A 2-year-old female pigeon (Columba livia domestica) was evaluated because of a 5-day history of lower than typical activity level, weight loss, and polyuria. No change in appetite was reported. The pigeon had been adopted by its owner approximately 1 year previously and was kept as a pet. It had produced 1 egg before adoption, according to its previous owner, and had since been producing eggs approximately every 2 to 3 months. Since adoption, the pigeon had sustained an injury of unknown origin to the left wing that prevented it from flying. It was kept with other pigeons in a room exclusively dedicated to them, which the owner cleaned daily. Items present in the room included wooden perches as well as water and food bowls.
On initial examination, the pigeon appeared alert and reactive when observed in the carrier. Formed excrement was noted that appeared to contain a greater than typical amount of urine. Body weight was 270 g (0.59 lb), and body condition was scored as 2.5/5 (3.5/5 is considered normal). Palpation of the crop revealed that the organ was almost empty, containing only a small amount of seeds. A moderate decrease was noted in the degree to which the left elbow joint could be extended, and this finding was considered likely related to the previous wing injury. All other results of physical examination were unremarkable.
To facilitate diagnostic imaging, the pigeon was anesthetized with 5% isofluranea delivered via face mask and intubated with a 3.0 uncuffed endotracheal tube. A blood sample was collected from a medial metatarsal vein and submitted for a CBC and plasma biochemical analysis. Results indicated mild increases in plasma calcium (4.73 mmol/L; reference interval, 2.0 to 2.6 mmol/L) and cholesterol (6.33 mmol/L; reference interval, ≤ 6 mmol/L) concentrations.
Whole-body lateral and ventrodorsal radiographs were obtained, revealing a 1.4-cm, linear, sharp metallic foreign object at the ventral aspect of the ventriculus (Figure 1). Within the ventriculus, numerous round mineral opacities were visible. A small metallic object was also noted close to the cloaca. The coelomic cavity appeared moderately distended with rounded soft tissue opacities ventral to the ventriculus, some of which contained central gas and small mineral opacities. These findings suggested a foreign body and grit in the ventriculus. At the mid-diaphysis of the left ulna, a malaligned transverse fracture bridged by a moderate amount of smooth new bone formation was visible. No other substantial abnormality was detected.
The bird recovered from anesthesia and was hospitalized. Sucralfateb (100 mg/kg [45 mg/lb], PO, q 12 h) was administered to treat any potential ventriculus ulcers or mucosal abrasions caused by the metallic foreign body.
The next day, fluoroscopyc was performed to further characterize the location of the metallic foreign body. For this procedure, the pigeon was placed in a cardboard box. and a lateral fluoroscopic examination was performed at 7.5 frames/s, with the pigeon standing. Findings confirmed that the metallic foreign body was associated with the ventral aspect of the ventriculus, and the ventral margin of the foreign body appeared to be within the coelomic cavity. The ventriculus contained multifocal, round mineral opacities consistent with grit, and the walls of the ventriculus were seen contracting dorsad to the linear foreign object. The dorsal aspect of the metallic object was sharp and extended to the level of the mineral opacities in the ventriculus. Given the fluoroscopic findings, the foreign body was deemed to be situated within and to pass through the ventral aspect of the ventriculus wall. The small metallic object that had been noted close to the cloaca was not visible anymore, and it was concluded that this object had been eliminated in the excrement. The gastric cycle frequency was approximately 4 cycles/min, and gastric motility appeared unremarkable.
The next day, the pigeon was sedated for additional imaging by administration of midazolam hydrochlorided (3 mg/kg [1.36 mg/lb], IM) and butorphanol tartratee (1.5 mg/kg [0.68 mg/lb], IM). A CT examination of the coelomic cavity was performed with a 16-slice helical scanner.f Images were acquired before and 2 to 5 seconds after administration of contrast medium (iopamidolg at 2 mL/kg [0.9 mL/lb], IV, over 2 seconds) through a catheter placed in the right metatarsal vein.1 The linear metallic-opacity structure was seen extending from the lumen of the ventriculus, through the ventral aspect of the ventriculus wall, and into the ventral part of the coelomic cavity (Figure 2). Surrounding the ventral aspect of the metallic structure was a round, 1.6-cm-diameter, well-circumscribed mass with a thin, contrast-enhanced wall and central, non–contrast-enhanced region. Multiple round, well-circumscribed, mineral-opaque structures were noted within the dependent portion of the ventriculus that were consistent with grit. Within the coelomic cavity, at the right lateral aspect of the ventriculus and within the caudal aspect of the coelomic cavity, medial to the spleen, 2 round, well-circumscribed nodules were noted. These nodules were predominantly of pure fluid opacity (0 Hounsfield units) and had a thin wall of soft tissue opacity. The CT findings were interpreted as confirming that the metallic foreign body had perforated the ventriculus; a structure compatible with a granuloma or abscess was adjacent to the ventriculus at the level of the perforation.
