Introduction al. 1994; Wagner, 2005). The ingestion of

Introduction

The Asian openbill stork (Anastomus
oscitans) is a large wading bird of the stork family, mainly
inhabitating the Indian subcontinent and Southeast Asia. The usual foraging
habitats are inland wetlands along with river banks and tidal flats.
On agricultural landscapes, birds forage in crop fields, irrigation canals, and
in seasonal marshes (Sundar, 2006). When hunting, the stork puts its head
inside the water, with its bill being partly open, this makes them prone to
accidental ingestion of fish hooks or other foreign bodies. Metallic foreign bodies
can lodge anywhere in the gastrointestinal tract, but are most commonly found in
the proventriculus and ventriculus (Dumonceaux, et. al. 1994; Wagner, 2005).
The ingestion of ferrous metal objects, such as nails, wire, hairpins, and needles,
accounts for the majority of cases (Peckham, 1978).

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Foreign body ingestion may be diagnosed using
plain and contrast radiography as well as gastric endoscopy (Champour and
Ojrati, 2014).

Several protocols have been suggested
for removing foreign bodies from the ventriculus of birds. Surgical removal is
documented and effective but is a high risk to the patient. The size of the
avian patient and its anatomy often make surgery extremely difficult (Bush and Kennedy,
1978).

The approach to ventricular foreign
bodies in birds is affected by the nature of the foreign body, the clinical
signs, the species affected, the tools available, and the preference or
experience of the veterinarian (Lloyd, 2009). In this case, the decision to remove
the foreign body by surgery resulted in a favourable outcome for the bird.

 

Case
Description

School of Wildlife Forensic and
Health, Jabalpur referred an Asian openbill stork (Anastomus oscitans) to
Teaching Veterinary Clinical Complex (TVCC), College of Veterinary science and
A.H., Jabalpur with history of uneasiness and abnormal cackle. Apparent
observation revealed extended neck and difficulty in swallowing. Close observation
of the neck revealed a pointed swelling over the upper ventral area of neck, which
appeared to be painful. Lateral and ventro-dorsal radiography
revealed presence of thin curved radioopaque object resembling fish hook in
cervical region of oesophagus (Figures 1, 2). It was suspected that the curved
hook has penetrated. As manual removal was not feasible, it had been decided to
go for surgical intervention.

The feathers of target and surrounding
area were clipped and painted with Povidone iodine 10%. A perforated drape was
used on designated field. The bird was anesthetised using Ketamine (20 mg/kg b.wt.)
intramuscularly. A 2 cm linear skin incision was made on ventral aspect of neck.
Subcutaneous tissues were separated by blunt incision. After locating the hook,
a small incision was made on oesophageal wall along with perforation. Then the
hook was manually manipulated and removed. The oesophageal incision was closed by
a simple continuous pattern with a 3-0 Vicryl. The surrounding subcutaneous tissue
was wiped with an antiseptic solution and routinely closed. Antibiotic powder
was sprinkled over the site and the skin incision was closed by a simple
interrupted suture pattern with 2-0 Vicryl. Antibiotics and NSAIDS were
prescribed for three days postoperatively. The bird showed uneventful recovery
and was released to its natural habitat after three days convalescence and the
skin sutures were allowed to remain in
situ.

Discussion

Anterior
gastrointestinal tract obstruction by a foreign body has been reported in
several avian species, most commonly in captive birds. It is often associated
with behavioural issues that lead to compulsive consumption of bedding
materials or bright moving objects (Castano-jimenez, et. al., 2016).  The size of the avian patient
and its anatomy often make surgery extremely difficult (Bush and Kennedy, 1978).
Furthermore, an accurate pre-surgical diagnosis, safe general anaesthesia,
adequate surgical exposure, and postoperative care all represent daunting
problems.

Radiography is essential in cases of
suspected foreign material ingestion. Survey radiographs in this case revealed multiple
foreign bodies of varying radio-density within the GI tract, and the perforation
was not apparent. Contrast radiographs were then performed post-endoscopy to determine
the exact location of the remaining wire and evaluate for other radiolucent material
in the GI tract before surgical removal. However, in the present case, since
perforation was suspected, no contrast radiography was applied due to risk of
leakage of media.

Forbes (2002) indicated parenteral
anaesthesia because the caudal thoracic and abdominal air sacs receive fresh
air from the trachea, it is important to consider that celiotomy is impossible
without opening the air sacs, which reduces the effectiveness of inhalant anaesthesia.
When administered parenterally, the combination of ketamine (100 mg/ml) and
xylazine (20 mg/ml) enhances muscle relaxation and analgesia and reduces the
incidence of stormy recoveries observed in some avian species compared to cases
in which ketamine is administered alone. The dose and route of administration of
these agents depend upon the degree of immobilization and speed of recovery desired.
Combining 10–30 mg/kg of ketamine with a half volume of xylazine (1–3 mg/kg) administered
intramuscularly induces an anaesthetic level adequate for surgical procedures (Champour
and Ojrati, 2014). However, Hayati et al. (2012) opted for inhalation anaesthesia
with isoflurane (1%–3%) and oxygen by face mask, whereas Bush and Kennedy (1978)
chose ketamine HCl (15 mg) for sedation, followed by 1.5% halothane and a
nitrous oxide/oxygen mixture at a ratio of 3: 2 administered via a face mask.

Removal of ingested foreign material is
medical or surgical depending on size, location, type of material, and
condition of the patient. Foreign material small enough to move freely through
the GI tract can be managed with hydration, emollients, laxatives, and the
adminstration of insoluble grit particles (Lupu and Robbins, 2009). Crop or
proventricular lavage may suspend small foreign pieces for tube aspiration. Most
large objects can only be removed endoscopically or surgically. Endoscopic
removal of gastrointestinal foreign bodies presents a less invasive alternative
to surgery but can only be performed in select cases. Large objects with
well-de?ned edges are more likely to be retrievable using the small grasping forceps
that accompany the endoscope (Taylor and Murray, 1999). However, in present case
since radiograph revealed perforation, only surgical removal was feasible and
adopted. The technique described by Altman (1997) was followed.

            The procedure was successful and
bird recovered without any complication and the authors concur with Castano-jimenez,
et. al., (2016) who demonstrated that the most indicated and preferred
method is not always possible and that knowledge of the biologic, anatomic, and
physiologic differences of the species may allow the use of an alternative and
more invasive approach with favourable outcomes.

 

 

 

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