47

CLOACAL PROLAPSE
R. AVERY BENNETT and
DOUGLAS R. MADER

ANATOMY (Figure 47-4, B) (see also Figure 47-7, A). With an oviductal
prolapse, the prolapsed structure has a lumen but no feces
Three compartments are located within the cloaca (see are identified. Although this structure also has a lumen,
Figure 11-1). The coprodeum is the most cranial and is located longitudinal striations are present on the surface that are
where the rectum enters the cloaca. Fecal and urinary waste not present on the colon (Figure 47-5).
from the terminal colon is deposited into this chamber. The
urodeum is in the midsection of the cloaca and contains
Copulatory Organ Prolapse
the openings of the ureters and the reproductive system. The
proctodeum is the caudal-most portion of the cloaca and Prolapse of the penis or hemipenis is most commonly the
serves as the reservoir for fecal and urinary waste before result of infection, swelling from sex determination probing,
excretion. The openings of the musk glands are located or forced separation during copulation. Other reported
within this compartment. causes include constipation and neurologic dysfunction.2,3
When an organ prolapses, it is not always easy to identify, The protruding tissue should be cleaned, lubricated, and
especially for the lay person. Prolapses should always be gently replaced into the cloaca. Frequently, a moistened
considered and treated as an emergency. When a client calls cotton-tipped applicator is helpful in reducing the prolapse.
and claims that the herp pet has “something coming out of its
rear end,” instruct them to bring the animal in right away.
Have them protect the tissue from further damage by wrap-
ping the cloacal area with a clean damp facial cloth, diaper, or
some other cotton fabric (Figure 47-1). Paper and tape that
could potentially damage the tissue should be avoided. Also
tell the owner not to try and reduce the prolapse because fur-
ther damage may occur or current injuries may be hidden.

CLOACAL ORGAN PROLAPSE

In reptiles, the distal gastrointestinal tract, the urinary bladder,

the penis (chelonians, crocodilians) or hemipenes (all other
reptiles) of males, and the oviduct of females may prolapse
through the cloaca and out through the vent. Cloacal organ
prolapse is generally the result of an excessive amount of A
straining from some inciting cause. For example, enteritis
may result in excessive straining and prolapse of the colon.
Identification of the underlying cause for the prolapse, in
addition to treatment of the prolapse itself, is important. For
example, in a female California Desert Tortoise (Gopherus
agassizii), prolapse of the reproductive tract was the result of a
cystic urinary calculus.1
Which organ has prolapsed must be determined before
a treatment plan is decided on. The urinary bladder is thin
walled and translucent (Figure 47-2). Coelomic fluid may col-
lect within the everted bladder, giving the impression of a
“urine”-filled, albeit exteriorized, bladder. A penis or hemipe-
nis prolapse presents as a solid tissue mass protruding from
the vent (Figure 47-3) (see also Chapter 64). These structures B
have no lumen (but a central “groove” or “sulcus” may be
present) and are therefore unique. With a prolapse of the FIGURE 47-1 A, This Yellow-headed Red-Footed Tortoise
(Geochelone carbonara) has a prolapsed oviduct. B, The emergency
colon, a lumen should be present (Figure 47-4, A). The surface
veterinarian wrapped the tissue in saline solution–soaked gauze and
is generally smooth, and in many cases, fecal material can be then taped the tissue into a makeshift “diaper” to protect the tissue
obtained through the lumen, either passed directly or with until the patient could be seen by a specialist. (Photographs courtesy
aspiration through a small catheter inserted into the lumen D. Mader.)

