原文轉載自Long Beach Animal
Tortoise Bladder Stone
One of the more interesting
surgeries we perform is the removal of a bladder stone from
California Desert Tortoises. Some of these stones grow to tremendous
size, and it is a wonder that these animals can survive with such a
There are no specific symptoms
that tell us a tortoise has a bladder stone, some of them don't show
any symptoms at all. The more common symptoms are nasal discharge,
poor appetite, and lethargy. Some of these stones are diagnosed as
incidental findings when we take an x-ray or perform an exam for an
unrelated problem. The tremendous size of some of the stones
indicates they may have been present for years before being
diagnosed. Anybody that has ever had a kidney stone can sympathize
with what these animals feel like with such large stones.
There are two methods utilized to
diagnose bladder stones. During an examination we can sometimes
palpate a stone by gently rolling the tortoise back and forth while
we feel in the soft spot by its rear leg.
To perform the palpation
technique you need to understand tortoise anatomy and be
experienced at palpation.
Not every stone can be
found on palpation. The other method to make a diagnosis,
and usually more reliable method, is to take an x-ray. Even
though the stone in this x-ray is large, this is not an
unusual finding. Some of the stones are so large that we
have to break them into pieces to get them out of the
opening in the shell.
The usual treatment for a bladder
stone in tortoises is to perform surgery. In this surgery we
literally cut a hole in the bottom of the shell and remove the stone
from the bladder. Most tortoises do fine postoperatively, and after
a few days in the hospital and a few weeks of recuperation at home,
they are back to normal.
Prior to surgery our patient is
prepared to minimize anesthetic risk. In some patients we place a
to insure adequate hydration and nutrition, both before and after
the surgery. In other patients we insert an
(IV) to maintain blood pressure during surgery.
This tortoise has an IV
catheter in its jugulare vein. We use this vein because it is
relatively easy to insert the catheter and it is large enough
to take the volume of fluid we need to give.
After the tortoise is
the bottom of the shell (called the plastron) is cleansed
thoroughly. This may take several scrubbings with the use of a
gentle brush to get clean enough for surgery. The black
rectangle outlines where the shell will eventually be cut to
gain access to the bladder.
As in any surgery we perform controlling
infection is critical. We use a specific draping technique to
minimize the chance of infection. Infection is especially
critical in this surgery because once the cut piece of shell
is resealed to the bottom of the shell, an infection can
fester on the inside without our knowing about it.
The rest of the surgical
team is preparing at the same time. These assistants are
students in our
They will be assisting the surgeon with flushing and
suctioning of fluids, along with the administration of
Dr. Ridgeway starts his cut
with his safety glasses on to protect him from particles
brought on by the drill used to cut into the shell.
A sterilized dremel is used
to cut through the shell. The blade spins at a high speed so
sterile water needs to be constantly applied to the cut
surface to minimize burning. The blade cuts at an angle
facilitating replacement of the shell when the surgery is
complete. If this angled cut is not made, the shell will just
fall back into the abdominal cavity (it is called the coelomic
cavity in a reptile) and the incision site will never heal.
When the shell has been cut
in a rectangular piece it is gently pried up with an
instrument called an elevator. There are muscular attachments
that are gently separated from the shell to allow the shell to
become completely free. The cut shell is living tissue and
needs careful handling. After it is removed it is kept moist
with sterile saline until it is replaced at the end of the
The next layer encountered
is the lining of the coelomic cavity. It is gently cut to give
full exposure to the organs in the cavity. The reddish areas
are the muscular attachments to the piece of shell that was
Internal organs can be
visualized easily through this large opening. These are loops
The bladder is gently exteriorized through
the hole in the shell. Dr. Ridgeway has made an incision into
the bladder and the stone is starting to bulge out.
Here is the culprit as it is being removed from
The bladder is usually filled with a sludge
like material. If the sludge is not removed healing will be
delayed and the potential for recurrence of the stone
increases. The larger clumps of sludge are removed with a
special instrument called an angle spoon. This high tech
instrument is made special in our lab by taking a regular
tablespoon and bending it.
The smaller pieces are suctioned after the
bladder has been flushed. This usually takes many flushings
with sterile saline. Only when the bladder has been thoroughly
flushed is it sutured back together.
A special suture material is used to close
the opening in the bladder. This suture is very strong yet
causes minimal tissue reaction, and will slowly dissolve over
The coelomic cavity is also flushed
copiously with warm sterile saline, then the fluid is
suctioned out. This process helps prevent an infection and
aids in the healing process. If an infection is sealed into
the coelomic cavity the outcome could be catastrophic.
The incision made in the tissue lining the
cavity is sutured next, using the same type of suture material
as the bladder. The muscular attachments to the cut piece of
shell will gradually reestablish themselves to the underside
of the cut piece.
While all of this was going on the piece of
shell that was removed at the beginning of the surgery was
kept moist by wrapping it with sterile gauze soaked with
saline. Doctor R is removing the gauze before putting the cut
piece of shell back in place.
Now the fun of putting the shell back
together begins. The previously removed piece of shell is put
back into position and a piece of fiberglass is measured and
cut so that it just covers the cut piece of shell.
A special quick drying epoxy is poured on
the shell. Once this epoxy hardens it can not be removed or
reshaped, so we have to move fast.
It is spread evenly over the cut piece by
two assistants. When it gets tacky we are ready for the next
The fiberglass piece is placed over the
sticky epoxy and another layer of epoxy is poured over the
fiberglass and rapidly smoothed over the fiberglass.
The epoxy becomes firm within a few
minutes. During this time it is important that the tortoise
does not wake up or breathe deeply because the pressure in the
lungs will push the patch out.
Cellophane is put over the patch as it
dries for cleanliness and protection purposes
Here is our friend just waking up from
anesthesia. At this point we will give her a
and place her in a special room that maintains a temperature
of 85 degrees. She will stay in the hospital for a few days
until she is eating and active.
1. 生長停滯. 2.