Vol. 21, No.
9 September 1999 V 20TH ANNIVERSARY
CE Refereed Peer Review
FOCAL POINT
★ With some variation, the surgical
procedures involved in treating
adrenal gland neoplasia,
paraurethral or prostatic cysts,
and pancreatic beta-cell tumors
in ferrets are similar to the
procedures routinely performed
in other small animals.
KEY FACTS
■ Any abdominal surgery for
neoplasia in ferrets should
include evaluation of the lymph
nodes and all abdominal organs
for concurrent neoplasia or
metastasis.
■ Paraurethral or prostatic cysts
generally occur secondary to
adrenal gland neoplasia.
■ During partial pancreatectomy,
leakage of small amounts of
pancreatic enzymes may not
be associated with pancreatitis.
■ Surgical removal of pancreatic
beta-cell tumors is frequently
considered a debulking
procedure because metastasis
and local recurrence are
common.
Ferret Abdominal
Surgical Procedures.
Part I. Adrenal Gland and
Pancreatic Beta-Cell Tumors
University of Florida
Jason Wheeler, DVM
R. Avery Bennett, DVM, MS
ABSTRACT: With the increasing popularity of ferrets as pets, veterinarians are being asked to
perform surgical procedures on these animals that they have previously performed only on
dogs and cats. This two-part article discusses common problems in ferrets that require ab-
dominal surgery and the proper surgical management of these conditions. Variations in ferret
anatomy and pertinent disease pathophysiology are also described. Part I covers adrenal
gland disease, paraurethral and prostatic cysts, and pancreatic beta-cell tumors. Part II will
discuss surgical techniques related to treatment of gastrointestinal foreign bodies, spleno-
megaly, liver biopsy, cystotomy, and ovariohysterectomy.
T
he popularity of ferrets as pets has been steadily increasing. As a result,
veterinarians are being asked to perform surgical procedures with which
they have had little experience in ferrets. In general, ferret abdominal
surgery is analogous to similar procedures routinely performed in dogs, cats, and
other small animals. With a more thorough understanding of the surgical condi-
tions most frequently encountered, the slight variations in anatomy, and the
pathophysiology of the disease in question, ferret abdominal surgery can be per-
formed in most general practice situations. Because ferrets have a high incidence
of tumors and clinical signs are often nonspecific, abdominal exploratory surgery
provides an opportunity to examine all abdominal structures.
This two-part article provides an overview of the most commonly encoun-
tered conditions requiring abdominal surgical intervention in ferrets. Part I dis-
cusses adrenal gland diseases, paraurethral and prostatic cysts, and pancreatic
beta-cell tumors (insulinomas). Part II will address surgical techniques related to
treatment of gastrointestinal foreign bodies, splenomegaly, liver biopsy, cystoto-
my, and ovariohysterectomy.
ADRENAL DISEASES
At least 95% of generalized alopecia in neutered ferrets 3 years of age or older
is caused by neoplasia or hyperplasia of the adrenal glands.1 This syndrome is
strictly an adrenal disease—the pituitary gland is not involved, which makes use
Small Animal/Exotics 20TH ANNIVERSARY Compendium September 1999

