An intact female, >80-year-old, 105-kg Galapagos tortoise (Geochelone nigra) was evaluated for cloacal prolapse of 3-week duration. Physical examination revealed prolapsed, edematous, pink, cloacal and clitoral tissue. The tortoise was sedated with morphine (0.5 mg/kg, IM) and midazolam (0.3 mg/kg IM) and the tissue was reduced after hypertonic sugar solution, DMSO and lidocaine/bupivacaine application. Initial reduction was followed by transverse sutures to reduce the size of the cloacal opening. The tissue re-prolapsed 2 days later. Over 6 weeks, multiple methods of reduction were attempted. These included cloacopexy, cloacal stinting, placement of absorbent pressure bandage, purse-string closure, and profound sedation, but all were unsuccessful. During this time, an indwelling subdural 24-gauge catheter was placed and used to administer analgesia and paralytics to prevent straining. Although this stopped the tenesmus, a 4-cm section of cloacal tissue was persistently swollen and prolapsed. This 4 cm of tissue was surgically amputated using a linear surgical TA 90 stapler. One week after amputation, the area was imaged using endoscopy and appeared to be healing normally. In the months following surgical amputation, the tortoise had no recurrence of cloacal prolapse.
The authors would like to thank Drs. Allesio Vigani and Dr. David Reese for assistance with anesthesia, imaging and placement of the subdural catheter. We would also like to thank Drs. Kirsten Cooke and Alex Gallagher for endoscopy support.