Use of a standard operative laparoscope for ventriculus foreign body removal in a Toco Toucan (Ramphastos toco)

ABSTRACT

Background: Cases of ventricular foreign bodies are common in some species of birds. Moreover, ventricular impactions may develop depending on the type of the material ingested. The diagnosis is based on physical examination, radiography, endoscopy and surgical exploration. The choice of the treatment basically depends on the nature of the foreign body. Endoscopy is a less invasive approach that can be used in some situations, in some species. The benefits of endoscopic approaches are wide, as traditional approaches are more invasive and inflict a higher postoperative morbidity and mortality. However, the correct endoscope technique never been described. This study reports a case of a foreign body in a toucan's ventriculus, removed using a standard operative laparoscope/nephroscope. Case A young Toco Toucan (Ramphastos toco) was referred to the Veterinary Hospital (São Paulo State University - FCAV/UNESP) by the State Environmental Guard. Survey radiographs indicated a foreign body in the ventriculus. The physical exam revealed apathy, but the bird was responsive to handling. The patient was pinioned. Based on the size of the foreign body, the endoscope retrieval was the first treatment option. The patient was fasted for 6 hours and anesthetized with isoflurane. The rigid endoscope/laparoscope with working channel was carefully passed through the esophagus, into the ventriculus. This view was impaired by a large amount of fibrin and gastroesophageal mucus, which was rinsed with normal saline and aspirated through the operating channel. There was marked hyperemia on the ventriculus mucosa and a large amount of fibrin and gastroesophageal mucus. The foreign body was retrieved using a standard 10-mm 0° rigid laparoscope/nephroscope with working channel, and a 42 cm long, 5-mm atraumatic laparoscopic Babcock forceps by gentile traction and axial rotation. The overall intervention time was 24 min, since mask induction until foreign body retrieve. The patient recovered with no complications in the early postoperative period and convalesced completely and uneventfully following 2 days. Discussion: The operative rigid endoscope allowed for both visualization of the oral cavity, esophagus, proventriculus and ventriculus and foreign body removal, through the working channel, demonstrating the potential benefits and feasibility of such approach in birds. Nevertheless, up to date, endoscopy have been used in toucans only for sex determination. The current report demonstrated the effectiveness of endoscopy in order to avoid the risk of death due to a surgical approach. Gastrointestinal foreign bodies are common indication for endoscopic approach. If the foreign body is present in the crop, it is easily removed with the use of an endoscope and grasper forceps, or by ingluviotomy. Even though the foreign body passes into the proventriculus or ventriculus, rigid endoscopy may still be the best treatment option. The 30º Trendelenburg positioning was crucial for the complete success of the procedure, not only for avoiding the risk of fluid aspiration, but also for improving the access to the ventriculus.