of the term Cushing’s disease inappro- largement is an indication for re-

priate.2,3 In some cases the histologic
diagnosis is adrenocortical hyperplasia,
whereas adrenocortical adenoma or
cortical adenocarcinoma is diagnosed
in others.4,5 Metastasis is uncommon
but has been reported1; however, some
tumors do show local invasion into the
vena cava, liver, and adjacent abdomi-
nal viscera.4,5
The primary clinical sign associated
with adrenal neoplasia is bilaterally
symmetric, pruritic or nonpruritic alo-
pecia, usually beginning at the hind-
quarters and progressing cranially along
the body.2 Spayed female ferrets fre-
quently have vulvar enlargement, with
or without alopecia (Figure 1). Male
ferrets with adrenal neoplasia occasion-
ally have prostatic or paraurethral
cysts, with or without alopecia. 5 Figure 1A
Splenic enlargement, pancreatic beta-
cell tumors, and cardiomyopathy are
also common in ferrets with adrenal
neoplasia.2,5
Adrenal disease is suspected based
on the physical examination, history,
and signalment. The diagnosis is fre-
quently confirmed via ultrasound eval-
1,6
uation of the adrenal glands. An
adrenal steroid panel to evaluate circu-
lating levels of hormone precursors in
ferrets and dogs is available through
the University of Tennessee (Clinical
Endocrinology Laboratory, Depart-
ment of Comparative Medicine, 423-
974-5638; $60 for ferret test, $120 for
canine test).7
Surgery is currently considered the
treatment of choice for adrenal neo-
plasia.8,9 Because adrenal neoplasia fre-
quently occurs coincidentally with Figure 1B
pancreatic beta-cell tumor and lym- Figure 1—A ferret with (A) alopecia the vessel wall. Removal requires tem-
phoma, the lymph nodes, liver, spleen, and (B) vulvar enlargement typical of porary occlusion of the caudal vena
and pancreas must be evaluated.10 In those seen with adrenal gland disease. cava, venotomy, and closure of the
female ferrets, it is also important to
evaluate the ovarian and uterine stumps and the mesen-
tery for any evidence of ectopic or residual ovarian tis-
sue that might cause similar clinical signs.
The adrenal glands are evaluated for size, color, and
shape. They should be 2 to 3 mm wide, 6 to 8 mm
1,6,10
long, light pink, and homogeneous. The presence A thin membrane (hepatorenal ligament) extends from
of lumps, firm areas, discolorations, cysts, or gross en-
moval. If it appears that the adrenal
gland cannot be safely removed with-
out damaging adjacent structures,
such as the caudal vena cava, it is best
to remove as much affected tissue as
possible in order to obtain a biopsy
specimen and debulk the mass.
The left adrenal gland is located
within the sublumbar fat just cranial
and medial to the cranial pole of the
left kidney (Figure 2).11,12 It is deep
within the lumbar fat in the retroperi-
toneal space. In general, only the ven-
tral surface of the gland can be visual-
ized through the peritoneum. In some
animals, the surface may appear gross-
ly normal with the abnormal portion
deeper and not readily visible. It is im-
portant to open the peritoneum, dis-
sect through the fat, and explore the
entire gland using blunt dissection be-
fore declaring it normal.
It is generally easy to remove the left
adrenal gland. The adrenolumbar
(phrenicoabdominal) vein courses over
the ventral surface of the left adrenal
gland and must be ligated on each side
of the gland before removal.12 Large
tumors may be receiving blood from
other large vessels that might require
ligation or cauterization. Hemostatic
clips are very valuable in controlling
hemorrhage from these vessels. After
the vessels have been ligated, the
adrenal gland is removed using sharp
or blunt dissection. Some large tumors
invade the caudal vena cava, presum-
ably migrating through the adreno-
lumbar vein. Once inside the vena
cava, they tend to grow cranially with-
in the lumen but are not attached to
venotomy as described below. Some
tumors are large enough to invade or compromise the
left kidney, thereby necessitating nephrectomy.
The right adrenal gland is found by elevating the
caudalmost pole of the caudate lobe of the liver, which
overlies the cranial pole of the right kidney (Figure 2).10
the caudal tip of this liver lobe toward the kidney and is

CLINICAL SIGNS ■ DIAGNOSIS ■ PHRENICOABDOMINAL VEIN

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tached to the caudal VC along the dorsal surface of the vein color photographs illustrating the full range of
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the caudal VC. The hepatorenal ligament (H) is transected
A lifetime resource that will never go out of date by two
and held with forceps (F) to elevate the caudate lobe of the
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nal ligament can then be used to retract the liver ven-
trally, allowing exposure of the right adrenal gland, FEATURES
which is visualized on the dorsal aspect of and tightly ■ Concise and well-organized by
attached to the caudal vena cava. Its location is actually Appropriate
anatomic feature for general
more dorsal rather than strictly on the right side of the
vena cava; thus the adrenal gland must be evaluated ■ Over 350 color images enhanced practitioners,
from both the right and left sides of the caudal vena by arrows students/residents
cava for abnormalities. Because of its intimate associa- ■ Captions discuss history, signs, in training, and
tion with the vena cava, removal of the right adrenal evaluation, and case highlights breeders
gland is significantly more difficult than is removal of ■ Separate index of all included
the left. Second in a series
breeds by the authors of
Vascular clamps are almost essential in performing a
complete right adrenalectomy in ferrets. These clamps ■ High-gloss finish and spiral bind- Atlas of Feline
are designed to occlude veins with minimal trauma to ing—ideal for use as a diagnostic Ophthalmology
the vessel wall. Clamps are placed on the caudal vena guide and client education tool
cava, cranially and caudally to the mass, isolating the ■ Extensive current bibliography for further information
portion of the vena cava that contains the adrenal mass. on treatment
We have occluded the caudal vena cava for up to 1
hour in ferrets with adrenal tumors without causing CALL OR FAX TODAY TO ORDER
overt clinical effects. The right adrenal gland is dissect-
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ANATOMY ■ RIGHT ADRENALECTOMY

