Vet. World, 2012, Vol.5(8):489-492 CLINICAL Cystic calculi removal in African spurred Tortoise (Geochelone sulcata) using transplstron coeliotomy

The present report was carried out to manage a case of calculi in the bladder of African spurred tortoise. A 6 year old African spurred tortoise presented with history of anorexia and whitish discharged from the vent. Upon physical examination, the tortoise were 10% dehydrated, hindlegs muscle wasting and whitish materials came out from the vent. Plain radiograph revealed increased radiopacity in the bladder and also both right and left kidney. Contrast gastrointestinal radiograph showed less possibility of foreign body. Inconclusive radiological findings required the decision to proceed with exploratory transplastron coeliotomy by using dental burr. About 4 cm solid, hard whitish mass was removed from the bladder and both kidney was congested with whitish material. The findings were suggestive for urates crystal calculi based on histology result.


Introduction
such as pakchoy , cherry tomato and carrot.She was presented to University Veterinary Hospital (UVH), The term urinary calculi refers to any macroscopic Faculty of Veterinary Medicine, Universiti Putra precipitates, or polycrystalline concretions, found Malaysia with primary complaint of anorexia, anywhere in the urinary tract.Uroliths have been dehydration and present of whitish discharged coming reported in amphibians, lizards, turtles, and snake.The out from the vent.The tortoise also showed abnormal urolith is called cystic calculi or bladder stone when behavior of hiding behind the refrigerator and like to located in bladder [1].This is usually due to eat paper.On first day presented to UVH, she was accumulation of uric acid and no access to water given 9 ml warm saline subcutaneously and 3 ml source which lead to dehydration in tortoise [2,3].diluted nutrigel orally.Contrast study was done and According to Mader et al. [1], there are 100 reported radiograph was taken.On the second day hospitalized, cases of captive desert tortoise (Gopherus agasizii).she was given another 3 ml saline subcutaneously.Ninety-two of the cases were diagnosed during routine Another radiograph was taken,16 hours after contrast annual physical examinations.The calculi is usually study using iohexol.On day 3, surgery was done and an accidental finding upon physical examination in biopsy was taken .However, on day 1 post surgery , the reptiles because there is no specific signs shown by the tortoise had bradycardia and died.Post mortem was patient for this problem.Coeliotomy is defined as done on the same day and sample of kidney was sent surgical incision into abdominal cavity [4].for histology analysis.

Physical examination
removing cystic calculi and combined with cystotomy.
Upon presentation to UVH, the tortoise was dull,

Patient signalment and history
weak and depressed.The tortoise was also dehydrated Balbasor is a 6 year-old African spurred tortoise with 10% dehydration which can be assessed based on (Geochelone sulcata), female, weighing 0.45 kg.She the skin turgor [5].The tortoise also showed sign of was managed indoor and fed with green vegetable anorexia and sunken eye.Besides that, the tortoise also had sign of muscle wasting of both hind leg.There was coeliotomy surgery was made on the plastron using the whitish discharge observed at the vent.
burr (Figure -2).After the outline was made, the plastron was cut by following the outline.Size 20

Diagnostic workout and findings
scalpel blade was used to help in completely cutting Radiological findings: Plain radiograph was taken the plastron.Haemostat was used to open the the first day presented to UVH.The radiograph was plastron,once the plastron have been completely cut taken on ventral-dorsal view.On the ventro-dorsal according to the outline.Once the four incised site of view (Figure 1), there is increased radio opacity at the the plastron have been freed using the haemostat , the center of the coelomic cavity , around 4 cm in diameter plastron was raised carefully.Extra care was taken to which is suspected to be cystic calculi.Both right and separate the soft tissue attachment from the plastron.left kidney also shows increased radio opacity which After the plastron have been completely removed , the suspected due to accumulation of urate salt, and oval midline of the coelomic membrane was identified. in shape without clear outline located caudo-laterally.Using size 15 scalpel blade, the midline of the On the same day, contrast study was done.Five ml coeliomic membrane was then punctured.The iohexol was given orally and radiograph was taken at 1 membrane was held using tissue forcep and mayo minute, 10 minutes, 30 minutes, 1 hour and 16 hours.scissor was used to cut the membrane extended However, the finding was less likely suggestive for cranially and caudally.Once the coeliomic membrane any obstruction along the gastrointestinal tract based have been successfully cut , the coeliomic contents are on the clearance of the contrast media and the amount revealed.The ventral abdominal blood vessels are of contrast media left.A study have been done on identified and preserved This vessel running parallel Leopard tortoise (Testudo pardalis) which takes about to the midline in a cranio-caudal direction.After 5 to 9 hours for gastric to be emptied [6].
incision of the coelomic membrane , the organ were examined in-situ.Then the bladder was identified and Anaesthetic protocol: On the third day of hospitawas filled with solid mass.Then the bladder was pull lization (27.10.2011)exploratory transplastron using the hook.Cystotomy was done by cutting the coeliotomy was done.The tortoise was premedicated middle part of the bladder using mayo scissor.The with atropine 0.05 mg/kg and 0.03 ml of atropine was content of the bladder, around 4 cm in diameter was administered subcutaneously.She was induced using removed.Warm saline was flushed to clean up the isoflurane 4% with oxygen flow rate of 0.4 L/min by bladder inner side and to retain the moisture.Then, the mask induction.After induction, she was intubated bladder was closed using 3.0, vicryl, simple continuous with size 2, uncuffed endotracheal tude.She was suture pattern.After the bladder successfully sutured, maintained with isoflurane 1.5%, with oxygen flow it is placed back into the coelomic cavity.Then, rate of 0.4 L/min.Modified Jackson Rees, noncoeliomic membrane was closed using 3.0, Vicryl, rebreathing circuit was used in this surgery.
simple continuous suture patterns.The suture site was Surgical protocol (Exploratory transplastron examined.For closure, hole was made at each four coeliotomy): Using a high speed burr , the outline for incised site of the plastron using speed burr.Size 2.0,

