- Email: [email protected]
Foreign Bodies
186 Foreign Bodies
BIRDS
Foreign Bodies BASIC INFORMATION DEFINITION A foreign body is an inanimate object that is abnormally located in a tissue, duct (e.g., gastrointestinal tract), airway, or cavity of the avian patient.
EPIDEMIOLOGY SPECIES, AGE, SEX All species and ages and both sexes are possible candidates to present with foreign bodies.
RISK FACTORS • Tracheal foreign bodies Anatomic characteristics of birds may make them more prone to tracheal foreign bodies: lack of an epiglottis, increased tracheal diameter, increased tidal volume, and narrowing of the distal trachea as it nears the syrinx Millet seed inhalation into the trachea in smaller companion avian species in which this seed is a major
part of the diet (e.g., cockatiels, budgerigars) • Gastrointestinal (GI) foreign bodies Juvenile psittacine species are vigorous feeders before fledgling; they are very curious and frequently ingest foreign bodies such as feeding tubes, cage substrate, toys, or whole seeds. GI foreign bodies are most commonly located in the crop, proventriculus, and ventriculus.
Foreign Bodies
CLINICAL PRESENTATION DISEASE FORMS/SUBTYPES • Respiratory • GI • Embedded in tissue HISTORY, CHIEF COMPLAINT • Nonspecific • Depression • Inappetence • Lack of fecal material • Nonhealing wound • Extreme dyspnea • The bird usually presents with an acute onset of clinical signs, but presentation may be chronic in cases of partial or intermittent obstruction. • Anorexia can result from a foreign body located in beak/oral tissue. Neurologic signs may be present when heavy metals (e.g., lead) have been ingested. • Penetrating foreign bodies can be encountered in the tongue, the mouth, the beak, and the skin. PHYSICAL EXAM FINDINGS • GI foreign bodies may cause vomiting and/or regurgitation, hemorrhagic enteritis, anorexia, crop stasis, weight loss, and lethargy. • In cases of perforation (e.g., wire, sewing needle), the bird may be presented with signs of shock or severe depression. • Open beak breathing • Distended glottis • Dehydration • Nasal, conjunctival, or aural foreign bodies cause an acute, unilateral discharge and/or discomfort. • Caudoventral displacement of the ventriculus can be palpated when the proventriculus is enlarged. • Birds with tracheal foreign bodies exhibit voice changes, dyspnea, tailbobbing, coughing, respiratory distress, open-mouth breathing, and neck extension.
ETIOLOGY AND PATHOPHYSIOLOGY The foreign body can partially block the respiratory tract or can partially/fully
block the GI tract. In either case, the function of the respective body systems will be impaired. If a foreign body perforates the GI tract, the septic condition will adversely affect the health of the animal, in many cases resulting in death.
DIAGNOSIS DIFFERENTIAL DIAGNOSIS • Tracheal foreign body Tracheitis: fungal (e.g., Aspergillus spp.), bacterial (e.g., Gram negative, Chlamydophila psittaci), viral (e.g., Amazon viral tracheitis, parakeet herpes virus, poxvirus, influenza) Aspergillus spp.: granuloma of the syrinx, other types of syringeal granulomas Tracheal trauma Glottis, periglottal lesions (e.g., internal papillomatosis) Squamous metaplasia of epithelial surfaces of trachea and syrinx due to hypovitaminosis A Parasites: Syngamus trachea (rare in companion birds), Sternostoma tracheacolum in passerines Postincubation tracheal stenosis, tracheal xanthogranuloma Neoplasia (e.g., tracheal, syringeal) Respiratory allergy, hypersensitivity (e.g., macaws, Amazon parrots) Airsacculitis, pneumonitis Toxin inhalation (e.g., Teflon [PTFE], cigarette smoke, other pyrrolysis products, ammonia) External compression of the trachea (e.g., goiter, thyroid