Intestinal Volvulus and Stricture Associated with a Leiomyoma in a Green Sea Turtle (Chelonia mydas)
A 30-kg female green sea turtle (Chelonia mydas) was presented to the Veterinary Medical Teaching Hospital, University of Florida, with a 2-mo history of anorexia, intermittent regurgitation, decreased fecal production, and positive buoyancy of the right side. Found stranded near Atlantic shore, Hutchinson Island, Florida, the turtle had been diagnosed as having a bowel obstruction and treated medically at a rehabilitation center prior to referral, with no response to therapy. Upon initial presentation, no abnormalities were detected on physical examination, and hematology and clinical chemistry results were within limits established for this species. Radiographs confirmed gaseous distension of bowel loops, suggestive of intestinal obstruction and the patient was placed on ceftazidime (20 mg/kg i.m. q 72 hr). Exploratory celiotomy was performed in order to identify and treat the cause of the obstruction. The turtle was induced with 1.15 mg of medetomidine (40 μg/kg) and 115 mg of ketamine (4 mg/kg) administered intravenously in the dorsal coccygeal vein and maintained on isoflurane and oxygen. The intestinal obstruction was initially palpated through a soft tissue approach into the right hindlimb fossa, but it could not be exteriorized. Through plastron osteotomy performed through the right abdominal scutes, a 540-degree torsion of the small intestine was identified. Following reduction of this torsion, an intestinal stricture was identified as well as a thickened bowel wall containing intramural nodules. Approximately 30 cm of abnormal bowel, including the stricture, were resected and submitted for histopathology. An end-to-end anastomosis was performed using techniques to accommodate the discrepancy in size between the sections of bowel orad and aborad to the stricture. The plastron osteotomy was stabilized using self-tapping screws and figure-eight wire. Fiberglass cloth and fast-drying epoxy were used to seal the defect. Atipamezole (4 mg) was administered intravenously in the dorsal coccygeal vein for reversal of the medetomidine and the patient recovered uneventfully.
Histopathology of the resected bowel segment identified a leiomyoma associated with the focal stricture. The margins of the resected segment were free of tumor. Markedly ectactic subserosal lymphatic and blood vessels occurred secondary to the torsion and accounted for the nodules noted during exploratory celiotomy. In addition, there was a moderate diffuse lymphoplasmacytic enteritis with widely scattered small granulomas centered around eggs consistent with the spirorchid trematode, Laeredius laeredii.
The turtle was returned to the rehabilitation center 6 wk following surgery. At 4 mo post-surgery the turtle remained positively buoyant but able to rest on the tank bottom for extended periods of time. The fiberglass cloth and fast-drying epoxy patch had begun to separate from the plastron and the underlying tissues treated using antibiotic-impregnated ointment and a water-resistant adhesive dressing. Appetite and defecation remained steady and no further clinical signs of gastrointestinal obstruction were observed.