tpvets_logo.jpg (2726 bytes)TOA PAYOH VETS
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Date:   11 October, 2011  

Focus:
 Small animals - dogs, cats, hamsters, guinea pigs, turtles & rabbits
Two cases of dwarf hamsters' everted cheek pouch
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
11 October, 2011
toapayohvets.com 
Be Kind To Pets
Veterinary Education
Project 2010-0129
Case 1
The young lady's dwarf hamster has a pink mass

The young lady's vet gave a baytril 1% oral antibiotic 2 days ago. He said he would not operate as he was not able to do so.

everted left cheek pouch, dwarf hamster, singapore, toapayohvetsSo the young lady must have had surfed the net and brought her hamster to me. I did not ask her. Nowadays, young people are "google" people and they sometimes know more than the vet regarding specific niche conditions of their pets! A vet has to know everything in the hamster from nose to toe and that is only one species. How about dogs, cats, terrapins, guinea pigs, birds and fishes, iguanas and others? This comes from time in practice. Vets are not Gods and will need time to become experienced. Pet owners need to understand this.   

She knew that her hamster's left pouch had turned inside out and needed to get a vet to operate. A pink mass dangled from the left cheek. One end had become black, a sign of gangrene. Blood supply has been cut off. The surrounding part had turned yellow due to bacterial infection.  A speck of yellow pus dried on the upper eyelid.

"Antibiotics will not shrink the dwarf hamster's cheek pouch inwards," I said. "Your hamster needs surgery and the end of the infected pouch needs to be cut away. There is anaesthetic risk. Will you accept the risk?"

The young lady had no choice. If she did not consent to the operation, the hamster will die from infections. If she consented, the hamster may return to a normal life.

I would operate together with Dr Vanessa. Everted cheek pouch surgery is best seen once. The risk is not surgery but anaesthesia. 

Isoflurane gas was used. The assistant must focus on this. Dr Vanessa operated with me. "It is a simple surgery compared to Caesarean section or spay. Clamp the pouch first," I said. "Cut and stitch".

It is easy to lecture. The hamster woke up from the gas anaesthesia and needed to be given the gas again. The necrotic end was excised with scalpel. Anesthesia again. Stitch 6/0 absorbable x 3 interrupted.

"Don't stress the hamster," I gave this advice to Dr Vanessa. "Unclamp as the hamster had woken up and may die of fright struggling with a clamp. The correct way is to give the gas anaesthesia again."

On unclamping, the cut end of the pouch shrank inwards. "No problem with that," I said. "Used the forceps to pull out the cut ends to give 3 simple interrupted stitches".

As long as the hamster is anaesthesized adequately without killing him, the stitching is not a problem. The pouch was thus stitched with 6/0 absorbable sutures. The hamster went home to a happy young lady. There was slight bleeding and she would take care of it. "Use the other vet's antibiotics to save you some money," I said. "Do you want to take the excised pouch home with you?"

She shook her head. I showed her the illustration of how the pouch was excised. She seemed to be in a hurry and so I did not detain her. Overall, this was a satisfactory outcome. As long as the hamster survives the anaesthesia, the surgery is not complicated and the hamster owner is usually very delighted with the surgical outcome. 

Questions asked by owner:
1. Feed liquid food? No need.
2. Can she store food? Not much as 80% had been cut off in the left cheek pouch. The right cheek pouch is still there.
3. What if she did not get surgery done?
Pus already in pouch. Gangrene tip. Hamster will die from infections.
4. "The hamster had pulled out a stitch," she phoned me later. "The stitch could have been cut longer and therefore looked loose," I said. But she did not turn up for a check up. I presumed all are well as I did not see her 7 days after surgery nor hear from her by phone.  

"Warts seen in right ear," I had said to the young lady. "If they grow bigger or the hamster feels itchy, they need to be excised." Presently her vet had give some anti-fungal wash to the other hamster with similar problem. Both hamsters live by themselves.
 

How an everted cheek pouch is operated at Toa Payoh Vets
Isoflurane + oxygen gas anaesthesia was used in this case

everted left cheek pouch, dwarf hamster, singapore, toapayohvets everted left cheek pouch, dwarf hamster, singapore, toapayohvets everted left cheek pouch, dwarf hamster, singapore, toapayohvets
everted left cheek pouch, dwarf hamster, singapore, toapayohvets everted left cheek pouch, dwarf hamster, singapore, toapayohvets  
  everted left cheek pouch, dwarf hamster, singapore, toapayohvets everted left cheek pouch, dwarf hamster, singapore, toapayohvets

A gentle hamster. Does not squeak or bite the vet! But my assistant Min does not take chances. He wears the hand grove when handling this hamster!

Case 2
AN E-MAIL FROM A HAMSTER OWNER


E-MAIL TO DR SING DATED MAY 22, 2011

Dear Doctor,
I have a hamster that has an everted cheek pouch. Since yesterday, her cheek pouch has been hanging outside her mouth. She seems to be in pain. Does she have to go to surgery? How much does it cost and how long does it take? I would also like to make an appointment on Wednesday, 25th May 2011 between 3 to 5 pm. Can you confirm if you are available? Please reply as soon as possible. Thank you.

Regards,
Name

E-MAIL REPLY FROM DR SING Tuesday, May 22, 2011 2.04 am

I am Dr Sing from Toa Payoh Vets. Thank you for your email.
In reply, your hamster may need surgery if the everted cheek pouch cannot be put back inside the cheek, e.g. if it is infected and damaged badly. Cost is capped at the maximum of $150 for consultation, anaesthesia and surgery (longer duration as likely to be in your case). It takes around 10 minutes for surgery but with preparation and gas anaesthesia to effect, it will be around 25 minutes.

I did not meet the writer myself.


Hamster cheek pouch cases and images seen by Dr Sing at Toa Payoh Vets:
http://www.bekindtopets.com/animals/
20100120Dwarf_Hamster_Cheek_Pouch_Prolapse_ToaPayohVets.htm

http://www.bekindtopets.com/animals/tpvets_Feb2509.htm

http://www.bekindtopets.com/animals/tpvets_Mar1308.htm

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All rights reserved. Revised: October 11, 2011

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