neoplasia) Extrarespiratory dyspnea due to marked organomegaly or ascites • GI foreign bodies With complete or partial obstruction Neoplasia (e.g., papilloma, carcinoma, sarcoma) Stricture Intussusception Abscess, granulomas Extraluminal obstruction (e.g., compressing neoplastic mass, egg binding) Impaction (e.g., parasitism, ingestion of excess fine grit) Koilin dysplasia with detachment Without obstruction Proventriculitis: fungal (e.g., Candida spp., Macrorhabdus ornithogaster), bacterial (e.g., Chlamydophila psittaci, Mycobacterium spp., Gram-negative bacteria) PDD Proventricular ulceration with perforation Volvulus Hemorrhagic enteritis, enteritis Lead toxicosis (acute, chronic) Systemic disease leading to GI stasis
• Other locations Nostrils: rhinitis, sinusitis, rhinolith (nasal granuloma located at the level of the nares), choanal atresia Surface epithelium (skin): ulcerative dermatitis, feather picking, trauma
INITIAL DATABASE • Direct visualization or transillumination of the trachea may reveal a foreign body. • Wheezing can be heard on auscultation. • Complete blood count: inconsistent findings. A slight heterophilic leukocytosis may be present because of stress. If a perforation occurs, peritonitis can cause high elevation of heterophils. Chronic disease results in hypoproteinemia, depression anemia (nonregenerative anemia), and sometimes monocytosis. • Blood gases: on ionogram and venous blood gas, findings are consistent with respiratory acidosis caused by hypoventilation with tracheal obstruction and metabolic alkalosis in cases of vomition • Microbiologic examination/cytologic examination: can help rule out bacterial, fungal, and neoplastic causes • Radiography: this imaging technique may be useful in visualizing radiopaque foreign bodies, especially if they contain metal. For GI foreign bodies, a functional ileus is often present with dilatation of the proventriculus and intestinal loops, depending on location. For tracheal foreign bodies, hyperinflation of air sacs is frequently observed.
ADVANCED OR CONFIRMATORY TESTING • Tissue biopsy for histopathologic examination of suspect mass • Contrast radiography: contrast radiography may delineate a foreign body in the GI tract with an intraluminal filling defect. Contrast fluoroscopy can also be performed to confirm and further delineate the functional defect. Contrast radiography of the trachea (tracheobronchogram) may be useful in localizing foreign bodies; however, pulmonary edema caused by contrast medium irritation should be a matter of concern. • Endoscopy is an invaluable tool in diagnosing foreign bodies. Tracheoscopy can be performed using a sheathed 3.5-mm rigid endoscope, an unsheathed 2.7-mm rigid endoscope, a 1.9-mm rigid endoscope, or a 1.2-mm semirigid endoscope, depending on the size of the patient. GI endoscopy can be performed using rigid endoscopy through an ingluviotomy incision or flexible endoscopy. Coelioscopy
BIRDS
Ingestion of grit and bedding materials may lead to impaction of the ventriculus. Pica may also occur secondary to proventricular disorders (e.g., gastritis, proventricular dilatation disease [PDD]). ASSOCIATED CONDITIONS AND DISORDERS • Anorexia • Depression • Lack of fecal material • Grinding of beak • Open beak breathing • Dyspnea • Open distended glottis • Nonhealing tissue wound
187
188 Foreign Bodies can also be used to evaluate the lungs and air sac system. • Exploratory surgery: an exploratory coeliotomy may be performed to visualize intestinal loops
TREATMENT THERAPEUTIC GOALS • Stabilize patient. • Remove foreign body to regain normal function of affected body system. • Treat secondary conditions associated with foreign body.
