Journal of Zoo and Wildlife Medicine 36(4): 698–701, 2005

Copyright 2005 by American Association of Zoo Veterinarians

PARAPHIMOSIS AND AMPUTATION IN A NILE CROCODILE

(CROCODYLUS NILOTICUS)

Felix Lankester, M.Sc. M.R.C.V.S., and Stephen J. Hernandez-Divers, B.Vet.Med., C.Biol.,

M.I.Biol., M.R.C.V.S., D.Zoo.Med.(Reptilian), Dipl. A.C.Z.M.

Abstract: A captive Nile crocodile (Crocodylus niloticus) developed recurrent episodes of paraphimosis over a 2-
yr period, which eventually led to hemorrhage and obvious inflammation. Two months postsurgery, the crocodile
remained clinically normal.
Key words: Crocodylus niloticus, Nile crocodile, paraphimosis.

CASE PRESENTATION ably in an attempt to relieve pressure from the vent

An approximately 8-yr-old male Nile crocodile
(Crocodylus niloticus), measuring 305 cm in
length, from The Limbe Wildife Centre (LWC),
South West Province, Cameroon, had a 2-yr history
of intermittent phallus prolapse. The affected croc-
odile shared an outdoor enclosure, 10 m 3 8 m,
with a conspecific of similar age of undetermined
sex. The enclosure contained a shallow concrete
pool, approximately 2 m 3 2 m, in one corner. The
rest of the enclosure was natural earth and rock
substrate, typical of the geographic location. Sea-
sonal temperatures varied between 28 and 328C,
mean annual rainfall was 400 cm/yr, and both ani-
mals were exposed to natural sunlight and photo-
periods. The crocodiles were typically fed once a
week, and their diet, since their arrival at the LWC
in 1998, alternated weekly between unsupplement-
ed neonatal calf (Bos indicus) carcasses and offal.
According to verbal reports from the curatorial
staff, the phallus had been seen to prolapse inter-
mittently over the previous 2 yr. These prolapse ep-
isodes had lasted for between 1 and 10 days before
the phallus retracted back into the cloaca without
any other signs of ill health.
In the 3-mo period before surgery, the principal
author witnessed four separate episodes of phallic
prolapse, which lasted 12, 10, 11, and 3 days, re-
spectively. Hemorrhage was seen emanating from
the vent during the last two of these episodes. The
crocodile adopted a characteristic posture during
each episode with the hind-limbs tucked under the
body and the pelvic region arched dorsad, presum-
From The Limbe Wildlife Centre, P.O. Box 878, Limbe,
SWP, Cameroon (Lankester); and the Exotic Animal,
Wildlife and Zoological Medicine Service, Department of
Small Animal Medicine and Surgery, College of Veteri-
nary Medicine, University of Georgia, Athens, Georgia
30602, USA (Hernandez-Divers). Correspondence should
be addressed to Dr. Lankester.
region. On the third day of the last episode of phal-
lic prolapse, surgical intervention was undertaken.
Surgical intervention had not been an option pre-
viously as the principal author was not attending
clinician at the LWC. During the first two episodes
that the principal author had witnessed, surgery had
not been elected as the crocodile demonstrated no
other clinical signs, and the prolapse had resolved
spontaneously. In the week preceding surgery, the
crocodile became depressed, anorectic, and unwill-
ing to move.
Reptile phalluses can be amputated under general
anesthesia or with localized anesthesia with physi-
cal restraint or sedation. It is recommended that sur-
gical amputation be performed under general an-
esthesia as much for restraint as for ablation of sur-
gical pain.4,6 In this case general anesthesia was
chosen to immobilize the crocodile. The lack of
available sedative agents, the practical difficulties
of physically restraining a large crocodile, the
health and safety implications for the curatorial
staff, their inexperience at physically restraining
large crocodiles, and lack of prior experience of
chemical immobilization for crocodiles at LWC
were the reasons for this choice.
The reptile, which had not eaten for a week, was
estimated at 100 kg bodyweight, and the resting
respiratory rate was 40 breaths/min. Anesthetic in-
duction was achieved using 300 mg (3 mg/kg) til-
etamine-zolazepam (Zoletilt 200 mg/ml, Virbac,
Barcelona, Spain)—a dose determined from the lit-
erature—delivered by i.m. injection into the caudal
musculature of the left thigh using a hand-made
pole syringe (Fig. 1).8,9 This anatomic site was cho-
sen for administration of the anesthetic agent for
ease, safety, and adequate muscle mass, despite the
potential effects from the renal-portal circulation.9
The pole syringe was fashioned from a 2-m
length of rigid rubber piping, inside which was in-
serted a 2.5 m metal pole. By pressing on the metal

