A 7-year-old Red Eared Slider was presented with a complaint of a protruding mass from the cloaca for 2 days. Physical examination revealed a prolapsed rectum from the cloacal opening. The turtle was sedated using Ketamine and Butorphanol (20mg/kg and 1 mg/kg)to perform the repair. The serosal tear was sutured using PDS 4-0 in a simple continuous pattern. The prolapsed rectum was irrigated with cold hypertonic dextrose (25D) for about 10 minutes to reduce the swelling and placed back into the cloaca A purse string suture was placed using PDS 4-0. The turtle recovered uneventfully from anesthesia and no recurrence was reported. Post-operatively, the turtle was treated with a single dose of Meloxicam at 0.3 mg/kg IM, Enrofloxacin at 15 mg/kg/day PO for 3 days, and Pyrantel Pamoate at 5mg/kg/day PO for 3 days. Oral calcium supplementation (Intacal®) was also advocated to treat any underlying hypocalcemia. (1 ml PO twice weekly)
Intraoperative photographs showing the serosal repair using PDS 4-0 and replacement of rectum into the cloaca
Prolapse is a common problem encountered in Turtles and Tortoises. Unlike what is seen in kittens, constipation is reported to be the main cause of rectal prolapse although diarrhea can cause a prolapse. Cloaca is a cavity that stores the urates and feces before it is expressed. It receives secretions and excretions from the gastrointestinal and urogenital systems. The cloaca per se isn't capable of prolapse as such, it's the components of the cloaca that gets prolapsed. So it is either the rectum that gets prolapsed or the genital organs (penis in males during copulation, uterus in females during egg-laying). While the prolapse of genital structures is completely physiological, prolapse of the rectum and large intestine is always pathological. The most commonly reported causes of prolapse are intestinal impaction, diarrhea, intestinal parasites, bladder stones, hypocalcemia, infection, and trauma.
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