Small Animal/Exotics 20TH ANNIVERSARY
cava to isolate the tumor as much as possible before
placing the clamps. The caudal vena cava is dissected
free from surrounding fat, which allows clamps to be
placed caudal and cranial to the mass. It is important to
dissect as much tissue off the vena cava as possible in
the event that suturing this vein is required.
With the aid of magnifying loupes and microsurgical
instruments, a plane of dissection between the adrenal
gland and the vena cava is identified. Through this
plane, dissection is continued until the adrenal gland is
removed from the surface of the vena cava. The wall of
the vena cava is inspected for defects. If an incision was
created in the vena cava during dissection, it is closed
with a simple continuous pattern of 8-0 nylon suture on
an atraumatic needle. Small holes are sutured with 8-0
nylon in a mattress pattern. Generally, there are very
small holes that go undetected even with inspection
through a magnifying loupe. Before the clamp is re-
leased, a piece of oxidized regenerated cellulose (Surgicel™;
Ethicon Inc., Somerville, NJ) is wrapped around the
vena cava where the adrenal mass was removed; this
will aid in hemostasis following clamp removal.
When the clamp is removed, hemorrhage will be not-
ed from the small holes in the wall of the vena cava; gen-
tle pressure is applied for approximately 5 minutes to al-
low clots to form and seal the holes. The oxidized
regenerated cellulose is left in place and not disturbed
during closure. The pressure in the vena cava is low,
which makes postoperative hemorrhage less problematic.
Tumors of the right or left adrenal gland may invade
the caudal vena cava. These may be removed through a
venotomy (more likely with left adrenal tumors) or by
resecting and anastomosing the caudal vena cava (more
likely with right adrenal tumors because of their more
diffuse attachment to the caudal vena cava). For the
venotomy, the caudal vena cava is occluded using vascu-
lar clamps as described. The venotomy should be just
large enough to remove the tumor from the lumen of
the vein. It is best to close the longitudinal incision
transversely to prevent attenuation of the luminal diam-
eter. It is generally easiest to place a few interrupted su-
tures to provide apposition and then close with a simple
continuous pattern, which will provide a better seal.
In some cases a portion of the caudal vena cava must
be removed to completely resect an adrenal tumor. We
have removed up to 1 cm of vena cava and still been
able to create a tension-free anastomosis. Vena cava lig-
ation cannot be recommended in ferrets until appropri-
ate research into its effects has been conducted.
A technique described for partial excision of the right
adrenal gland involves the use of hemostatic clips.13
Once the gland is freed from surrounding tissues, hemo-
static clips are applied between the gland and the vena
ABDOMINAL CLOSURE ■ GLUCOCORTICOID THERAPY ■ PROSTATE ■ HYPOGLYCEMIA
Compendium September 1999
cava. The tissue is then transected along the clips, which
provide hemostasis of vessels between the adrenal and
the vena cava. Using this technique, more of the adrenal
tissue remains in the ferret, which increases the chance
that tumor will recur.
Abdominal closure is routine. A postoperative dose of
dexamethasone (1 mg/kg) may be administered. After
24 hours, prednisone (0.1 mg/kg orally once daily for 3
days) is administered.8 Although postoperative steroids
may not be necessary, it appears that many ferrets suffer
less depression and have a more rapid return to their
normal state when glucocorticoids are administered for
a short time (i.e., 3 days). Patients are returned to a
normal diet within 6 to 12 hours of surgery. Following
adequate removal of the adrenal neoplasia, a swollen vul-
va will generally return to normal within 2 weeks and
hair loss will begin to resolve in 1 to 4 months.
Following bilateral adrenalectomy, ferrets often re-
quire glucocorticoid therapy for longer periods. Miner-
alocorticoid supplementation is required as well in
some ferrets with bilateral adrenalectomy. In a study in
which bilateral adrenalectomies were performed in nor-
mal ferrets, no abnormalities were identified12; however,
this study did not evaluate steroid levels. Ferrets were
given 0.9% saline for drinking water, but electrolyte
levels were not determined either.
PARAURETHRAL OR PROSTATIC CYSTS
Male ferrets with adrenal neoplasia may develop pro-
static enlargement, prostatitis, paraprostatic cysts, or
paraurethral cysts. It is likely that these problems are a
result of excessive quantities of hormones produced by
the adrenal tumor.5,10 Treatment is aimed at surgical re-
moval of the affected adrenal gland(s). After the adrenal
neoplasia has been removed, the prostate rapidly de-
creases in size, often within 1 or 2 days. In some ferrets
with prostatic enlargement and paraprostatic cysts, the
cystic structure may be as large as or larger than the uri-
nary bladder. These cysts frequently contain a tena-
cious, green, often odoriferous material.1 The contents
of the cyst are aspirated intraoperatively and submitted
for culture and sensitivity testing. Biopsy of the affected
prostate is recommended to rule out primary prostatic
disease. Marsupialization of the cyst is not usually nec-
essary. Omentalization may be indicated. A defect is
created in the cyst, and omentum is sutured in place
over this defect. The omentum will absorb fluid if the
cyst continues to be productive postoperatively. After re-
mov-al of the adrenal neoplasia, cystic structures tend to
regress rapidly.
PANCREATIC BETA-CELL TUMORS
Hypoglycemia in ferrets is usually caused by pancre-
Compendium September 1999 Small Animal/Exotics

