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As promised, Hemipene prolapse

Kokopelli

Resident Boa Fanatic
Greetings,

As promised, here is a summary of the Hemipene prolapse condition that occurred on the night of the 28'th of October 2009 to a male Boa Constrcitor Imperator. "Spiritus" is a 2008 male who proved himself an eager breeder since the 4'th of the same month.
Several confirmed copulations were observed during this period without unexpected occurrences, a warm and cool side were maintained in their proper spectrum.

On the night of the 28'th, after a lengthy copulation of roughly 4 hours the Boas separated at around 10:30 PM.
On 10:45 PM I noticed that Spiritus had his tail slightly bent, so I went over to check it out and I saw that his Hemipene was exposed and bulging.

IMG_1557.jpg


I phoned my vet friend and told him of the condition. His advice was to leave the male be and wait until morning- if by then the condition persists, to put him in a tub with lukewarm water.
Due to the late hour I could not send over a picture nor did I know to identify the severity of the condition.
I have decided against my better judgment to let it remain as it is until morning- I rinsed in the water bowl and made sure that Spiritus remained nestled on the female, thus preventing contact between the tissue and the aspen. The vet assured me that it was normal and that by morning it should correct itself.
With hiis conclusive answer and my own wish not to separate the breeding pair- I decuded ti wait until morning.
In retrospect the vet agreed that it was a bad call on his part, however, he couldn't have been made aware to the severity of the condition because I was not yet experienced enough to differentiate one hemipene prolapse from another.

on 5 AM of the 29'th, I woke up(for the third time that night) and went to see if the condition persisted- the hemipene was still prolapsed.

I decided to act and contacted some Boa keepers at RedTailBoas.net and read articles about hemipene prolapse.

I have received two main suggestions:

1- use ice/ice-cold water directly on the tissue and reduce the swelling.
2- apply sugar paste(mix a lot of sugar with a bit of water) or honey to cause negative Osmosis, the high concentration of glucose will force the fluids out of the swollen tissue and thus allow it to reduce in size.

I have tried them all, and found the application of honey most efficient- though the swell did not disappeared, it receded by 20-30%.
I then tried to gently push the hemipene back in, but was unsuccessful.

The prognosis of a hemipene prolapse if left untreated is infection, which will lead to necrosis of the tissue which would result in need to amputate- if it is not amputated, the hemipene can either fall off or cause blood poisoning and death.

There is a crucial importance to keeping the tissue clean, moist and vital while it is left exposed, and the snake should be kept in a clean tub with very moist paper towels.

IMG_1551.jpg


I phoned the vet yet again and he sent me to buy an ointment named "Hemo" which is used to treat hemorrhoids. The ointment can be bought without a prescription and is highly efficient for not only helps with the swelling, it also has general antibiotics that help prevent infection.
The ingridients are: Bismuth subgallate, Benzocaine, Zinc Oxide, Zinc Sulfate and Chloroxyleonl solution.

It's Avocado green and oily, so it helps well with keeping the tissue alive.
However, it was impossible to reinsert the hemipene.

A vet interference was needed and so I took an hour an a half drive up north to the clinic.

Meanwhile he studied similar cases(in which the snake is incapable of retracting the hemipene on his own) and the general consensus in the literature was to put the snake under anesthetics- Isofloren was specified, and it is considered the best type of anesthetics in vet practice. After the snake is sedated, to re-insert the hemipene back into place.

However when I got there we understood the full scale of the problem. Spiritus had in fact prolapsed -both- hemipene, thus jeopardizing his ability to reproduce and becoming sterile if it the tissue is infected- Boa Constrictors normally use just the tip of a single hemipene when breeding. Spiritus was so eager that he tried both, or mayhap the excitement caused him to do so.

Sadly we did not have Isofloren available so we used a mix of Ketamine and Valium- I will not go into detail about the dosage. I will say however that we had to administer possibly twice or even three times the suggested dosage in the literature- because some of those books are relatively old(2002 or so) and because the spectrum suggested per kilo was very broad.
Make sure you work with an experienced herp vet who can properly evaluate the correct dosage- we played it safe, injecting and waiting to make sure we did not over-medicate him.

We also used a Lidocaine gel on the hemipene itself to loose it.

I will now try to explain what physically happened. You see, the base of the Hemipene is actually in the Cloaca, and it built like an inverted sock, ending in two tips, like the letter Y. when retracted, the hemipene is tube like, but when it is inverted and outside, it "blossoms" out and looks a bit like an unfolded flower. The issue was that in Spiritus case it was fully inverted, meaning that we had to both fold it back -and- reinsert it.
That is why anesthetics were essential for it is a painful procedure and the snake's own reaction wouldn't allow us to properly handle it.
Try as we might, we remained unsuccessful and so we had to resume our efforts the following day.

