Chronic Intermittent Esophageal Prolapse in a Red-Eared Slider (Trachemys scripta elegans)
A 48-yr-old female red-eared slider (Trachemys scripta elegans) presented for a chronically swollen neck and tongue with variable severity of about 6–8 months duration, and tongue swelling for approximately 20 yr. Physical examination revealed an ulcerated, erythematous tongue and an irregular mass in the caudal oropharyngeal region. The hyoid region was markedly enlarged. Initial diagnostics included complete blood count (CBC), plasma chemistry, cytology, and serial computed tomography (CT) scans. The CBC showed signs of basophilia and a regenerative response suggestive of prior anemia. The CT revealed an ill-defined thickening of the tongue base and pulmonary changes consistent with pneumonia. Chelonian herpesvirus PCR was negative. The patient was started on antibiotics and other medications without resolution of signs. Endoscopic evaluation revealed a prolapsed esophagus. A biopsy was taken with subsequent histologic analysis that revealed an ulcerative esophagitis with a fibrovascular polyp. Chronic trauma from the prolapse was the likely cause of these changes. The patient initially did well, but eventually declined and was euthanized after several months.Abstract
Gross antemortem images of red-eared slider (Trachemys scripta elegans) with ventral cervical mass effect (A), extraoral protrusion and bite trauma to exposed esophageal tissues (B), and visible eversion of prolapsed esophageal mucosa (B). Postmortem image of disarticulated mandible with severely ulcerated esophageal tissues in comparison with the oral cavity and tongue (C). Gross photograph of red-eared slider depicting protrusion of red-to-purple, polypoid, and edematous soft tissue from the oral cavity (D and E). Removal of the tongue and esophagus showing the mass at the cranial aspect of the esophagus (F).
Second follow-up computed tomography images of red-eared slider (Trachemys scripta elegans) illustrating tapering of trachea (A) and the animal’s hyoid apparatus (B).
Second follow-up computed tomography image of red-eared slider (Trachemys scripta elegans) illustrating mineral fragment of basihyoid.
Third follow-up computed tomography image of red-eared slider (Trachemys scripta elegans) illustrating pulmonary changes and coelomic effusion.
Formalin fixed esophagus of red-eared slider (Trachemys scripta elegans) opened using a linear longitudinal incision to expose the mucosal surface. At the cranial aspect of the esophagus there is a soft tissue mass expanding the mucosa (A, dotted box). Transverse section through the esophagus at the level of the mass shows a transmural area of tan tissue underlying an area of ulceration (dotted box) at one margin. At the other margin is the polypoid mass. Photomicrographs taken of hematoxylin and eosin–stained histological sections (C–F) of the mass and abnormal soft tissue. Polypoid mass (denoted by the box in A) composed of loose fibrovascular tissue (asterisk), vascular dilation, and large congested vessel (arrow; C). Ulceration (arrowhead), transmural inflammation (black arrow), and suture material is noted in the thick band of tissue denoted in the box from B. The red arrow (D) points to suture artifact and inflammation. Within the inflammation, there are high numbers of heterophils, rare multinucleated giant cells, and foreign material (arrow) surrounded by proliferative mesenchymal cells (E). Proliferative spindle cells seen at the margin of the polypoid mass and adjacent to inflamed areas showing mitotic activity (arrow; F).
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