ACUTE GENERAL TREATMENT • Tracheal foreign bodies Limit stress and place the patient in a critical care unit with supplemental oxygen 10 minutes before an intervention. Air sac cannulation is a necessity. Endoscopically guided removal using grasping forceps may be possible. Suction with a urinary catheter in the smaller bird is another acute treatment option. A needle can be passed through the trachea distal to the foreign body to prevent it from migrating downward. Insertion of a needle below the foreign body to dislodge and expulse via the glottis using a syringe has also been described. Pushing the foreign body into bronchi or an air sac must be considered as a final option for deep foreign bodies. Tracheotomy can be performed in an attempt to retrieve the foreign body. Surgical approach at the level
of the thoracic inlet is useful in cases of syringeal obstruction. Tracheostomy should be considered as a final surgical option. • GI foreign bodies Fluid replacement is mandatory, given that birds with GI foreign bodies are frequently dehydrated. Proventricular lavage can be tried. The bird must be intubated during this procedure. Removal using endoscopy can be attempted, but care should be taken not to lacerate the upper GI tract. Some foreign bodies may be manipulated from the crop to the oral cavity in young birds. A strong magnet glued to the end of a red rubber tube may be used to remove magnetic metal foreign bodies from the crop, proventriculus, and ventriculus. Medications GI motility depressors may be used to relieve GI hypermotility and abdominal discomfort associated with obstruction. Loperamide 0.2 mg/kg IM, IV q 12 h Butylscopolamine 0.4 mg/kg IM, IV q 12 h Gastrokinetics should be avoided in cases where a GI foreign body may be involved. When regurgitation and vomiting are noticed, antiemetic medications that are not gastrokinetic may be given. Metopimazine 0.5-1 mg/kg IM q 24 h Maropitant 1 mg/kg IM q 24 h Gastric protectors are a valuable adjunct for gastric foreign bodies
Sucralfate 25 mg/kg PO q 8 h Aluminum hydroxide 30-90 mg/ kg PO q 12 h Mineral oil may be tried to help lubricate and pass a foreign body. Chelation therapy should be started when metal objects are discovered and should be continued until blood levels for zinc and lead have been evaluated. • Other locations (e.g., tissue, coelomic cavity) Removal of the foreign body is followed by débridement, cleaning, and wound care.
CHRONIC TREATMENT • Tracheal foreign body Tracheal resection and anastomosis may be performed depending on the location and severity of tracheal lesions. Removal of a maximum of five tracheal rings or approximately 10% of the trachea is acceptable. • GI foreign bodies Ingluviotomy: for foreign bodies also located in the posterior esophagus: An incision is made through the skin overlying the left lateral area of the crop. An incision is made through the crop wall in an avascular area. After the foreign body is removed, the crop incision is closed using a two-layer inverting pattern or one layer of simple continuous sutures followed by an inverting pattern. The skin is closed as a separate layer using a simple interrupted pattern. Proventriculotomy: A left lateral coeliotomy should be performed to visualize the proventriculus. The
L
B
A
Foreign Bodies Heavy metal toxicity. A, A large amount of foreign material (metal) in the GI tract of this chicken; freeranging birds (indoors and outdoors) are very prone to ingest foreign material. B, A piece of a feeding tube lodged in the GI tract of this macaw. Removal was possible with endoscopy. (Photo courtesy Jörg Mayer, The University of Georgia, Athens.)
proventriculus is identified, and two stay sutures are placed in this structure. The coelomic cavity is then packed with moistened gauze sponges. The proventriculus is incised underneath the liver for removal of the foreign body. The proventriculus incision is closed in two layers (one simple continuous and the second inverted). The liver is then placed over the incision to promote healing. Enterotomy: Microsurgical techniques are required when performing enterotomy surgeries due to the thin and delicate nature of the avian intestines. The enterotomy procedures are required for intestinal foreign body removal.
POSSIBLE COMPLICATIONS • Pressure necrosis of the tissue where the foreign body lodges • Septicemia if the foreign body perforates the GI tract • Heavy metal toxicosis associated with lead, copper, and zinc foreign body ingestion
RECOMMENDED MONITORING • Surgical sites • Respiratory function post removal • GI function post removal
PROGNOSIS AND OUTCOME • In most cases, the prognosis is good if secondary complications are minor and the foreign body is completely removed. • Management of tracheal foreign bodies in small psittacines (e.g., cockatiels, budgerigars) and syringeal granulomas in medium-sized parrots (e.g., African grey) and macaws is challenging, and these conditions may carry a poor prognosis.