1,4,14–17
Share Your
atic beta-cell tumors (insulinomas). The disease oc-
curs at approximately the same frequency as adrenal
neoplasia; the two diseases commonly occur at the
Knowledge
same time and affect both male and female ferrets 3
years of age or older.14 The tumor produces high levels We invite you to impart your clinical knowledge
of insulin, driving glucose out of circulation and into by discussing your interesting cases, unusual
cells. Clinical signs associated with pancreatic beta-cell
tumor are related to hypoglycemia and generally consist presentations, or procedures for clinical solutions
of weakness and depression. These signs may be subtle
and short-lived and may resolve on their own early in for the following features:
the course of the disease. Frequently, ferrets salivate and E
IC CHALLENG

paw at the mouth as if experiencing nausea. As the dis- DIAGNOST

rn on a Rat Po
isoning
Unexpected Tu
ease progresses, the periods of weakness and lethargy DIAGNOSTIC CHALLENGE By Marjory
Brooks, D.V.M
and Jeff Jacobs
on, D.V.M
.
., Dipl. A.C.V.
I.M.,

become more pronounced and persistent. 3,15,16 Al-

was exam-
d male Beagle,
r-old, neutere Con-
ugsy, a four-yea n of the rat poison
M ined within one
hour of ingestio l placement

A detailed account of a clini- trac® . Initial

of apomorphine
treatment consiste
and 30 mL of
this
d of subconjunctiva
oral hydrogen
therapy
peroxide to induce
, Mugsy vomited
a large

though uncommon, some animals eventually develop

response to the rat bait.
Addi-
vomiting. In identified as
of green-b lue material d charcoa l by gas-
amount mL of activate
nt included 200 neously (SC).
tional treatme 2.5 mg/kg subcuta

cal dilemma takes readers from

and vitamin K1 supply of
tric intubation with a 10-day
ed to his owners
Mugsy was discharg

seizures and coma and may die.3,16 Definitive diagnosis

hours orally.
mg every 24
vitamin K1 50

SEALING ry
NS BY LES
blood chemist
nation. All
ILLUSTRATIO

for PT determi PT at recheck

specific patient presentation

hours later limits. The
d for 48 hours within normal because cor-
tion was schedule values were ted finding
, an unexpec K deficiency

is frequently made based on a fasting (4 to 6 hour)

confirm
A recheck examina vitamin K regimen to was 65.9 seconds al PT due to vitamin
ion of the owners report- initiating an
after complet Although his rection of abnorm 48 hours of
coagulopathy. and Mugsy within 24 to
resolution of K1 as directed should resolve K1. of
had given vitamin re to rat poison, clotting appropriate
dose of vitamin persistent prolongation
ed that they y the cause of
nity for reexposu was markedl To determine al vitamin
had no opportu time (PT) assay whether addition for more
prothrombin finding in the PT and
time in the : 9.5-12.5). This clotting time was sent

through the steps leading to the

(normal a sample

blood glucose below 70 mg/dl (normal, 90 to 100

pre- was needed, was drawn
prolonged at
57 seconds that his early . Whole blood
it appeared prevented
K therapy
ion analyses 3.8 percent
ted because detailed coagulat anticoagulant (one part
was unexpec ive vomiting had
product Contrac, how- citrate ged, and the
sentation with of rodenticide. directly into and centrifu
a toxic dose poison. parts blood) to a vet-
absorption of iolone, a long-acting K citrate to nine shipped on cold packs
s bromad vitamin 1 plasma was Coagulation
ever, contain at the same supernatant (Comparative
therefore resumed e laboratory University,
Treatment was erinary referenc ory, Cornell

mg/dl).1 Determining the insulin:glucose ratio may be

two weeks. completion tic Laborat
dosage for another recheck, 48 hours after Section, Diagnos

ultimate diagnosis in 1000-1500

ed and d
At Mugsy’s next was still markedly prolong York). d of activate
Ithaca, New ion panel consiste
, the PT sample. A thrombin
of vitamin K1 from the previous The initial coagulattime (aPTT), PT, and g
unchanged vita-
essentially submitte d, parenteral partial thrombo
plastin
aPTT and
TCT screenin
ry profile was were (TCT). The
owners clotting time
blood chemist SC, and the
given 50 mg and recheck
48
min K1 was oral vitamin K1 2000

