and clinical examination, evaluation of blood parameters, rectal examination and recto-colonoscopy, the condition was diagnosed as impaction of intestine. From these results the location of the impactions was suggested at the caeco-colic junction. Based on the physical status of the animals, degree of the disease, age and risk factors involved, an elaborate treatment protocol was followed in all the cases.
Primary aim of the treatment was to stabilise the animals and to maintain their hydration status within the normal range.1 For this, dextrose normal saline, Ringer‘s lactate, dextrose 10%, dextrose 5%, and saline infusions (injections RL 500 ml, DNS 500 ml, D10 500 ml, Fresenius Kabi India Pvt. Ltd) were used. The amount of these fluids was determined based on the hydration level of the animals, and ranged from 40 to 60 L per animal per day and administered intravenously.8,10 Almost 1.5 L of calcium borogluconate intravenous infusion (25% w/v equivalent to calcium gluconate 1.854% w/v) was administered in all cases to enhance the peristalsis and to promote smooth muscle contraction.9 Antibiotic preparations, preferably amoxycillin-sulbactam combination (4 mg/kg/i.v.; Amoxirum forte, 3 g total pack, Virbac Animal Health India Pvt. Ltd) were administered intravenously as an antibiotic umbrella mainly for protective shower on the gut mucosa.10 Ranitidine hydrochloride was given (0.5 mg/kg) on alternate days i.m. anticipating a mild prokinetic action on gut mucosa further initiating peristalsis.9 Metronidazole (15 mg/kg per rectum; Metrogyl 100 ml sachet, JB chemical and Pharmaceuticals India Pvt. Ltd) and metoclopramide (0.5 mg/kg i.v.; inj. Perinorm 2 ml ampoule, IPCA Laboratories India Pvt. Ltd) were also administered to modify the rate of gastric emptying.9 Intestinal edema was evident in animal I and II and was controlled using mannitol (2 g/ml solution) intravenously (1 g/kg). Amino acid preparation (Infusion-Inj. Aminowell, 500 ml i.v., Fresenius Kabi India Pvt. Ltd) was administered to enhance the viability of protein synthesis and to activate the peristaltic movement.
The control of flatulence in the stomach and duodenum as reported in animal II, was controlled by administering proton pump inhibitors (Pantoprazole at a dose rate of 1mg/kg) – i.v.9 As varying degrees of colic were reported in all the cases, analgesic and nonsteroidal anti-inflammatory agents (flunixin-meglumine 1.1 mg/kg; injectable solution 83 mg/ml, Virbac Animal Health India Pvt. Ltd) were administered intravenously.9 Oral antacids like sodium bicarbonate (100 g, orally twice daily) were given with liver correctives to normalise the pH level in the stomach.7 Four litres of liquid paraffin were administered orally per day to soften the faecal matter and facilitate easy movement of the obstructed mass through the intestine. Since the greater colon acts as the major site of water absorption in elephants and being hindgut fermenters, enemas were performed in all cases with isotonic fluids including Ringer‘s lactate and normal saline on alternate days.
Results and Discussion
The described treatment protocol was found effective and resulted in successful resolution of GI tract impaction in three Asian elephants. Animal I, II and III responded to the treatment 40, 37 and 5 days after the onset of the condition, respectively. In animal II, the condition recurred on 45th day of treatment. The impacted fecal bolus which came out were different in three cases (i.e., elongated, hard and fibrous [animal I], hard and massive followed by small boluses [animal II] and small soft normal textured [animal III]).
The major goal of the treatment was to stabilize the animal during the progressive stages of the condition. This was achieved by intravenous and rectal administration of fluids and by pharmaceutical management of the gut mobility. Surgical intervention in the case of gastrointestinal obstruction is practically impossible in elephants as the gastrointestinal system is too lengthy and complicated in topography. A clear-cut diagnostic technique is also not practical in case of elephants, only a tentative diagnosis based on the clinical condition can be made. Recto-colonoscopy was found very effective in diagnosing the condition to a great extent. Direct visualization of the rectal/caecum mucosa is therefore highly recommended in animals under colic suspicion.
Conclusion
Gastrointestinal impaction in captive Asian elephants is primarily a management defect and may be fatal if not properly addressed. Timely diagnosis, selection of modern treatment protocol along with adlib supply of water is regarded as imperative, remedial activity in this situation. Strictly adhering to scientific management practices, appropriate diet, adequate exercise, and stress-free life, etc., are precautionary measures to avoid this condition. The treatment protocol with the principle of stabilizing the animal, enema procedures, antibiotic shower and gut motility modifiers is suggested to all veterinarians for the successful management of gastrointestinal impaction in captive Asian elephants.
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