Foreign Bodies Foreign body (tube) removed from macaw.
PEARLS & CONSIDERATIONS COMMENTS • A quick presentation of an avian patient suffering from foreign body ingestion or inhalation will usually increase the chance for treatment success. • Pet bird owners should be aware of clinical signs associated with foreign body disease. • New pet bird owners should purchase only domestically raised, weaned companion psittacine species.
PREVENTION • Proper feeding and careful supervision of young companion avian species are recommended. • Unweaned birds should be hand-fed only by experienced personnel. • Cage toys and furniture appropriate for the size of the bird in question should be purchased. • Prevent access to heavy metals (e.g., lead).
CLIENT EDUCATION See above.
SUGGESTED READINGS Bennett RA, et al: Soft tissue surgery. In Ritchie BW, et al, editors: Avian medicine: principles and application, Lake Worth, FL, 1994, Wingers Publishing, pp 1096–1136. Clayton LA, et al: Endoscopic-assisted removal of a tracheal seed foreign body in a cockatiel (Nymphicus hollandicus), J Avian Med Surg 19:14–18, 2005. Ford S: Tracheal foreign body removal in small birds, Proc Annu Conf Assoc Avian Vet 49–53, 2007. Hadley TL: Disorders of the psittacine gastrointestinal tract, Vet Clin North Am Exotic Anim Pract 8:329–349, 2005. Lumeij J: Gastroenterology. In Ritchie BW, et al, editors: Avian medicine: principles and application, Lake Worth, FL, 1994, Wingers Publishing, pp 482–521. Tully TN, et al: Pneumonology. In Ritchie BW, et al, editors: Avian medicine: principles and application, Lake Worth, FL, 1994, Wingers Publishing, pp 556–581. Westerhof I: Treatment of tracheal obstruction in psittacines using a suction technique: a retrospective study of 19 birds, J Avian Med Surg 9:45–49, 1995. AUTHORS: HUGUES BEAUFRεÈRE AND W. MICHAEL TAYLOR EDITOR: THOMAS N. TULLY, JR.
BIRDS
Foreign Bodies BASIC INFORMATION DEFINITION A foreign body is an inanimate object that is abnormally located in a tissue, duct (e.g., gastrointestinal tract), airway, or cavity of the avian patient.
EPIDEMIOLOGY SPECIES, AGE, SEX All species and ages and both sexes are possible candidates to present with foreign bodies.
RISK FACTORS • Tracheal foreign bodies Anatomic characteristics of birds may make them more prone to tracheal foreign bodies: lack of an epiglottis, increased tracheal diameter, increased tidal volume, and narrowing of the distal trachea as it nears the syrinx Millet seed inhalation into the trachea in smaller companion avian species in which this seed is a major
part of the diet (e.g., cockatiels, budgerigars) • Gastrointestinal (GI) foreign bodies Juvenile psittacine species are vigorous feeders before fledgling; they are very curious and frequently ingest foreign bodies such as feeding tubes, cage substrate, toys, or whole seeds. GI foreign bodies are most commonly located in the crop, proventriculus, and ventriculus.
Foreign Bodies
CLINICAL PRESENTATION DISEASE FORMS/SUBTYPES • Respiratory • GI • Embedded in tissue HISTORY, CHIEF COMPLAINT • Nonspecific • Depression • Inappetence • Lack of fecal material • Nonhealing wound • Extreme dyspnea • The bird usually presents with an acute onset of clinical signs, but presentation may be chronic in cases of partial or intermittent obstruction. • Anorexia can result from a foreign body located in beak/oral tissue. Neurologic signs may be present when heavy metals (e.g., lead) have been ingested. • Penetrating foreign bodies can be encountered in the tongue, the mouth, the beak, and the skin. PHYSICAL EXAM FINDINGS • GI foreign bodies may cause vomiting and/or regurgitation, hemorrhagic enteritis, anorexia, crop stasis, weight loss, and lethargy. • In cases of perforation (e.g., wire, sewing needle), the bird may be presented with signs of shock or severe depression. • Open beak breathing • Distended glottis • Dehydration • Nasal, conjunctival, or aural foreign bodies cause an acute, unilateral discharge and/or discomfort. • Caudoventral displacement of the ventriculus can be palpated when the proventriculus is enlarged. • Birds with tracheal foreign bodies exhibit voice changes, dyspnea, tailbobbing, coughing, respiratory distress, open-mouth breathing, and neck extension.