helpful in questionable cases. Pancreatic beta-cell tu-

resume August
instructed to
ed
Peer Review

words. 76 Veterinary
Forum

mors are generally too small to detect with ultrasonog- THERAPEUTIC

raphy.17
CHALLENGE

THERAPEUTIC CHALLENGE

KAREN WILSON
The recommended treatment for pancreatic beta-cell Intussuscep
tio
tumor is surgical excision.16 Patients with this tumor While the course of therapy is of- In a Yearlin n
g
should receive either intravenous 2.5% dextrose and
By Linnea Lentz,
D.V.M.

ten clear-cut, some patients pre-

B
0.45% NaCl or intravenous 5% dextrose in water in- sent true challenges to medical
eau, a 15-mont
when the owners
described as mild,
nixine) administe
h-old colt, had been
called the referring
and Beau was treated
red intravenously
colicky for about
veterinarian. The
four hours

with 10 cc Banamin ®
colic was
e (flu-
and no other
ties. An initial
abnormali-
IV injection
of xylazine appeared
to

stead of lactated Ringer’s solution during the proce-

approximately 1 (IV), 10 cc of control the pain
⁄2 gallon of mineral dipyrone IV, and for only 20
oil administered minutes before
tube. Within the via nasogastric a second
hour, Beau was dose was necessary.
University of Minneso again colicky and Rectal
was referred to the palpation revealed

skills. In 1000-1500 words, these

ta. many
distended loops
of small
testine. After placemen in-
Initial Treatme t of

dure.1,10,16 As described for adrenal neoplasia, a com-

nt on Referra a nasogastric
Clinical signs l reflux were obtained. tube, 6-7 L of
on presentation Abdominocen-
included profuse tesis results were
sweating, numerous normal.
attempts to lie Because of the
down, and a distended severity of the
abdomen. Physical colic, the small
examination re- intestinal distention

cases describe the steps that

vealed a pulse and nasogastr ,
of 84 beats per ic reflux, we
decreased gastrointe minute, mended explorato recom-

plete exploratory celiotomy is performed to evaluate for

stinal motility ry laparotomy
all four quadrants in diagnose the cause to
, slightly toxic of the colt’s colic.
cous membran mu- The owners quickly
es, a capillary agreed, and pre-
time of 2.5 seconds refill operative antibiotic
(normal: 1-2),
and a normal
temperature. potassium penicillin s, including
work revealed Blood 22,000 units/kg
a packed cell IV and Gentocin
volume (gentamicin) 6.6

eventually lead to case resolu-

of 48 percent mg/kg IV, were

the presence of concurrent disease. A pancreatic beta-

(normal: 32-48), administered before
protein of 7.2 g/dL total preparing the colt
(normal: 5.7-7.9), for surgery. During
surgery, a jejunocec
August 2000 al intussuscep-➔
Peer Reviewed
Veterinary Forum
73

cell tumor may metastasize to the liver, spleen, and re- tion.
gional lymph nodes, indicating the need to collect CASE OF THE
MONTH

biopsy specimens from these tissues during the ex- Canine Hemipares
is , D.V.M.

CASE OF THE MONTH

By Donivan Hudgins

ploratory celiotomy.16–18
The pancreas has a right limb that is longer and larg- Some case presentations are so J asmine, a four-year-
kg, spayed Golden
old, 29-
Retriev-
to the clinic
activity levels
and vaccinations
for distemper,
had been normal,
were current
hepatitis, lep-
nza, par-
er, was presented tosporosis, parainflue
irus, Lyme

er than the left limb and is located within the meso-

of lameness.
for sudden onset vovirus, coronoav

confounding that both diagnosis

found a stray
The owner had sus- disease, and rabies.
and given Solu
goat in the backyard The patient was
goat may have ® (prednisolone)
pected that the Delta Cortef
On presenta- usly (IV) and
butted Jasmine. ry 100 mg intraveno 2.5 cc in-
was ambulato
tion, the dog amoxicillin injectable

duodenum (Figure 3).19 At the caudal duodenal flexure,

uncoordi nated, The owner was
but obviously tramuscularly.
n revealed the provide cage rest
and observatio instructed to

and therapy are perplexing. Often,

deficit was in and return
primary walking over the weekend
dog’s condition
the right rear leg. ion re- Monday if the
Physical examinat .
had not improved
re of 101.6˚F, week, Jas-
vealed a temperatu The following
es, capil- to improve, and

the right limb turns onto itself so that the entire right
pink mucous membran (normal:
CORBIS

mine appeared
of 1 sec she did have
lary refill time whatever problems
heart and Over the next
1-2 sec), normal seemed subtle.