Celiotomy was planned to remove the foreign body. Because a small part of the metallic object was seen in the lumen of the ventriculus, blood zinc and lead testing was recommended to the owner to rule out heavy metal toxicosis. However, because the pigeon had no clinical sign compatible with that condition, and to limit costs, the owner declined the test. Prior to surgery, treatment with amoxicillin–clavulanic acidh (150 mg/kg [68.2 mg/lb], PO, q 12 h) was initiated.
In preparation for surgery, the pigeon was premedicated with midazolam (2 mg/kg, IM) and butorphanol (2 mg/kg, IM). Anesthetic induction was performed with 5% isoflurane administered via face mask, and intubation was performed with a 3-mm uncuffed endotracheal tube. A Doppler ultrasonic flow detector, ECG machine, microstream capnograph, pulse oximeter, and esophageal temperature probe were used for patient monitoring during anesthesia. A pressure-controlled ventilator was used to provide intermittent positive pressure ventilation. The pigeon was positioned in dorsal recumbency on a heating mat. A 26-gauge IV catheter was placed in the right ulnar vein, and a constant rate infusion of isotonic fluidi (10 mL/kg/h [4.5 mL/lb/h], IV) and butorphanol (1 mg/kg/h [0.45 mg/lb/h], IV, for pain management and to decrease the amount of isoflurane required) were administered.
A midline celiotomy was performed to allow easiest access to the foreign body and associated granuloma, as judged on assessment of the CT images. The feathers at the planned surgical site were plucked, and the skin was aseptically prepared. A skin incision was performed with a monopolar needle electrode connected to a radiosurgical unitj from the dorsal aspect of the keel to approximately 1 cm above the cloaca. The celiotomy was extended laterally under the ribs in a T shape. The abdominal muscles were incised in the same pattern with Harrison bent-tip bipolar radiosurgical forceps, allowing inspection of the ventral aspect of the hepatoperitoneal cavities dorsal to the keel. Because the ventriculus is situated completely within the intestinoperitoneal cavity, the intestinoperitoneal cavity was not penetrated.
The granuloma had caused the ventriculus to adhere to the keel, so blunt dissection was performed to detach the ventriculus from the ventral aspect of the keel bone and bring it closer to the surgical opening. A self-retaining rectractork was used to increase the size of the surgical field. Two stay sutures of 5–0 polydioxanone were placed on the ventriculus thick muscles to bring the ventriculus into view through the celiotomy incision (Figure 3). Moistened gauze was placed around the ventriculus to prevent spillage of its content into the peritoneal cavities. The granuloma was visible ventral to the ventriculus. It was difficult to distinguish the capsule of the granuloma from the healthy serosa of the ventriculus. Therefore, to conserve tissues for sealing the surgical opening, most of the capsule was left untouched. The granuloma content was debrided, and the necrotic tissues were removed as thoroughly as possible by use of a curette. A swab specimen was collected from the granuloma and submitted for aerobic bacterial culture and antimicrobial susceptibility testing.
The extremity of the foreign body was visible within the abscess, and the object was removed with a small hemostat. It was well embedded in the ventriculus wall, and considerable traction was necessary to extirpate it from the wound. After all necrotic tissues had been debrided, the inside of the capsule was gently flushed with warm sterile saline (0.9% NaCl) solution and continuous suction, and the capsule was closed with 5–0 polydioxanone in a simple interrupted pattern and oversewn with a single cruciate tension-relieving suture. Gloves and surgical instruments were changed, the abdominal muscle was closed with 5–0 polydioxanone in a simple continuous pattern, and the skin was sutured with the same suture material in an interrupted pattern.
