VCBE Case of the Month

     Jade, a 3-year-old female leopard gecko, first presented to the Veterinary Center with a 1-2 week history of what the owner presumed to be constipation.  On physical exam, she had a very large and distended abdomen, but was bright and alert.  X-rays showed an enlarged structure within her abdomen but no discrete masses, foreign objects, urinary tract stones, or eggs.  Dr. Hess and Dr. Ravich ran blood tests which were normal.  Jade returned for an abdominal ultrasound (belly sonogram) the following day.  Approximately 5 round to oval structures were present throughout her abdomen, which were suspected to be developing follicles (early eggs) on her ovary.  As leopard gecko eggs take about 3-4 weeks to develop prior to being laid, and Jade’s condition was stable, the doctors started her on an oral calcium supplement, and they recommended also providing her with a moist/humid hiding spot in which she could lay her eggs.
     Over the next few weeks, Jade’s appetite continued to wax and wane. The doctors repeated her ultrasound examination and saw one large circular mass in her mid-abdomen.  Using the ultrasound image to help guide the needle, they aspirated (took a sample using a small needle) of the mass.  The aspirated material was thick and white.  It was placed on slides and submitted to a lab for a pathologist to analyze (a test called cytology).  The analysis did not show any cancer cells, inflammatory cells or bacteria, and the pathologist thought it was likely made up of egg protein, suggesting that the mass in Jade’s belly was an egg.  Dr. Hess and Dr. Ravich discussed that surgery might be necessary if Jade had a large egg that she couldn’t pass on her own (a condition known as egg binding).  Jade’s owner was sent home with a syringe feeding supplement for carnivores like this gecko so her owner could supplement her if she wasn’t eating well.
     Jade became more active and her appetite increased.  On a recheck exam, the doctors noticed that her abdomen did not appear as distended.  However, a repeat ultrasound exam showed that a large (1.6cm) circular mass was still present in her abdomen (see image).  As this mass was likely an egg, based on the previous analysis, and this problem had been present for at least 2 months, the doctors diagnosed Jade with egg binding.  As Jade’s condition appeared improved and she was bright and alert, Dr. Hess and Dr. Ravich elected to treat her conservatively, since, at that point, surgery carried more potential risk than benefit.  Jade was started on an oral antibiotic and an anti-inflammatory medication.
     Jade was brought back to the Veterinary Center 3 weeks later when she started acting more lethargic and quiet, with little interest in food.  Her owner had been diligently soaking her to keep her hydrated, as well as giving her the medications.  As Jade’s condition had declined, at this point, Dr. Hess and Dr. Ravich recommended proceeding with surgery.
     Surgery was scheduled for that afternoon.  Jade was sedated and intubated (a breathing tube was placed in her trachea) by the Veterinary Center technicians to make anesthesia as safe as possible.  She was given injections of pain medication, an antibiotic, and supplemental fluids under her skin.  Her heart rate was monitored with a machine called a Doppler that actually allows the doctors and technicians to hear every heart beat during surgery, and she was positioned on a heating pad.  Lizards have a blood vessel that runs down the middle of their belly, under their skin, so the doctors made their skin incision just to the right of midline.  There was some unusual free fluid in the abdomen, which can occur secondary to inflammation; however, a culture of the fluid was taken just in case it was due to bacterial infection. The doctors located the right ovary and noted that it was approximately 10 times the normal size, irregular, and discolored.  They surgically removed the right ovary and oviduct.  The doctors also removed the left ovary which was normal size (a few millimeters long).  The right ovary was submitted for analysis by a pathologist. Jade recovered from surgery uneventfully and was up and about that evening.
     The pathologist determined that the ovaries were normal but that the right one was unusually large; Jade may not have been able to pass it simply because of its size. Despite her owner’s diligent attempts to make her rest after surgery, Jade felt so well that she actually rubbed open part of her incision, so the doctors had to suture it closed again and placed a bandage over it. After several weeks of confinement, Jade’s incision finally closed (reptile skin can be very slow to heal), and now she is doing just fine!
 

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