751
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752 Section VII SPECIFIC DISEASES AND CLINICAL CONDITIONS

A A

B
B
FIGURE 47-4 Prolapsed colon in, A, a juvenile Anaconda (Eunectes
FIGURE 47-2 Prolapsed bladder in a tortoise (A) and a frog (B). sp.) and, B, Desert Tortoise (Gopherus agassizii). The tissue is smooth
Note the fluid-filled, thin-walled, membranous urinary bladder. The and shiny and may be gas filled. Feces can often be found within
fluid is not urine. It is coelomic fluid that has been trapped within the the lumen of the prolapsed organ. (Photographs courtesy D. Mader.)
everted structure. (Photographs courtesy D. Mader.)

opening, allowing the swollen gland to be reduced. Once the

organ is replaced, a purse-string or transverse cloacal suture
may be placed to prevent the organ from prolapsing again
(see Chapter 64 for details). The transverse cloacal suture
provides the advantage of allowing normal urination and
defecation.
If the tissue is badly damaged, severely swollen, or
necrotic, amputation may be performed. Because the urinary
system does not pass through the penis or hemipenes, no
disruption is seen in the flow of urine. Mattress sutures are
placed at the base of the prolapsed organ to control hem-
orrhage, and the tissues are transected distal to the sutures.
The stump may then be replaced within the cloaca. In those
species with hemipenes, if one organ is amputated, the
animal is still considered fertile because the opposite side
FIGURE 47-3 An engorged prolapsed penis in a tortoise. This should still be functional.3
reproductive organ is so swollen that it cannot be replaced. A small
incision can be made in the lateral cloacal wall to help reduce the
tissue. Compare this prolapse with the images in Chapter 64.
Prolapse of the Oviduct
(Photograph courtesy D. Mader.) Females may have the oviduct prolapse as a result of egg
binding or other conditions that cause tenesmus. In some
cases, reduction of the prolapse may be possible; however, the
Glycerin or concentrated sugar solutions may be helpful in suspensory structures likely have been damaged. This affects
decreasing the tissue edema if the organ is significantly the ability of the oviduct to receive yolks ovulated from the
enlarged. ovary in the future. Amputation of the exposed and damaged
If the prolapse cannot be manually reduced, the vent tissue has been performed in some cases.4 In most cases,
opening may be enlarged with incision of the vent laterally celiotomy for removal of the affected portion of the reproduc-
on one or both sides (see Figure 47-3). This enlarges the vent tive tract and its accompanying ovary is recommended.
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Cloacal Prolapse 753

A
A

FIGURE 47-5 A, The shell gland or oviduct is fleshy and striated.

B, Both the oviducts (purple tissue) and colon (red tissue) prolapsed in
this Desert Tortoise (Gopherus agassizii). (Photographs courtesy D. Mader.)
B
FIGURE 47-6 A, A chronically prolapsed, and now traumatized,
urinary bladder in a Desert Tortoise (Gopherus agassizii). Note that one
lobe of the bladder is necrotic. B, The same tortoise as in Figure 47-6,
A. A ventral celiotomy has been performed to allow enough access to
Female reptiles have a bicornuate reproductive system
properly excise the diseased tissue. Captive animals can handle subto-
and two ovaries. Through celiotomy, if one side of the tal cystectomies provided they are allowed continuous access to fresh
reproductive tract is involved, the oviduct, and the ovary on water. (Photographs courtesy D. Mader.)
the affected side may be removed. With the contralateral side
left intact, the patient is still be able to reproduce. In reptiles
in which reproduction is not a concern, bilateral ovariohys-
terectomy should be performed to prevent future occurrence urinary system, and if possible, an attempt should be made to
of this condition or other reproductive tract–related abnor- salvage as much of the viable bladder tissue as possible.
malities (see Chapter 35 for surgical procedures).
Colon Prolapse
Urinary Bladder Prolapse
Prolapse of the colon is generally the result of tenesmus.
In most cases prolapse of the urinary bladder is the result of Constipation, bacterial enteritis, and parasitic enteritis have
cystitis, often associated with cystic calculi (see Chapter 49). been implicated. Constipation may result from environmen-
Because the ureters empty into the urodeum and do not have tal factors, such as an enclosure that is excessively small and
a direct connection to the urinary bladder, they are seldom inhibits sufficient exercise to stimulate normal defecation.
affected or damaged in a simple prolapse of the bladder. Determination of the cause of tenesmus and treatment of
If a small portion of the urinary bladder is prolapsed, it this in conjunction with management of the prolapse are
may be successfully reduced with the previously described important.
techniques. If the exposed tissue appears to be nonviable, it In the acute phase, the prolapsed tissue is easily reduced
needs to be resected (Figure 47-6, A). An atraumatic clamp and can be managed with either purse-string or transverse
may be placed across the viable section of tissue, allowing the cloacal sutures. The venous return from the prolapsed
nonviable tissue to be removed distal to the clamp. A double- colon is frequently compromised, resulting in rapid engorge-
layer inverting closure is then placed distal to the clamp, seal- ment of the tissue. The tissue becomes edematous and
ing the urinary bladder. The remainder is then replaced friable. This type of prolapse is often difficult or impossible
through the cloaca and into the coelomic cavity. If a large por- to reduce. In such cases, a celiotomy allows for traction to
tion of the bladder is damaged, a celiotomy may be per- be applied to the colon and for external pulsion, resulting in
formed for better exposure and excision of the diseased tissue reduction of the prolapse. In addition, through a celiotomy
(Figure 47-6, B). One must keep in mind that the bladder does approach, a colopexy may be performed to prevent recurrence
participate in water and electrolyte reabsorption from the of the prolapse (see Chapter 35 for surgical procedures).
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754 Section VII SPECIFIC DISEASES AND CLINICAL CONDITIONS