ETIOLOGY AND PATHOPHYSIOLOGY The foreign body can partially block the respiratory tract or can partially/fully
block the GI tract. In either case, the function of the respective body systems will be impaired. If a foreign body perforates the GI tract, the septic condition will adversely affect the health of the animal, in many cases resulting in death.
DIAGNOSIS DIFFERENTIAL DIAGNOSIS • Tracheal foreign body Tracheitis: fungal (e.g., Aspergillus spp.), bacterial (e.g., Gram negative, Chlamydophila psittaci), viral (e.g., Amazon viral tracheitis, parakeet herpes virus, poxvirus, influenza) Aspergillus spp.: granuloma of the syrinx, other types of syringeal granulomas Tracheal trauma Glottis, periglottal lesions (e.g., internal papillomatosis) Squamous metaplasia of epithelial surfaces of trachea and syrinx due to hypovitaminosis A Parasites: Syngamus trachea (rare in companion birds), Sternostoma tracheacolum in passerines Postincubation tracheal stenosis, tracheal xanthogranuloma Neoplasia (e.g., tracheal, syringeal) Respiratory allergy, hypersensitivity (e.g., macaws, Amazon parrots) Airsacculitis, pneumonitis Toxin inhalation (e.g., Teflon [PTFE], cigarette smoke, other pyrrolysis products, ammonia) External compression of the trachea (e.g., goiter, thyroid neoplasia) Extrarespiratory dyspnea due to marked organomegaly or ascites • GI foreign bodies With complete or partial obstruction Neoplasia (e.g., papilloma, carcinoma, sarcoma) Stricture Intussusception Abscess, granulomas Extraluminal obstruction (e.g., compressing neoplastic mass, egg binding) Impaction (e.g., parasitism, ingestion of excess fine grit) Koilin dysplasia with detachment Without obstruction Proventriculitis: fungal (e.g., Candida spp., Macrorhabdus ornithogaster), bacterial (e.g., Chlamydophila psittaci, Mycobacterium spp., Gram-negative bacteria) PDD Proventricular ulceration with perforation Volvulus Hemorrhagic enteritis, enteritis Lead toxicosis (acute, chronic) Systemic disease leading to GI stasis
• Other locations Nostrils: rhinitis, sinusitis, rhinolith (nasal granuloma located at the level of the nares), choanal atresia Surface epithelium (skin): ulcerative dermatitis, feather picking, trauma
INITIAL DATABASE • Direct visualization or transillumination of the trachea may reveal a foreign body. • Wheezing can be heard on auscultation. • Complete blood count: inconsistent findings. A slight heterophilic leukocytosis may be present because of stress. If a perforation occurs, peritonitis can cause high elevation of heterophils. Chronic disease results in hypoproteinemia, depression anemia (nonregenerative anemia), and sometimes monocytosis. • Blood gases: on ionogram and venous blood gas, findings are consistent with respiratory acidosis caused by hypoventilation with tracheal obstruction and metabolic alkalosis in cases of vomition • Microbiologic examination/cytologic examination: can help rule out bacterial, fungal, and neoplastic causes • Radiography: this imaging technique may be useful in visualizing radiopaque foreign bodies, especially if they contain metal. For GI foreign bodies, a functional ileus is often present with dilatation of the proventriculus and intestinal loops, depending on location. For tracheal foreign bodies, hyperinflation of air sacs is frequently observed.