a patient may return again and

sign of pain. The weeks, her prob-
lungs, and no two to three
did knuckle over, but not as pro-
right rear foot proprio- lems recurred the
indicating decreased indicat- before, and
nounced as the dog

limb is to the right of the root of the mesentery. The

pinch that
ception, but toe owner reported
were intact. to her deficits.
ed sensory nerves seemed to adjust
of the affected next few weeks,
Temperatures Then, over the
no different of coördination
foot and leg were Jasmine’s lack

again with continuously changing

other three feet
than that of the seemed to worsen.
and flexion 21, Jasmine
and legs. Extension were On October
examina-
joints for

left limb is shorter and thicker and lies within the deep
hip
of the stifle and reflex on was re-presented
on a leash
normal, but patellar tion. When followed appeared
exaggerated,
the right was in the lawn, Jasmine
upper motor ated, with
which suggested to be very uncoördin
Appetite and
neuron disease.

leaf of the greater omentum. The pancreas is V-shaped, signs. Word count: 1000-2000. 66 Veterinary Forum
Peer Reviewed
August 2000

and the right and left limbs meet at the apex of the V,
which is called the body of the pancreas and lies at the
pyloroduodenal junction. In most ferrets, there is one
duct within each limb of the pancreas; the two pancre- SEND YOUR ARTICLES TO:
atic ducts join to form the common pancreatic duct.
The common pancreatic duct then joins the bile duct Editor, Veterinary Forum
and empties into the duodenum as the major duodenal 275 Phillips Blvd.
papilla, 2.8 cm caudal to the cranial duodenal flexure. Trenton, NJ 08618
An accessory pancreatic duct and minor duodenal
papilla are present in a small percentage of ferrets. The Fax: (609) 882-6357
cranial and caudal pancreaticoduodenal arteries are the E-mail: lmiller.vls@medimedia.com
major blood supply to the right limb of the pancreas,

METASTASIS ■ COMMON PANCREATIC DUCT

Small Animal/Exotics 20TH ANNIVERSARY
scopic and nonpalpable to 2 cm3 but frequently can be
visualized within the pancreas as small firm masses (0.5
to 2 mm).1,10 These small masses can generally be re-
moved by blunt dissection. Hemorrhage is minimal
and is typically controlled
using gentle digital pressure
and a hemostatic agent (e.g.,
Gelfoam®, Pharmacia & Up-
john, Bridgewater, NJ, or
Surgicel™). Small pancreatic
ducts will generally seal;
leakage of pancreatic en-
zymes in small amounts is
not associated with pancre-
atitis because enzyme activa-
tion has not occurred and
the peritoneum will absorb
these enzymes.20 Pancreatic
wounds heal by fibrin depo-
sition and polymerization,
fibrous protein synthesis,
and reepithelialization. Pan-
creatitis caused by rough tis-
sue handling can occur but
is uncommon. 17,20
In some cases, multiple
masses are observed, which
is an indication for partial
pancreatectomy. It has also
Figure 3—Diagram of the anatomy of the ferret pancreas. The been recommended that a
thick black arrow indicates the major duodenal papilla (a = section of pancreas should
cranial pancreaticoduodenal vessels; B = common bile duct; b be removed and submitted
= splenic vessels; c = gastroepiploic vessels; D = duodenum; d
for histologic examination
= caudal pancreaticoduodenal vessels; L = liver; Lt = left limb;
even if no masses are palpable;
P = pancreas; PD = major [common] pancreatic duct; Rt =
right limb; S = spleen; Sv = splenic vessels; St = stomach). on occasion, these tumors
are microscopic and diffuse-
ly disseminated within the
whereas the pancreatic branch of the splenic artery sup- 1
pancreas. There are two
plies the left limb. Analogous veins provide drainage. methods for performing par-
To evaluate the pancreas, the free border of the tial pancreatectomy—dissec-
greater omentum is pulled out of the abdomen and tion and ligation of ductules
wrapped in saline-moistened sponges. The proximal and vessels, or suture frac-
portion of the duodenum is exteriorized while the ture technique.20 The suture
colon is retracted caudally. The left lobe of the pancreas fracture technique requires
is visualized in the deep leaf of the greater omentum. less time but is associated
The right lobe is visualized within the mesoduodenum. with more inflammation.
The body of the pancreas is along the pyloroduodenal The area of the lesion and
junction. By moving the duodenum toward the mid- distal to it are isolated by
line, the dorsal aspect of the right lobe can be seen; dissection, taking care not to
moving the duodenum laterally allows visualization of disrupt the common pancre-
the ventral surface of the pancreas. These manipula- atic duct. The mesoduode-
tions allow inspection of the lymph nodes as well. num or the deep leaf of the
Pancreatic beta-cell tumors range in size from micro- greater omentum is incised,
PARTIAL PANCREATECTOMY ■ SUTURE FRACTURE TECHNIQUE
Compendium September 1999
ENDIU
MP
M’
20th

