Case report

Hernia mesenterialis and intestinal rupture

Date: 2002

Place: Rotterdam Zoo

Data provided by: Willem Schaftenaar

History

Species: Asian elephant

Accommodation: Zoo, free contact

Age, gender: 1 year, male

Five years before this episode, a 3 yrs-old calf at the same zoo had died of EEHV1a.

The calf (300 kg estimated BW) was heavily hit on its abdomen by a herd mate. Two days later (Day 1) it became very lethargic and stopped drinking from its mother.

Day 1

08:30:
Very lethargic, not eating. Laying flat on the ground, while kicking with his hind legs (
colic). Sometimes standing with the mouth widely opened.
Conjunctivae: slightly congested.
Tongue: normal color.
No edema on head or shoulders.
Defense musculaire: normal.
Rectal temperature: 36.8°C

A standing sedation using xylazine (0.1 mg/kg BW IM for the calf, 0.08mg/kg BW for the dam) was performed in both the affected calf and its mother. As soon as sedation started, the calf was brought to its mothers mammary glands and it started drinking from the mother.

EDTA and full blood samples were taken and rectal fluids were given during the sedation.


Rectal palpation: only one handfull of soft feces in distal part of the rectum. The rectal wall is very dry.
Urine sample: all values (dipstick) within normal ranges.
Blood sample collected.

Hematology and blood chemistry results were all within normal ranges.

EDTA whole blood sample submitted for PCR on EEHV. Results: PCR-positive EEHV1a.
Rx: 6 ml Finadyne (flunixinemeglumine 50 mg/ml, NL1726) i.m.
15 ml Baytril 10% (enrofloxacin 100 mg/ml, NL3489) i.m.
3000 mg famciclovir mixed with 15 ml utrasound gel per rectum.

Calf during standing sedation and suckling from its mother. Note the penis relaxation, typical for alpha-2-agonist sedation.

16:30:
No change. Not eating, laying.
Less signs of colics.
Rx: 1500 mg famciclovir mixed with 10 ml ultrasound gel per rectum.


23:00:
Animal is lethargic. Laying down most of the time.
Rx: 1500 mg famciclovir mixed with 10 ml ultrasound gel per rectum.

Day 2

Slightly alerter than before. Treatment was continued similar to day 1.

Day 3

08:30
Alerter, but no attempts to nurse from its mother.
Rx: 15 ml Baytril 10% (enrofloxacin 100 mg/ml, NL3489) i.m.
1500 mg famciclovir mixed with 10 ml ultrasound gel per rectum.


16:00
Agian very lethargic. Has not eaten or nursed at all. No feces nor urine produced.

 

Standing sedation (calf and dam, see day 1).

Again the calf was drinking well during the sedation.  Also defecating and urinating. Firm feces.
Rx: 1500 mg famciclovir per rectum dissolved in 20 ml water.
600 ml Amynin (per ml: 50 mg glucose anhydrate, electrolytes, aminoacids and B-vitamins, NL 4137) per rectum.


Blood and urine samples collected. All values within normal ranges.

EDTA: EEHV-PCR signal much lower than day 1.

Day 4

08:00
Alerter, has not been laying excessively long during the night.
Rx: 1500 mg famciclovir per rectum (dissolved in 20 ml water).
During the morning the animal has been drinking spontaneously from his mother.

Treatment similar today 2.

Day 5

09:00
Leaning against the poles.
Rx: 1500 mg famciclovir per rectum (dissolved in 20 ml water).
Keepers think his behaviour is about the same.
Is drinking water from the hosepipe.
Some normal feces manually removed from the rectum.
16:00
Still leaning against the poles but sometimes giving a more alert impression by moving his tail.
Rx: 1500 mg famciclovir per rectum (dissolved in 20 ml water).
Standing sedation (xylazin 0.1 mg/kg IM). Drinking from his mother.

Day 5

08:00:
Very lethargic; did not drink during the night.
Tympanic, bilateral; intestinal obstruction suspected. Some dry feces were collected from the rectum.
Rx: 1500 mg famciclovir per rectum (dissolved in 20 ml water).
6 ml Finadyne (flunixinemeglumine 50 mg/ml, NL1726) i.m.
15 ml Baytril 10% (enrofloxacin 100 mg/ml, NL3489) i.m.

During the day the condition of the animal deteriorated.
 

14:00: sedated with xylazine (0.1 mg kg IM).
Blood sample collected - heparin and EDTA and fluride. 

Rectal palpation: balloon-like intestines.
The calf suddenly regurgitated and threw up stomach content.
Rectal fluids were given.


At 15:00 the animal died.

Necropsy

 

1) Cause of death:

* Rupture of the ileum resulting in peracute peritonitis.
* Mesenteric hernia.
* Intestinal mesentery, small intestine (jejunum), ileum: Venous infarction, acute, marked, with venous and lymphatic thrombosis, fibrinoid arterial necrosis, and interstitial haemorrhage and necrosis.
* Intestinal mesentery, small intestine, hepatic capsule, pancreas: Peritonitis, fibrino-purulent, diffuse, peracute, moderate, associated with bacterial infection.


2) Significant diagnoses:
* Liver: pericholangitis, eosinophilic, diffuse, chronic, severe, with bile duct hyperplasia and portal fibrosis.
* Liver: hepatitis, granulomatous, eosinophilic, multifocal, chronic, moderate.


3) Incidental diagnoses:
* Heart: haemorrhage, subendocardial, epicardial, multifocal, acute, mild.
* Lung: pulmonary oedema, diffuse, acute, mild.
* Adrenal cortex: adrenocortical necrosis, multifocal, acute.

Cyanosis of the tongue and epicardial hemorrhages that are seen in EEHV-HD were also present in this case. They are the result of circulatory shock and are not pathognomitic for EEHV-HD. The intestinal contents was found freely in the abdomen. The hernia and the torio of the mesenterium is well demonstrated on the last photo.

Conclusion

Initially, when the PCR-result was positive for EEHV, EEHV was considered the cause of the disease and anti-EEHV treatment was started. Based on previous findings, the mother of the calf was assumed to be a carrier of EEHV1. However, the normal hemogram was not in line with what was seen in other EEHV-HD cases.

At necropsy, multiple hemorrhages were seen in almost all organs, which is also seen in EEHV-HD. However, the predominant pathological conditions (hernia mesenterials, volvulus, torsio and rupture of the ileum were the cause of death. The presence of EEHV1a can only be explained as a virus reactivation due to a heavy stress respons of the calf in relation to the intestinal problems.