On the 30'th we decided to use Ketamine and Xylazine initially(Xylazine being reversible by administrating a counter-shot). Today too we had to administer two more shots before he was fully sedated. It required a lot of caution because snake's liver is very susceptible and it takes them a long while to clear the anesthetics- so we had to consider the fact that he still was medicated from the previous day.

We decided to create a cut angled roughly 90 degrees from the cloaca and upwards towards the tip of the tail in order to make the gap bigger and make it easier to re-insert the hemipene- It was unnecessary however, with the method the vet came up with. We used two catheters and pushed in the tip of both hemipene simultaneously. The lidocaine gel and general anesthetics neutralized the hemipene from contracting and we managed to push it all in.

We spent around 6 hours in total before coming up with that method.

The cloaca vent was loosely stitched in order to make sure that the hemipene does not pop back out.
The stitches will be removed within a month's time- as for this year, I can only hope that the month he spent breeding will be fruitful but... it matters little. I am just happy he is alive and that amputation was not necessary.

IMG_1570.jpg


Conclusions:

1- Once detected, a prolapse should be immediately treated. Leaving the snake on Aspen is a bad call as the tissue can easily be punctured and dry out.

2- The tissue should be kept moist, the snake should be kept on wet paper towels.

3- The use of honey, ice, sugar paste or hemorrhoid ointments are all applicable- try everything to reduce the swelling.

4- In most cases the snake -is- able to retract the hemipene. The use of anesthetics on reptiles is always dangerous and it is best to try and correct the condition without their use- however if the hemipene cannot re-enter by the use of the methods stated above- anesthetics are in order for the contractions will not allow you to re-invert the hemipene.

5- stitching the Cloaca is highly recommended to prevent the hemipene from again inverting itself outwards.

Spiritus is now well and sound, still awakening from the heavy doses of anesthetics.

IMG_1566.jpg


I hope this piece of info will prove useful.

Oren.
 
Wow, the pictures really relay the severity of what happened to the poor guy.

Again, I hope everything improves for him. Good luck, Oren!
 
Thanks for this thread Oren. I've been following and waiting for the outcome. I know I'll probably never need this info personally but I may be able to help a friend a little some day.
 
Wow, the pictures really relay the severity of what happened to the poor guy.

Again, I hope everything improves for him. Good luck, Oren!

He is doing well and I believe everything is alright. The tissue remained healthy and now everything's healing.

Thanks for this thread Oren. I've been following and waiting for the outcome. I know I'll probably never need this info personally but I may be able to help a friend a little some day.

Hopefully no one will need to find this post useful :)
 
Wow Oren, what an ordeal! Thanks for taking the time to do this for us. I too hope that I (or anyone here) will never need to use the information you posted, but I'm very glad to know it is here, just in case. I hope for a speedy recovery for your beautiful boy.
 
Thanks for the info!

I will keep a link handy, to direct people who inquire about this problem here. Even their vets may find this very useful, since many vets who see snakes probably don't run across this every day.
 
I am quite sure it will prove to be of some use... I haven't stumbled upon too many cases of a prolapse of -both- hemipene.
At least it ended well
 
Very very interesting. Sorry your Spiritus was an unwilling participant in this exercise. But your account was fascinating. Hope he'll lead a normal life after all this, Oren.
 
I don't see a reason why not. The hemipene were kept in good shape and condition, they are now inside and no swelling occurred...
He is recovering... I believe he will be breeding hard and true next year :)

And who knows, he may end up being a daddy this year too, if the month they were together will prove to be enough.
 
Thought I'd post a short update:

Over the last two days Spiritus has received 5 CC it total of fluids(lactated ringer's via a tube into the stomach) and I have applied Ceforal(by opening the pill and putting it's contents on the operated tissue).

He is doing very well, tongue flicking and cruising about.
 
no, as they were stitched loosely, he should still be able to pass on a stool easily enough.
To make it easier for him though, I will feed him again only in a month's time... as he is a male Boa... it's only a week past his appointed feeding day anyways...
 
I will never be the same again after reading this thread.

Really? Why?

Just an update though most already know... a week following the procedure, Spiritus died- the anesthetics were not administered as well as they should have- getting the right dosage for such a boa was difficult... it was a trial by error... the vet learned allot from it in the future... but Spiritus is no longer with me... I miss him dearly.
 
At least lessons were learned from this that will help snakes in the future, so his death wasn't for nothing.
 
I'm so sorry Spiritus didn't survive the ordeal. I hope you get some beautiful babies from him to keep his memory alive.
 
Really? Why?

Just an update though most already know... a week following the procedure, Spiritus died- the anesthetics were not administered as well as they should have- getting the right dosage for such a boa was difficult... it was a trial by error... the vet learned allot from it in the future... but Spiritus is no longer with me... I miss him dearly.

I just couldn't believe that something like that could happen! Was it blue from bruising, or is that just their coloration? Poor guy.. he sure went through a lot. I'm really sorry you lost him; that's terrible. :awcrap:
 
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