CO
S

9 - 1
9 9 9
1 9 7
ANNIVERSARY
A LookBack
Twenty years ago, ferret
medicine and surgery were in
their infancy. Little published
information was available, and
ovariohysterectomy, castration,
and anal sacculectomy were the
most commonly performed
surgical procedures. Over the
past two decades, our knowledge
of ferret medicine and
physiology has expanded,
placing demands on our
surgical skills to be able to
perform more intricate
procedures on these loving pets.
We are now able to routinely
perform such procedures as
removal of adrenal masses using
vascular clamps to provide
temporary occlusion of the
caudal vena cava. The degree of
difficulty in ferret surgery has
expanded with the widespread
use of magnifying loupe
telescopes, microsurgical
instrumentation, and various
hemostatic aids. Currently,
nearly any surgical procedure
that can be performed in dogs
and cats can be accomplished in
pet ferrets as well. (Pictured:
Jason Wheeler [left] and R.
Avery Bennett)
Compendium September 1999 Small Animal/Exotics
Produce the ultimate
providing access to the right or left lobe of the pancreas,
respectively. After isolation, a ligature is passed around the
in dental x-rays
portion of pancreas to be excised. As the suture is tight-
ened, it crushes the parenchyma of the pancreas and lig-
Atlas of Canine & Feline
ates the vessels and ducts. The tissue distal to the ligature
is excised. The defect in the mesentery or omentum is
DENTAL RADIOGRAPHY
closed to prevent entrapment of viscera. Thomas W. Mulligan • Mary Suzanne Aller •
In the dissection and ligation technique, the lobules Charles A. Williams
are gently separated from adjacent tissue until the ves- Mary Suzanne Aller, Editor
sels and duct or ductules are exposed. These are ligated
with hemostatic clips or fine, absorbable monofilament 248 pages, 846 radiographs with arrow
suture and then transected distal to the ligatures to al- overlays to indicate notable features
low removal of the tissue.
During partial pancreatectomy, care must be taken to
ensure that the blood supply to other structures has not
been compromised. If the pancreaticoduodenal vessels
are ligated when a portion of the right limb of the pan-
creas is removed, the blood supply to the proximal duo-
denum may be impaired. On the left side, ligation of
the splenic vessels could occur, thereby restricting blood
flow to the spleen. After partial pancreatectomy, the
duodenum and spleen must be evaluated prior to clo- RATED
sure to ensure patency of the blood supply. In dogs, re- ★★★★★
moval of 80% to 90% of the pancreas will not alter ex-
ocrine or endocrine pancreatic function as long as the
common duct is maintained intact to drain the remain-
ing portion20; this has not been studied in ferrets.
After surgery, an intravenous catheter should be
$
80
maintained for 24 to 48 hours and the patient should
receive 2.5% dextrose and 0.45% saline or 5% dextrose
$89
in water at 10% of body weight for 24 hours. On the
% off! First in the field
first day after surgery, the patient is fed a bland diet in
small but frequent meals and lactated Ringer’s solution
0
1 846 reference radiographs
is administered intravenously or subcutaneously at 10%
of body weight per 24 hours. On the second day after ■ Practical tips throughout
surgery, the patient is returned to its normal diet and ■ More than 840 real-case images with indicative
generally requires no additional medication. Blood glu- arrows
cose is monitored every 12 to 24 hours and may take 2 ■ State-of-the-art techniques for the beginning
to 3 days to return to normal.1 practitioner, technician, and specialist
Surgical removal of pancreatic beta-cell tumors is fre-
■ Precise information on positioning, supplies
quently considered a debulking procedure because these
and equipment, processing, safety, film
tumors have a high recurrence rate and metastatic poten-
tial.16,18 Surgery provides definitive identification of the handling, and more
tumor and temporary relief of clinical signs associated
with hypoglycemia. Fasting blood glucose level should be
evaluated 2 weeks postoperatively and then every 1 to 3
months to determine whether the pancreatic beta-cell tu- VLS
VE T E R I N A RY
BOOKS
L E A R N I NG SYS T E M S
mor is recurring. Subsequent surgeries may be performed
if the beta-cell tumor recurs.
CALL OR FAX TODAY TO ORDER
800-426-9119 • Fax: 800-556-3288
REFERENCES
1. Brown SA: Ferrets: Common disorders, in Jenkins JR, Price valid only in the US, Canada, Mexico, and
Brown SA: A Practitioner’s Guide to Rabbits and Ferrets.
the Caribbean. Request international pricing.
Email: books.vls@medimedia.com