Figure-3. Urates salt precipitation observed
Ethilon was placed into each hole and tighten using tortoise [7].It can occur in terrestrial chelonians fed surgeon's knot followed by square's knot.The surgical with high protein diet, water deprivation, inflamsite was sealed using sealent.The gauze was placed on mation of the bladder, a foreign body serves as a nidus around which urates accumulate to form one or more the plastron and wrapped using coban bandage.

Post-surgical medication:
Reptiles excrete their nitrogenous waste in form 1.
Meloxicam, 0.2mg/kg , SID, PO for 3 days of uric acid.Uric acid is water insoluble which means 2.
Enrofloxacin,10mg/kg ,SID , PO for 7 days less water will be used to removed it.This mechanism 3.
Multivitamin syrup, 0.3ml ,PO, BID for 2 weeks occur to prevent water loss in reptiles especially desert 4.
Nutrigel, diluted, PO, given as needed tortoise.This mechanism also is the main factor that Post-mortem findings: The tortoise died on day 1 lead to calculi formation in reptiles.The formation of post surgery and post mortem was done immediately.calculi begins from degradation of protein into nucleic The only abnormal finding was the kidney.The kidney acid.Nucleic acid in the diet are then degraded by was filled and congested with whitish material.nucleases to nucleotides.These nucleotides undergo Sample of kidney was taken and sent to histology further enzymatic hydrolysis to yield free purines and pyrimidine bases.Additional purines and pyrimidine laboratory for analysis.Histology findings were the bases are synthesized in the liver from amino acid.If area is composed of large lightly eosinophilic areas these free bases not reused by the body, they are further which is suggestive for urate crystal deposition and degraded and ultimately excreted.The pyrimidines are almost lost of tubules.However, the remaining tubules catabolized to end products CO2 and NH3.In reptiles, were atrophied.A biopsy from sediment removed purines will undergo further breakdown .Purine will from the bladder and the result revealed it was urate be degraded into adenine and guanine.Adenine will be salt (Figure -3).
converted to hypoxanthine and converted to xanthine Discussion by xanthine oxidase and eventually converted to uric acid by xanthine oxidase.Guanine is converted In this case the tortoise died most probably due to directly to xanthine and then become uric acid.Uric respiratory failure.Reptiles tend to breath-holding acid will be accumulated in the bladder and mixed when they are under anaesthesia.This mechanism lead with other cation such as potassium lead to urate to retention of anesthetic drug in the circulatory precipitation.Prolong accumulation of urate salt system.This causing the tortoise not fully recover finally lead to formation of calculi.The type of calculi from anesthetic effect after surgery.This eventually usually formed are potassium or calcium urates salt lead to further breath-holding which finally lead to [1].hypoxia which is most probable cause of death in this Plastrotomy is the most commonly treatment case.Because of the habit of breath holding in reptiles, because it provides access to the bladder.This invasive usage of anesthetic drug alone such as isoflurane procedure often associated with prolonged healing usually not successful in reptiles surgery.In this case, and rehabilitation.Non-invasive technique is the tortoise was pre medicated with atropine because removing urinary calculi via the vent with forceps of the muscle relaxing properties effect of the drug.This effect will help to avoid breath-holding which under sedation or anaesthesia.The limitation of this will prolong the induction time [1].During the method is include cases which the calculus is trapped surgery, intermittent positive pressure ventilation within the pelvic region or where the calculus can be (IPPV) was performed every 30 seconds.This is to visualized and directly palpated from the vent with help in breathing process of the tortoise.In reptiles, forceps [7].they generate negative pressure in the lung by There are few complications that can occur increase the size of coelomic cavity which is through following transplastron coeliotomy.One of it is poor movement of the pelvic, axillary limbs and muscles.healing of plastron.The plastron may not closed or Another way the reptiles generate negative pressure is healed if fissure between the flap is blocked by sealent through contraction of smooth muscle within the lung.due to non-union.The flap need to be in contact for During anesthesia, this movements are decreased and healing process to take place.There are possibility of IPPV need to be performed.Performing IPPV will also haemorrhage to happens.It is possible for shorten the recovery time from anesthesia.However, haemorrhage to occur due to accidentally cut the the mechanism is still not fully understood [3].
vessel associated with the visceral surgery such as the Calculi is common in some species namely African ventral abdominal blood vessel.This can be prevented spurred tortoise, spur-tighed tortoise and Russian by identifying the vessel and preserved the vessel.

Figure- 1 .
Figure-1.An increased opacity located at the centre of the coelomic cavity (Empty arrow) and in the kidney (Filled arrow).