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Rabbits/URGENT decision has to be made about possible abdominal rupture

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Question
Dear Dana,

I'm facing a terrible dilemma.  

For background, I have 17 years of experience as a houserabbit owner, and have cared for many episodes of G.I. stasis successfully in rescue rabbits and my own.  Frankly, my success rate is entirely due to following your advice all those years and working with the only rabbit-savvy vet in our area.  Unfortunately he's out of town and I've had to rely on far less experienced vet for my rabbit, Pippin, this last week.  He won't be back for another week.

Pippin was rescued at 2 years old after serious neglect including probably terrible diet.  I've always kept him on timothy hay, about 1/4 the standard amount of timothy kibble, along with generous amounts of leafy greens.  He especially loves kale and italian parsley.  He gets a about 5-10 small chunks of carrot a day and occasionally a since small chunk of apple.  He's appetite is usually excellent, almost voracious.

he's only had a couple of very brief G.I, slowdowns, usually while heavily shedding until 1 week ago.  All of sudden he stopped eating completely.  I have some cisapride on hand.  After checking his gut and hearing slow but definite sounds I began cisapride when I found out Dr. B, the rabbit-savvy vet wasn't available.  I took him to a local vet who has approved the Cisapride, given sub-cataneous fluids and confirmed small but definite movement. I've been giving Critical Care, although it was hard to get much in and coaxing him into eating fresh greens. He's have occasional spells of relief and eat hay voluntarily.

After a week his appetite was still poor.  He would periodically produce fecal material, sometimes larger hard lumps, but later a mix of rather liquid stuff and some dark, light-weight, smelly fecal material. He would nibble a few minutes on fresh greens but then give up.  He started arching and producing very smelly farts

I gave infant simethicone for gas and while he wasn't improving, he wasn't deteriorating either.  I became concerned about lack of progress so I took him to the emergency animal hospital this weekend.  They continued fluids, gave pain medication, did x-rays, and kept him overnight for observation.

They re-did xrays this morning and report there's a mass that isn't moving and are now concerned he may have an "abdominal rupture." They report he's in more pain and they're unable to get much Critical Care into him. He did produce a few more fecal pellets overnight.  I agreed to an ultrasound in hopes of further clarification.  I'm concerned that they seem so uncertain about what's going on.  If they confirm the rupture, they want to euthanize immediately since I've said I don't want surgery.  Your educational materials have convinced me of the poor odds of THAT.

My instinct is telling me they aren't qualified to diagnose a rupture, which seems like it would create a much more rapid, total collapse and death.  I'm thinking I should wait for the ultrasound results but then pick Pippin up and try to continue standard treatment at home unless there is intractable pain or deterioration.  

I need your advice ASAP.

Thanks so much,
Lane

Answer
Dear Lane,

If he had a rupture, he would be dead within 24 hours.  I agree that an Emergency Hospital will usually know next to nothing about a rabbit.  There are so many possibilities here that it's hard to list them all.

Questions:

1.  What color is he?

2.  For the time you've known him, has he produced normally shaped/textured fecal pellets, or have they been relatively large and misshapen?

It's possible he has a congenital intestinal disorder if he's white with pigmented eyes and spots, and has produced misshapen pellets in the past (on a regular basis).

Oral hydration and hydration via enema can help hydrate a mass like this, even if it's high up in the intestine.  Lactulose will serve as an osmotic laxative.  DO NOT force Critical Care.  Water, water, water only, to get that mass moving.

If it's in his stomach, then the hospital staff might not realize that a rabbit's stomach is never empty, and that's normal.  

I think you may have seen this, but the hospital staff might not have.  I hope it helps:

http://www.bio.miami.edu/hare/ileus.html

I'm sorry I didn't see this until now, but I was traveling yesterday and had no access to email until now.

I hope your bunny will be better soon.

Dana

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Dana Krempels, Ph.D.

Expertise

I've lived with companion rabbits for more than 35 years, and consider them members of my family. I can answer any questions about the biology and health of rabbits, from the commonplace to the unusual. But please note:

RULE #1:
THE INTERNET IS NOT THE PLACE TO SEEK HELP IN AN EMERGENCY.

...it is an EMERGENCY.

Find a rabbit vet at www.rabbit.org/vet for immediate help, and don't risk your bunny's life by spending time asking questions online! If you can't get in touch with your vet, read these Emergency Sick Bunny Instructions.

If you have found a wild baby rabbit, please read these EMERGENCY INSTRUCTIONS FOR WILD BABY RABBITS and then use this link to FIND A LOCAL WILDLIFE REHABILITATOR who can give you the right advice.


RULE #2:
Help me help you! Please make your subject line informative if you have an urgent question. then LET ME KNOW IN THE SUBJECT LINE so I can give your question highest priority over non-urgent questions. If you don't do this, then I can't guarantee timely assistance!

For all the best, most accurate rabbit health, care and behavior information, visit The House Rabbit Society.

Experience

I have been rescuing and rehabilitating domestic and wild rabbits for about 30 years. I have written articles for many rabbit rescue publications, as well as for the veterinary journal, Exotic DVM. I own EtherBun, the internet's largest listserve dedicated to health, care, and behavior of domestic rabbits.

Organizations
Houserabbit Adoption, Rescue, and Education, Inc. (H.A.R.E., Inc.) president National House Rabbit Society (Board member)

Publications
Exotic DVM
Warren Peace (Journal of the House Rabbit Society of Miami)
Various newsletters of the House Rabbit Society, nationwide

Education/Credentials
Ph.D - Biology
B.S. - Biology
B.A. - English

Awards and Honors
Lightspan Academic Excellence Award for web site on rabbit health and biology
(http://www.bio.miami.edu/hare)

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