Cystotomy and Percutaneous Endoscopic Gastrostomy (PEG) Tube Placement in a Victorian Koala (Phascolarctos cinereus victor)
In July 2005, a routine urinalysis on a 10-year-old intact female Victorian koala (Phascolarctos cinereus victor) revealed hemorrhagic cystitis. Medical treatment over the following 6 months, guided by serial urine culture and sensitivity results was incompletely effective. An abdominal ultrasound exam found two uroliths present in the urinary bladder. A cystotomy was successfully performed and analysis of the uroliths found them to be composed of calcium phosphate. Postsurgical anorexia led to significant weight loss, so a percutaneous endoscopic gastrostomy (PEG) tube was placed as a means to deliver nutritional support.2 The koala was periodically supplemented through the feeding tube with a blend of eucalyptus leaves, water, and a human nutritional powder (Portagen®, Mead Johnson, Evansville, IN, USA). After 8 months, the koala’s appetite stabilized enough to allow removal of the feeding tube.
Due to persistent dysuria, a repeat ultrasound exam in January 2007 found two additional uroliths and a mass associated with the urinary bladder. During a second cystotomy, the soft tissue mass was located at the trigone making complete surgical removal impossible. Histopathologic evaluation identified a soft tissue sarcoma, likely a fibrosarcoma or fibroleiomyoma. At the time of this writing, the koala remains well following the second cystotomy.
Two postmortem cases of cystitis with fragmented calculi have been reported in koalas1 but to our knowledge, this is the first antemortem report and first cystotomy performed in this species. Application of a PEG tube in a koala has also not been previously reported.
1. Canfield, P.J. 1989. A survey of urinary tract disease in New South Wales koalas. Aust Vet J. 66(4):103–106.
2. Mauterer Jr., J.V. 1995. Endoscopic and nonendoscopic percutaneous gastrotomy tube placement. In: Bonagura J.D. (ed.). Kirk’s Current Veterinary Therapy XII Small Animal Practice. WB Saunders, Philadelphia, Pennsylvania. 669–674.