VCBE Case of the Month

Birds can get hernias, too
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Snowball, a 36-year-old female lesser sulfur crested cockatoo, was referred by another veterinarian to the Veterinary Center because of a large soft swelling adjacent to her vent (the common opening for the colon, urinary tract and reproductive tracts).  She was also eating much less than usual and had lost a great deal of weight.  Based on appearance and location of the swelling, the veterinarians at the Veterinary Center suspected a hernia (see picture with arrow pointing to swelling).  An intestinal hernia is a protrusion of an organ through a hole that develops in a weak layer of the body wall, so that the organ ends up outside the belly but underneath the skin.  With gentle pressure on Snowball’s swelling, the veterinarians were able to reduce (or gently push) the hernia’s contents back into the belly where they belong.  Many different structures can be located within a hernia including: intestines, reproductive tract, an egg, or other organs.  Snowball also had very malodorous stool that the doctors suspected was the result of the hernia interfering with the normal passage of food through her intestines, allowing excessive numbers of bacteria to grow in her intestinal tract.

Snowball had also been laying eggs.  Female parrots can lay infertile eggs on their own, without a male bird, just as chickens lay the eggs you buy in the supermarket.  If a female bird has increased estrogen levels as a result of prolonged, repeated egg-laying, this high estrogen level can weaken muscles of the body wall.  If the bird then strains to pass an egg, the weakening of the body wall muscles can then develop into a hole in the body wall – a hernia.

The doctors drew Snowball’s blood for routine testing, which showed Snowball had an increased blood calcium level.  This often occurs in female parrots that are reproductively active, as they move large amounts of calcium from their bones into their blood to form egg shells.  The doctors also examined a stool sample from Snowball under the microscope which showed an overgrowth of abnormal bacteria.  They submitted the stool sample to a laboratory for a culture to determine the type of abnormal bacteria and the best antibiotic to treat it. They then gave Snowball an injection of Lupron hormone to temporarily shut down the reproductive system.  The vets administered this injection to prevent further egg-laying which could lead to a potentially life-threatening condition if the hernia enlarged and entrapped abdominal organs (such as intestines) inside it.  The doctors then started Snowball on a broad-spectrum antibiotic and sent her owner home with a syringe feeding formula to assist feed her to help her gain some weight back.  The doctors discussed with Snowball’s owner that surgery would be needed to repair the hernia.  However, first Snowball needed to get stronger through a combination of antibiotics and syringe feeding.  Also, Snowball would need to have x-rays taken first, so the doctors could get as much information as possible about the contents of the hernia before they attempted to repair it.

Snowball came back a few days later for a barium x-ray study.  First, the doctors took plain x-rays (without barium contrast) of Snowball which demonstrated air within the hernia.  The presence of air increased their suspicion that the hernia contained loops of intestines, as intestines frequently normally contain air.  Then the doctors started the barium imaging study by administering a liquid contrast material through a tube they passed into the bird’s crop (an outpouching of the esophagus in the neck).  As the contrast material makes its way down through the stomach and intestines, a series of x-rays are taken. The contrast material appears bright white on the x-ray, thereby outlining the gastrointestinal tract. Compared with a regular x-ray, this barium x-ray series allows the doctors to make a more detailed interpretation of intestinal abnormalities. The barium x-rays showed that the passage of barium through Snowball’s intestines was much slower than normal.  Typically, barium passes through a bird’s entire intestinal tract within 3 hours; however, in Snowball’s case, the barium still hadn’t started to pass all the way though her intestinal tract even after 6.5 hours. The barium study confirmed that the swelling was a hernia containing intestines and that the intestinal infection was likely secondary to the delayed passage of food through the gastrointestinal tract due to entrapment of intestines in the hernia.

Surgery was scheduled shortly afterwards.  Snowball was dropped off early in the morning.  The doctors gave her both an injection of a sedative and a pain medication, as well as an antibiotic.  They placed a breathing tube in her trachea and connected it to the anesthesia machine.  They then placed an intraosseous (in the bone) catheter in Snowball’s ulna (in her upper wing), so that fluids could be delivered during surgery.  An intraosseous catheter serves essentially the same function as an intravenous (in the vein) catheter, except it can be easier to place in small exotic patients that have very tiny veins.

Once Snowball was completely anesthetized, the veterinary technicians prepped the hernia site for surgery (feathers were removed, and the skin was cleaned and sterilized with disinfectant).  The doctors reduced the hernia (compressed the hernia gently to place the intestines back inside the body wall) and then removed excess stretched out skin that had formed over the hernia.  They then sutured (placed stitches) in the in the hole in the body wall to close it and sutured the skin closed over the repaired hernia.

Snowball recovered well from anesthesia and returned home.  When she came in for a follow-up examination 1 week after surgery, her incision was healing well.  Her stool no longer smelled, she had started regaining weight, and she was back to her normal self.

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