HEALTH CARE
Treatment often involves direct replacement of the tissue back into normal anatomic position either by manual or
surgical means in combination with correction of the underlying etiology.
The patient should be fully evaluated for general health status and treated accordingly.
The prolapsed tissue should be evaluated for presence of devitalization, which must be surgically or medically addressed prior to prolapse reduction.
In severe oviductal prolapses, discussion with the owner about desired reproductive status should take place with a potential for coeliotomy and ovariosalpingectomy.
In some cases, the internal reproductive structures may be medically or surgically repaired; further reproductive events could result in dystocia.
The prolapse may be reduced in size by coating with a hyperosmotic solution such as 2–5% ophthalmic saline or concentrated sugar solution.
Direct application of dry salt or sugar may be attempted, but the extreme osmolar difference could lead to direct tissue damage and should be closely monitored.
After several minutes of application, the prolapsed tissue should become less edematous and capable of reduction back into the body cavity.
A moistened and lubricated (water soluble) cotton tip applicator or metal probe is used to gently push the tissue back inside the body cavity aligning the lumen.
Surgical options such as resection of the diseased tissue and double‐layer closure can be performed prior to tissue replacement.
In more extensive cases, a coeliotomy/ plastronotomy may be undertaken, with the tissue resection performed within the coelomic cavity where the tissue is in approximate “normal” anatomic position.
Colonic prolapses may require a colopexy where sutures are placed to facilitate the “tacking” of the colon to the dorsolateral body wall.
In cases of reproductive system prolapse (i.e., oviduct), the tissue may be replaced but damage to the suspensory ligaments and internal vasculature may be present.
A purse‐string suture around the cloaca or lateral sutures across the cloacal margin may be placed for 10–14 days to allow for the tissue swelling to resolve in place.
NUTRITIONAL SUPPORT
The reptilian patient may need weight and body condition monitoring to determine whether additional caloric supplementation is needed.
CLIENT EDUCATION/HUSBANDRY RECOMMENDATIONS
If surgical correction of the prolapse was undertaken, the client should be directed on postoperative care of any surgical sites, suture, etc.
A detailed log of activity, as well as food intake/defecations, should be maintained and related back to the veterinarian.
If any changes to the husbandry are determined, the owner should correct those prior to the patient returning home, such as changes to temperature and/or humidity, exposure UVB lighting, etc.
DRUG(S) OF CHOICE
NSAIDs or opioids may be used in management of the inflammation and pain associated with the physical discomfort of the prolapse or surgery.
Depending on the determined etiology, antibiotics or anti‐parasiticides may be indicated.
PRECAUTIONS/INTERACTIONS
When replacing the prolapse, extreme care must be taken not to tear or perforate the delicate, inflamed tissue.
After the sutures are removed, the tissue may re‐prolapse if swelling/inflammation are still present or the underlying etiology has not been corrected.
Placement of additional sutures may be required. Hydration status of the patent must be considered before use of NSAIDs.
PATIENT MONITORING
The patient should be followed up daily after clinical repair of the prolapse for reoccurrence.
The owner should monitor and record all food intake and defecations during this time.
Any abnormal changes should be related back to the veterinarian to determine any further changes to the therapy.
EXPECTED COURSE AND PROGNOSIS
Prolapses of the oviduct and bladder tend to have a guarded to grave prognosis due to the degree of underlying physical damage to the affected tissues and cloaca.
Rectal and cloacal prolapses tend to have a fair prognosis if treated promptly.
Phallus prolapses have excellent to good prognosis, as these are purely copulatory organs.
The length of time the prolapse presents has an inverse effect on the prognosis.
When treated early in the disease process and the tissue appears viable, cloacal prolapse replacement may lead to clinical resolution if the underlying etiology is addressed.
Once the tissue begins to desiccate and become devitalized, there is a guarded to grave prognosis.
COMMENTS
N/A
ZOONOTIC POTENTIAL
N/A
SYNONYMS
N/A
ABBREVIATIONS
CBC = complete blood count
NSAIDs = nonsteroidal anti‐inflammatory drugs
UVB = ultraviolet B
Suggested Reading
1 Barten,