A B

C D

E F
FIGURE 47-7 A, Prolapsed colon in a Green Iguana (Iguana iguana). B, A syringe case is lubricated and placed into
the prolapsed lumen. The tissue is cross-pinned through the viable areas. C, The necrotic portion is excised. D and
E, The remaining two layers are then anastomosed with a monofilament, synthetic, absorbable suture material.
F, The dead tissue and syringe case are then removed, allowing the healthy tissue to retract back into the coelomic
cavity. (Photographs courtesy D. Mader.)
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Cloacal Prolapse 755

If the primary cause of tenesmus is identified and treated, these mattress sutures have been placed circumferentially,
creation of permanent adhesions between the colon and the the tissue may be transected distal to the sutures. When the
body wall is not necessary. However, during the treatment exposed tissue is returned to the coelomic cavity, an inverting
period, internal suturing of the colon is beneficial so that it end-to-end intestinal anastomosis is created. Alternatively, a
will not prolapse. The coloplexy should be performed in an resection and anastomosis may be performed through a
area of healthy viable colon tissue.5 In this location, sutures celiotomy with standard techniques.
are placed between the colon and the body wall. A small
atraumatic needle should be used to minimize the amount of
colon contents that leak through the suture tracks. REFERENCES
Alternatively, the colon may be incorporated into the body
wall closure, thus immobilizing the colon. With this tech- 1. Bennett RA: Uterine prolapse caused by cystic calculus in
nique, the suture is passed through one side of the body wall, a California desert tortoise (Gopherus agassizii), Orlando,
through the colon, then through the other side of the body Fla, 1993, Proceedings of the North American Veterinary
wall, and tied. This technique is used along the length of the Conference.
2. Rosskoph WJ, Woerpel RW, Pitts BJ: Paraphimosis in a
body wall incision.
California desert tortoise, Calif Vet 36(1):29, 1982.
In cases of colon prolapse in which the exposed tissue is 3. Frye FL: Biomedical and surgical aspects of captive reptile
devitalized, a resection and anastomosis can be performed.6 husbandry, Edwardsville, Kan, 1981, Veterinary Medicine
This may be performed without celiotomy with insertion of Publishing.
a smooth, tubular object into the lumen of the colon (Figure 4. Frye FL: Clinical obstetric and gynecological disorders in
47-7). In many patients, a thermometer or clean syringe case is reptiles, Proc AAHA 41:497, 1974.
of an appropriate size to provide support to the lumen. 5. Bodri MS, Sadanaga KK: Circumcostal cloacapexy in
Mattress sutures are placed from the external surface toward a python, JAVMA 198:297, 1991.
the thermometer or stent, bouncing off the stent and exiting to 6. Leash AM: Amputation of a prolapsed rectum in an African
the external surface. These sutures are placed circumferentially rock python, J Am Vet Med Assoc 171:980, 1977.
around the tubular colon in a healthy portion of tissue. Once