The pigeon remained in stable condition throughout the whole procedure, and it recovered from anesthesia without complication. One dose of flumazenill (0.05 mg/kg [0.02 mg/lb]) was administered IM. The pigeon remained hospitalized in a temperature-controlled (28°C) incubator during recovery, and IV fluid administration (5 mL/kg/h [2.27 mL/lb/h]) as well as a constant rate infusion of butorphanol (1 mg/kg/h) were continued until the next day. In the evening on the day of surgery, the pigeon was force-fed a 30-mL/kg (13.6-mL/lb) dose of a hand-feeding baby parrot formula,m treatment with meloxicamn (1 mg/kg, PO, q 12 h) was initiated, and treatment with amoxicillin–clavulanic acid (150 mg/kg, PO, q 12 h) and sucralfate (100 mg/kg, PO, q 8 h) was continued.
The next day, the pigeon was transferred to a regular cage, and the catheter was removed. The pigeon was hospitalized for another 2 days, during which it was observed to eat normally, its body weight increased slightly, and no polyuria was noted. The owner was shown the foreign body, which looked like a nail, but could not determine where the pigeon could have ingested it.
The pigeon was sent home with the previously mentioned doses of amoxicillin–clavulanic acid, meloxicam, and sucralfate to be administered for 10 days, 5 days, and 10 days, respectively. The owner was also instructed to feed the pigeon its regular food, and a recommendation was made to screen the pigeon's environment again for potentially hazardous objects and clean it on a regular basis.
One week later, the pigeon was brought back for a recheck evaluation. The owner reported that it had been doing well at home. Body weight at this point was 265 g (0.58 lb), and body condition was similar to that at initial evaluation. The surgical wound appeared clean and almost healed over. All other physical examination findings were unremarkable. Results of aerobic bacterial culture for the swab specimen obtained during surgery indicated no growth.
At a recheck examination 3 months later, the pigeon remained apparently healthy, and its appetite and excrement were unremarkable. The pigeon had been producing eggs on a regular basis. Results of a CBC and plasma biochemical analysis performed at this time were unremarkable. The pigeon was reevaluated 1 year after surgery, at which point it remained apparently healthy. It died suddenly at home 1 year and 9 months after surgery, after which a postmortem examination was performed.
Gross findings on postmortem examination included mild accumulation of white material over the serosal surface of the right lobe of the liver and the right lateral surface of the apex of the heart, but no other visible lesions. Neither the surgical site nor the granuloma debrided during the surgery could be identified, and the ventriculus had an unremarkable appearance. Histologic examination revealed multifocal granulomatous and necrotizing lesions within tissues from the liver, ventriculus, spleen, and coelomic cavity. Mild myositis of the ventriculus with edema was noted. Necrotizing vasculitis was also identified in tissues from the spleen, liver, and level of the carotid artery.
Bacterial culture of liver specimens yielded a Salmonella strain susceptible to amoxicillin–clavulanic acid, ampicillin, ceftazidime, doxycycline, florfenicol, and trimethoprim-sulfamethoxazole and resistant to enrofloxacin, amikacin, cefoxitin, and cephalothin. The histologic presence of the inflammatory infiltrate targeting the centrilobular hepatic veins, large veins in the spleen, and carotid arteries supported hematogenous spread of the pathogen. Bacterial septicemia due to Salmonella infection was therefore the suspected cause of death. No lesion associated with the surgery performed on the ventriculus could be identified.
Presented in abstract form at the International Conference on Avian, Reptile, and Exotic Pet Medicine, Paris, April 2015.
Isoflurane, Fresenius Kabi, Richmond Hill, ON, Canada.
Sucralfate, Novopharm, Toronto, ON, Canada.
Philips BV Endura C-Arm fluoroscopy unit, Philips Medical Systems, Bothell, Wash.
Midazolam, Sandoz, Boucherville, QC, Canada.
Torbugesic, Wyeth, Markham, ON, Canada.
GE Bright Speed, General Electric Healthcare, Milwaukee, Wis.
Isovue-370, Bracco Diagnostics, Princeton, NJ.
Clavamox, Zoetis, Kirkland, QC, Canada.
Plasmalyte-A, Baxter, Mississauga, ON, Canada.
Ellman International Inc, Hicksville, NY.
Lone Star, Coopersurgical, Trumbull, Conn.
Anexate, Hoffman La-Roche, Mississauga, ON, Canada
Tropican hand feeding formula, Hagen, Baie d'Urfé, QC, Canada.
Metacam, Boehringer Ingelheim, Burlington, ON, Canada.
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