ADVANCED OR CONFIRMATORY TESTING • Tissue biopsy for histopathologic examination of suspect mass • Contrast radiography: contrast radiography may delineate a foreign body in the GI tract with an intraluminal filling defect. Contrast fluoroscopy can also be performed to confirm and further delineate the functional defect. Contrast radiography of the trachea (tracheobronchogram) may be useful in localizing foreign bodies; however, pulmonary edema caused by contrast medium irritation should be a matter of concern. • Endoscopy is an invaluable tool in diagnosing foreign bodies. Tracheoscopy can be performed using a sheathed 3.5-mm rigid endoscope, an unsheathed 2.7-mm rigid endoscope, a 1.9-mm rigid endoscope, or a 1.2-mm semirigid endoscope, depending on the size of the patient. GI endoscopy can be performed using rigid endoscopy through an ingluviotomy incision or flexible endoscopy. Coelioscopy
BIRDS
Ingestion of grit and bedding materials may lead to impaction of the ventriculus. Pica may also occur secondary to proventricular disorders (e.g., gastritis, proventricular dilatation disease [PDD]). ASSOCIATED CONDITIONS AND DISORDERS • Anorexia • Depression • Lack of fecal material • Grinding of beak • Open beak breathing • Dyspnea • Open distended glottis • Nonhealing tissue wound
187
188 Foreign Bodies can also be used to evaluate the lungs and air sac system. • Exploratory surgery: an exploratory coeliotomy may be performed to visualize intestinal loops
TREATMENT THERAPEUTIC GOALS • Stabilize patient. • Remove foreign body to regain normal function of affected body system. • Treat secondary conditions associated with foreign body.
ACUTE GENERAL TREATMENT • Tracheal foreign bodies Limit stress and place the patient in a critical care unit with supplemental oxygen 10 minutes before an intervention. Air sac cannulation is a necessity. Endoscopically guided removal using grasping forceps may be possible. Suction with a urinary catheter in the smaller bird is another acute treatment option. A needle can be passed through the trachea distal to the foreign body to prevent it from migrating downward. Insertion of a needle below the foreign body to dislodge and expulse via the glottis using a syringe has also been described. Pushing the foreign body into bronchi or an air sac must be considered as a final option for deep foreign bodies. Tracheotomy can be performed in an attempt to retrieve the foreign body. Surgical approach at the level
of the thoracic inlet is useful in cases of syringeal obstruction. Tracheostomy should be considered as a final surgical option. • GI foreign bodies Fluid replacement is mandatory, given that birds with GI foreign bodies are frequently dehydrated. Proventricular lavage can be tried. The bird must be intubated during this procedure. Removal using endoscopy can be attempted, but care should be taken not to lacerate the upper GI tract. Some foreign bodies may be manipulated from the crop to the oral cavity in young birds. A strong magnet glued to the end of a red rubber tube may be used to remove magnetic metal foreign bodies from the crop, proventriculus, and ventriculus. Medications GI motility depressors may be used to relieve GI hypermotility and abdominal discomfort associated with obstruction. Loperamide 0.2 mg/kg IM, IV q 12 h Butylscopolamine 0.4 mg/kg IM, IV q 12 h Gastrokinetics should be avoided in cases where a GI foreign body may be involved. When regurgitation and vomiting are noticed, antiemetic medications that are not gastrokinetic may be given. Metopimazine 0.5-1 mg/kg IM q 24 h Maropitant 1 mg/kg IM q 24 h Gastric protectors are a valuable adjunct for gastric foreign bodies
Sucralfate 25 mg/kg PO q 8 h Aluminum hydroxide 30-90 mg/ kg PO q 12 h Mineral oil may be tried to help lubricate and pass a foreign body. Chelation therapy should be started when metal objects are discovered and should be continued until blood levels for zinc and lead have been evaluated. • Other locations (e.g., tissue, coelomic cavity) Removal of the foreign body is followed by débridement, cleaning, and wound care.
