rabbit abscess

Re: rabbit abscess

Marie Kubiak — Mon, 11 Nov 2013 17:24:20 GMT

Hi,

Diverticulitis alone can be managed with emptying of the pocket by milking the debris to the top of the canal and using cotton buds/swabs to empty it. This is tolerated well by some rabbits and if an infrequent requirement can be done by owners at home without too much stress. in others they hate it, get irate and it is unsuccessful, or debris builds up really quickly and the rabbit gets little respite. In these cases a LWR is an option but I prefer a TECA as rabbit ear anatomy doesn't lend itself well to partial resection.

If the ear canal has ruptured (and progressing abscessation in this case would suggest so) then I would consider a TECA necessary. To confirm location of infection you can usually see pus in the canal on otoscopy if the ear canal is not already too inflamed/stenosed but if you have external abscessation over the canal and evidence of opacity in the bulla then this is highly suspicious.

The process is well described by Kevin Eatwell and others at Edinburgh Uni and a combined approach of canal resection and lateral bulla osteotomy are used for attempted resolution. As with other species, post-op head tilt is a complication and seems slightly more common in rabbtis that domestic species (I suspect this is a combination of smaller size making surgery less precise and the fact that rabbits mask the infection until it is very advanced). I can dig out the surgical references if needed.

Marie

Re: rabbit abscess

HMC — Mon, 11 Nov 2013 13:09:35 GMT

Thank you very much. He is a lop, as you guessed. The tympanic bulla did look slightly more radiopaque than the contralateral side on dv skull xray.

So, does a diverticulitis necessitate a TECA? Sorry, just trying to understand. I have referral surgeons here who can operate if I tell them what to do. Though I doubt the owners will pay for surgery, I should still get an estimate for them.

What would be the chance of medical management?

Cheers.

Re: rabbit abscess

Marie Kubiak — Fri, 08 Nov 2013 17:55:18 GMT

Is this a lop? 'Diverticulitis' of the weakened fold of ear canal that is the cause of the lopped ear is commonly followed by abscess formation secondary to sequestration and bacterial multiplication. If it has burst out into surrounding muscle and soft tissue then it can progress rapidly. Otitis media can also cause a similar picture when pus bursts through the tympanum and causes an occlusion and severe infection of the external canal.

Progression along the mandible further complicates management as this will also need clearing. A CT to assess middle ear and true extent of disease and abscess extension would be ideal but sounds like that is out of the question. The opacity may be visible on radiographs but frequently is too subtle to show.

You may be left only with surgical debridement (be as radical as you can and if the ear canal is involved start with a TECA but be prepared to do a bulla osteotomy too) and marsupialisation of the surrounding area for ongoing topical management. I like manuka honey for this and get owners to clean and apply all sites twice daily. I would wait until sensitivity results are back and have the rabbit on appropriate cover for a minimum of 3d before surgery if you can.

Marie

Re: rabbit abscess

HMC — Fri, 08 Nov 2013 17:39:15 GMT

It's on the face. The honeycomb abscess is just below the ear base and there was a second 'regular' abscess immediately ventral to it (and joined).

I initially saw it last week and was too cautious to try to remove en-bloc so I expressed as much as possible and covered in a manuka honey'd swab and closed. I saw bunny again yesterday (7 days later) for removal of manuka swab and this time managed to remove the slightly shrunken honeycomb abscess. And I am now managing it as a draining open wound with more manuka.

However, what really concerns me is that there was an extension of the abscess along the mandible, which had not been there at the first surgery.

The rabbit has been on pen-strep daily injections since the first op (baytril prior to the op did not seem to halt the rapid abscess growth at all). A culture and sensitivity from the original surgery is pending.

I have recommended referral but cost is prohibitive. I have checked teeth both in the mouth and on xray and they seem ok (9 month old rabbit so should not really be dental disease).

Any helpful pointers?

Hannah

Re: rabbit abscess

Marie Kubiak — Fri, 08 Nov 2013 17:07:16 GMT

Where is it? Subcutaneous abscesses following trauma on the body often form multiple pockets and facial ones can be multifocal as the infection breaks out of the bone at multiple points simultaneously. Can be more tricky to remove completely where you have indistinct capsule and extension into surrounding tissues at various points.

Marie