698
 LANKESTER AND HERNANDEZ-DIVERS—CROCODILE PHALLUS PROLAPSE
Figure 1. Pole-syringe administration of tiletaline-zolazepam to induce anesthesia in the Nile crocodile (Crocodylus
niloticus).
pole the principal author was able to depress the
plunger of the 20-ml syringe with an 18-gauge (3.5
cm) needle attached, which was inserted and se-
cured without adhesives to the end of the rubber
piping.
The respiratory rate decreased to 10 breaths/min
by 10 min postinjection, and to 4 breaths/min by
25 min postinjection, at which time the crocodile
was unresponsive to stimulation.
The animal was physically immobilized by four
men who straddled the crocodile and applied pres-
sure along the dorsum. The crocodile’s jaws were
taped closed using adhesive tape (Mag Tape Orig-
inal, The Gaffer Tape Company, St. Ives, Cambrid-
geshire, United Kingdom), and the fore- and hind-
limbs were retracted in a dorsal–caudal direction
and were tied together with rope. Once the animal
was secured, a dorsal physical examination was
performed without abnormalities being detected. A
699
wooden plank (3 m 3 50 cm 3 4 cm) was then
placed along the dorsum of the animal and securely
tied in place with rope. The crocodile was rolled
into dorsal recumbency, and a ventral examination
was performed. No abnormalities other than the
prolapsed phallus were detected.
The partially prolapsed phallus was fully extrud-
ed from the vent using manual pressure in a cranial
direction. Close inspection of the cloaca revealed
foreign material consisting of enclosure substrate.
Generalized inflammation and multifocal necrosis
were observed throughout the mucosa of the phal-
lus and proctodeum. The phallus, proctodeum, and
pericloacal tissue were aseptically cleaned using di-
luted povidone iodine solution (Vetedine Savon,
Vetoquinol S.A., Specialites Pharmaceutiques Ve-
terinaires 70204, Cedex, France). No obvious cause
of the condition could be identified. A local anes-
thetic block was achieved by infiltrating 5 ml of
700 JOURNAL OF ZOO AND WILDLIFE MEDICINE

Figure 2. Ventral view of the vent region of the Nile crocodile (Crocodylus niloticus) with prolapsed phallus (P)
and cloacal tissue (C). The craniad direction is indicated for orientation (Cr). The position of the two circumferential
sutures (arrows) and site of amputation (hashed line) are shown.

lidocaine hydrochloride (Ilium 20 mg/ml, Troy
Laboratories PTY Limited, Smithfield NSW 2164,
Australia) into the base of the phallus. After a delay
of 5 min the base of the phallus was double ligated
with two circumferential ligatures using 4 metric
(1/0) polyglactin 910 suture material (Vicryl, Eth-
icon Inc., Piscataway, New Jersey 08855, USA)
(Fig. 2). Following ligation, the phallus was am-
putated 2 cm distal to the distal ligature. After am-
putation, hemorrhage occurred from the two central
arteries of the phallus. Hemostasis was achieved us-
ing electrocautery (Cautery High Temperature
Loop Tip, Aaron Medical Industries, Inc., St. Pe-
tersburg, Florida 33710, USA). The phallic stump
and exposed cloacal tissues were lavaged using di-
luted povidone iodine solution and replaced inside
the vent using gentle digital pressure. The crocodile
was returned to sternal recumbency and 500 mg (5
mg/kg) of enrofloxacin (10% injectable Baytril,
Bayer Animal Health, Pittsburgh, Pennsylvania
15205, USA) was injected into the musculature of
the right antebrachium.
The crocodile, which could not be weighed be-
cause of lack of available equipment, was untied,
and the respiration rate monitored during recovery.
Anesthetic recovery was prolonged with initial
movement first detected 5 hr and 50 min after in-
duction; however, the crocodile accepted food the
day after surgery. Postoperatively, additional 500-
mg doses of enrofloxacin were administered by
deep i.m. injection via pole syringe every 48 hr for
three treatments. The abnormal posture identified
before surgery resolved by 7 days postoperatively,
with the crocodile adopting a more usual basking
pose. No further hemorrhage was observed, and the
animal remains clinically normal 2 mo after the
procedure.
The crocodilian phallus is a copulatory organ
without urinary function; hence, a descriptive pref-
erence of the term phallus over penis.10 It is a dis-
tensible, grooved, unpaired organ located in the
ventroposterior region of the cloaca, near the
vent.7,10 The phallus is primarily cartilaginous and
has little erectile tissue.7 Paraphimosis is a common
condition in reptiles.1,5 However, the authors were
unable to find previous reports of phallic prolapse
 LANKESTER AND HERNANDEZ-DIVERS—CROCODILE PHALLUS PROLAPSE
in a crocodilian. The described causes of phallic
prolapse include trauma from bites by conspecifics,
traction during copulation, infection, inflammation,
neurologic deficits involving the retractor phallus
muscles or cloacal sphincter, impaction of the clo-
aca with urates, and iatrogenic damage during prob-
ing.1,2,5,11 It is possible that this crocodile was hy-
pocalcemic because the offal and neonatal calf car-
casses fed to the crocodiles were the only source
of calcium. However, the other Nile crocodile and
the two dwarf crocodiles (Osteolaemus tetraspis)
resident at the LWC, which were fed the same diet,
show no signs of hypocalcaemia. The authors were
unable to find evidence of a relationship between
phallic prolapse and hypocalcemia in the literature.
In this case, no cause could be conclusively iden-
tified.
Following prolapse, the phallic tissue quickly be-
comes traumatized and inflamed, making retraction
back through the vent impossible.3 If the tissue is
not irreversibly damaged, it can be cleaned and re-
duced using glycerine or concentrated sugar solu-
tions to reduce swelling, and lubricated to facilitate
replacement into the cloaca.2 Cases involving ex-
tensive trauma, desiccation, necrosis, or recurrent
episodes of prolapse are best treated by amputa-
tion.1,3,4,11 Because the reptilian phallus has no uri-
nary function, the only consequence of amputation
is an inability to copulate and breed,1,2 a conse-
quence that was not considered important given
that the Nile crocodile is not listed as endangered8
and that the function of the crocodile in question at
the LWC, a rescue and rehabilitation center that
specializes in endangered west Central African pri-
mates, was purely for conservation education.
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701
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Received for publication 15 March 2005