BLOOD SUPPLY ■ POSTSURGICAL CARE

Small Animal/Exotics 20TH ANNIVERSARY
Denver, American Animal Hospital Association, 1993, pp
65–90.
2. Rosenthal KL: Adrenal gland disease in ferrets. Vet Clin
North Am Small Anim Pract 27(2):401–418, 1997.
3. Hillyer EV: Ferret endocrinology, in Kirk RW, Bonagura JD
(eds): Current Veterinary Therapy XI. Philadelphia, WB
Saunders Co, 1992, pp 1185–1189.
4. Hillyer EV, Quesenberry KE: Endocrine diseases, in Hillyer
EV, Quesenberry KE (eds): Ferrets, Rabbits, and Rodents
Clinical Medicine and Surgery. Philadelphia, WB Saunders
Co, 1997, pp 85–98.
5. Weiss CA, Scott MV: Clinical aspects and surgical treatment
of hyperadrenocorticism in the domestic ferret: 94 cases
(1994–1996). JAAHA 33:487–493, 1997.
6. Ackermann J, Carpenter JW, Godshalk CP, Harms CA: Ul-
trasonographic detection of adrenal gland tumors in two fer-
rets. JAVMA 205(7):1001–1003, 1994.
7. Rosenthal KL, Peterson ME: Evaluation of plasma androgen
and estrogen concentrations in ferrets with hyperadrenocor-
ticism. JAVMA 209(6):1097–1102, 1996.
8. Rosenthal KL, Peterson ME, Quesenberry KE, et al: Hyper-
adrenocorticism associated with adrenocortical tumor or
nodular hyperplasia of the adrenal gland in ferrets: 50 cases
(1987–1991). JAVMA 203(2):271–275, 1993.
9. Lawrence HJ, Gould WJ, Flanders JA, et al: Unilateral
adrenalectomy as a treatment for adrenocortical tumors in fer-
rets: Five cases (1990–1992). JAVMA 203(2):267–270, 1993.
10. Mullen H: Soft tissue surgery, in Hillyer EV, Quesenberry
KE (eds): Ferrets, Rabbits, and Rodents Clinical Medicine and
Surgery. Philadelphia, WB Saunders Co, 1997, pp 131–144.
11. Mullen HS, Scavelli TD, Quesenberry KE, Hillyer E: Gas-
trointestinal foreign body in ferrets: 25 cases (1986 to 1990).
JAAHA 28:13–19, 1992.
12. Filion DL, Hoar RM: Adrenalectomy in the ferret. Lab
Anim Sci 35(3):294–295, 1985.
Compendium September 1999
13. Birchard SJ: Adrenalectomy, in Slatter D (ed): Textbook of
Small Animal Surgery. Philadelphia, WB Saunders Co, 1993,
pp 1510–1514.
14. Brown SA: Adrenal and pancreatic neoplasia. Proc North Am
Vet Conf :725–727, 1993.
15. Ehrhart N, Withrow SJ, Ehrhart EJ, Wimsatt JH: Pancreatic
beta cell tumors in ferrets: 20 cases (1986–1994). JAVMA
209 (10): 1737–1740, 1996.
16. Elie MS, Zerbe CA: Pancreatic beta cell tumor in dogs, cats,
and ferrets. Compend Contin Educ Pract Vet 17(1):51–59, 1995.
17. Caplan ER, Peterson ME, Mullen HS, et al: Diagnosis and
treatment of insulin-secreting pancreatic islet cell tumors in
ferrets: 57 cases (1986–1995). JAVMA 209(10):1741–1745,
1996.
18. Rosenthal KL: How we treat a pancreatic beta cell tumor in
the ferret. Proc North Am Vet Conf:822, 1994.
19. Evans HE, An NQ: Anatomy of the ferret, in Fox JG: Biolo-
gy and Diseases of the Ferret. Baltimore, Williams & Wilkins,
1998, pp 19–69.
20. Harari J, Lincoln J: Surgery of the exocrine pancreas, in Slatter
D (ed): Textbook of Small Animal Surgery. Philadelphia, WB
Saunders Co, 1993, pp 678–691.
About the Author
Drs. Wheeler and Bennett are affiliated with the Depart-
ment of Small Animal Clinical Sciences, College of Veteri-
nary Medicine, University of Florida, Gainesville, Florida.
Dr. Bennett is a Diplomate of the American College of
Veterinary Surgeons.