CHRONIC TREATMENT • Tracheal foreign body Tracheal resection and anastomosis may be performed depending on the location and severity of tracheal lesions. Removal of a maximum of five tracheal rings or approximately 10% of the trachea is acceptable. • GI foreign bodies Ingluviotomy: for foreign bodies also located in the posterior esophagus: An incision is made through the skin overlying the left lateral area of the crop. An incision is made through the crop wall in an avascular area. After the foreign body is removed, the crop incision is closed using a two-layer inverting pattern or one layer of simple continuous sutures followed by an inverting pattern. The skin is closed as a separate layer using a simple interrupted pattern. Proventriculotomy: A left lateral coeliotomy should be performed to visualize the proventriculus. The
L
B
A
Foreign Bodies Heavy metal toxicity. A, A large amount of foreign material (metal) in the GI tract of this chicken; freeranging birds (indoors and outdoors) are very prone to ingest foreign material. B, A piece of a feeding tube lodged in the GI tract of this macaw. Removal was possible with endoscopy. (Photo courtesy Jörg Mayer, The University of Georgia, Athens.)
proventriculus is identified, and two stay sutures are placed in this structure. The coelomic cavity is then packed with moistened gauze sponges. The proventriculus is incised underneath the liver for removal of the foreign body. The proventriculus incision is closed in two layers (one simple continuous and the second inverted). The liver is then placed over the incision to promote healing. Enterotomy: Microsurgical techniques are required when performing enterotomy surgeries due to the thin and delicate nature of the avian intestines. The enterotomy procedures are required for intestinal foreign body removal.
POSSIBLE COMPLICATIONS • Pressure necrosis of the tissue where the foreign body lodges • Septicemia if the foreign body perforates the GI tract • Heavy metal toxicosis associated with lead, copper, and zinc foreign body ingestion
RECOMMENDED MONITORING • Surgical sites • Respiratory function post removal • GI function post removal
PROGNOSIS AND OUTCOME • In most cases, the prognosis is good if secondary complications are minor and the foreign body is completely removed. • Management of tracheal foreign bodies in small psittacines (e.g., cockatiels, budgerigars) and syringeal granulomas in medium-sized parrots (e.g., African grey) and macaws is challenging, and these conditions may carry a poor prognosis.
Foreign Bodies Foreign body (tube) removed from macaw.
PEARLS & CONSIDERATIONS COMMENTS • A quick presentation of an avian patient suffering from foreign body ingestion or inhalation will usually increase the chance for treatment success. • Pet bird owners should be aware of clinical signs associated with foreign body disease. • New pet bird owners should purchase only domestically raised, weaned companion psittacine species.
PREVENTION • Proper feeding and careful supervision of young companion avian species are recommended. • Unweaned birds should be hand-fed only by experienced personnel. • Cage toys and furniture appropriate for the size of the bird in question should be purchased. • Prevent access to heavy metals (e.g., lead).
CLIENT EDUCATION See above.
SUGGESTED READINGS Bennett RA, et al: Soft tissue surgery. In Ritchie BW, et al, editors: Avian medicine: principles and application, Lake Worth, FL, 1994, Wingers Publishing, pp 1096–1136. Clayton LA, et al: Endoscopic-assisted removal of a tracheal seed foreign body in a cockatiel (Nymphicus hollandicus), J Avian Med Surg 19:14–18, 2005. Ford S: Tracheal foreign body removal in small birds, Proc Annu Conf Assoc Avian Vet 49–53, 2007. Hadley TL: Disorders of the psittacine gastrointestinal tract, Vet Clin North Am Exotic Anim Pract 8:329–349, 2005. Lumeij J: Gastroenterology. In Ritchie BW, et al, editors: Avian medicine: principles and application, Lake Worth, FL, 1994, Wingers Publishing, pp 482–521. Tully TN, et al: Pneumonology. In Ritchie BW, et al, editors: Avian medicine: principles and application, Lake Worth, FL, 1994, Wingers Publishing, pp 556–581. Westerhof I: Treatment of tracheal obstruction in psittacines using a suction technique: a retrospective study of 19 birds, J Avian Med Surg 9:45–49, 1995. AUTHORS: HUGUES BEAUFRεÈRE AND W. MICHAEL TAYLOR EDITOR: THOMAS N. TULLY, JR.