Page 8 - Clinical Connections - Autumn 2024

RVC RESEARCH STUDY VETERINARY SERVICES RVC.AC.UK
Exotics Referrals
APPENDICITIS – UNDERDIAGNOSED IN

RABBITS?

Joanna Hedley, Senior Lecturer in Exotic Species and Small Mammal Medicine and Surgery

ut stasis or ‘gastrointestinal Dental changes, arthritis and spondylosis abdominal ultrasound, the amount of gas
syndrome’ is one of the most are common causes of pain which may present in rabbits with gut stasis may limit
G common reasons for rabbits to be diagnosed with radiography once definitive diagnosis in some cases. This is
be presented to the RVC Exotics Referral changes are moderate-advanced, but often where we find CT scans to be an invaluable
Service. appreciated at a much earlier stage on CT diagnostic tool, as dilation of the appendix
While a rabbit with uncomplicated scan. and thickening of the sacculus rotundus
gut stasis can usually be managed Once underlying causes like these are can be quickly visualised, allowing speedy
symptomatically in first opinion practice, identified and treated, gut stasis episodes treatment.
many of the cases we see are more critical can often be resolved. However the more
patients, often requiring intensive care in CT scans performed in these cases,
hospital with us. the more we are finding not just these
We also see patients who are having common causes of gut stasis but also some
recurrent bouts of stasis with no obvious unexpected findings.
trigger.
The initial approach to any rabbit with gut Important differential
stasis always starts with stabilisation, often In recent years, appendicitis with associated
including active warming, intravenous fluid sacculitis has been recognised as an
therapy, nutritional support, analgesia and important differential for gut stasis +/-
prokinetics as required. Once treatment has abdominal pain, inappetence and weight
been initiated, the focus can then move onto loss in rabbits.
identifying the underlying cause. As a prey species, the presence and
degree of pain in rabbits can be hard to
Diagnostic approaches assess, as they will naturally hide any
The diagnostic approach will depend on signs of weakness from us, the predator
whether the signs are thought to be primarily species. Appendicitis cases can, therefore,
due to gastrointestinal disease or secondary often be chronic with rabbits just presenting
to pain elsewhere, stress or systemic with a prolonged non-resolving gut stasis
disease. episode or recurrent signs, despite standard Bluey, who was treated by the RVC Exotics
Bloodwork, full dental examination supportive treatment. Referral Service
under sedation and initial imaging – such Some cases provide more obvious clues,
as radiography – can be easily performed such as pyrexia or haematological changes, In the literature, a mix of medical and
in-house. However in many of the more but this is not always the case. In fact, some surgical treatment is described and surgical
challenging cases, we have found cases may actually present hypothermic treatment has been suggested to carry a
advanced imaging to be increasingly instead and co-morbidities are not better prognosis. However the majority of
helpful, specifically to identify any focus of uncommon, which can confuse diagnosis. cases that we have seen have been rabbits
pain or structural abnormality, which may be While changes in the appendix and with recurrent gut stasis episodes, rather
resulting in the gut stasis signs. sacculus rotundus may be visualised on than critical cases requiring appendectomy.
These more chronic cases, in our
experience, have responded extremely
well to medical treatment with antibiotics, in
addition to the normal supportive treatment
given to our gut stasis patients.
We therefore strongly recommend
considering appendicitis and sacculitis
as a differential for these patients – and
advanced imaging for diagnosis, when
required, as it can make a real difference to
resolving these more challenging cases.

CT image of Bluey: The caecal wall (CYAN callipers) is diffusely thickened (2-3mm, normal 1.2
+/- 0.1mm) and diffusely contains gas foci. In the caecal lumen there is a moderate amount of gas
and faecal contents. Colonic contents are hyperdense but formed. The colon wall is normal. Jejunal
lymph nodes are prominent (4.8mm thick) but enhance normally For the RVC Exotics and Small Mammals
Service, please call: 020 7554 3528
Email:
londonreferrals@rvc.ac.uk

8 Autumn 2024