Rehabilitation of wildlife refers to the treatment and temporary care of injured, diseased, and displaced animals, and the release of healthy animals to appropriate habitats after recovery (9). Treating injured wild animals and releasing them into nature is important from a species conservation standpoint as they contribute to population growth through reproduction (8). The rehabilitation process depends on the species of wildlife, and the type or severity of the injury (10). According to a study in East Tennessee, USA, rescue after trauma (26.3%) is the most common reason for mammals to be admitted to a wildlife rescue center. Getting hit by a car (8.6%) has been identified as the fourth most common cause of trauma (14). However, since trauma and related hospitalization may include unconfirmed road accidents, the actual proportion of trauma due to road accidents is likely to be higher. In South Korea, road accidents involving wild animals are on the rise due to habitat fragmentation, a high car ownership rate, and a high road ratio compared to the land area, all of which pose a significant threat to maintaining the wildlife population (6,15). According to a study in Brazil, mammals rescued from road accidents were often observed to have multiple injuries in various body parts. Up to 89% of the animals suffered abdominal and pelvic injuries, 87% suffered chest injuries, 84% head and neck injuries, and 67% extremity injuries (13). We can infer from these results that multiple injuries occur in various parts of an animal’s body when a road accident occurs. This paper describes the rehabilitation of an Amur leopard cat (Prionailurus bengalensis) injured in a road accident.

A 2.2 kg adult female Amur leopard cat exhibiting lethargy and cachexia was rescued from a road accident. A physical examination showed body condition scores of 1/9 (1), severe lacerations and ulcerations of the left chin (Fig. 1), and corneal erosion of the oculus sinister (OS) (Fig. 2A). A complete blood count (CBC) revealed leukocytosis (Table 1) (12). The skin injury on the left chin was washed with normal saline and 10% povidone-iodine daily and then 10 mg/g silver sulfadiazine (Silmazin 1% cream; Dong Wha Pharm) was applied under general anesthesia with isoflurane (Terrell; Piramal Critical Care). In addition, ofloxacin (OcuFlox; Samil) and 5% sodium chloride (Muro 128; Bausch&Lomb) eye drops were administered once a day for the OS to relieve corneal edema and to prevent secondary bacterial infection.

Table 1 . The changes in hematology and blood chemistry in the treatment of the Amur leopard cat (Prionalurus bengalensis) by a road accident.

Parameter	Value										Bornean leopard cats#
	Day 0	Day 6	Day 20	Day 33*	Day 42	Day 50**	Day 58	Day 77	Day 83	Day 93
WBC (×103/μL)	37.2	8.9	32.4	29.5	19.1	7.7	10.4	16.8	11.7	10.9	4.8-15.9
Neu (%)	42.5	40.7	51.0	36.3	35.2	26.9	69.2	42.2	78.6	32.9
Lym (%)	56.8	55.9	48.4	58.8	64.2	72.5	25.8	57.3	17.2	66.4
Mon (%)	0.8	3.4	0.6	4.9	0.6	0.6	5.0	0.5	4.2	0.6
Neu (×103/μL)	15.8	3.7	16.6	10.7	6.7	2.1	7.2	7.1	9.3	3.6
Lym (×103/μL)	21.1	5.0	15.7	17.3	12.3	5.5	2.7	9.6	2.0	7.2
Mon (×103/μL)	0.3	0.3	0.2	1.4	0.1	0.1	0.5	0.1	0.5	0.1
RBC (×106/μL)	7.4	3.2	2.9	4.7	6.3	7.0	7.4	6.1	8.5	8.1
PCV (%)	34.2	14.8	15.4	23.7	28.7	30.6	30.1	25.1	33.2	32.6	27-40
Hgb (g/dL)	10.0	3.9	4.2	7.5	7.7	8.5	8.7	7.2	9.9	9.8
MCV (fL)	46.1	45.9	52.8	50.2	45.7	43.4	40.8	41.0	39.3	40.1
MCH (pg)	13.5	12.1	14.4	15.8	12.3	12.1	11.8	11.8	11.7	12.1
MCHC (g/dL)	29.3	26.3	27.3	31.6	26.8	27.8	28.9	28.7	29.8	30.1
PLT (×103/μL)	117	269	170	356	143	507	376	118	388	581
TP (g/dL)	6.8	6.6	ND	8.3	8.5	9.0	ND	ND	ND	8.1
K (mmol/L)	4.6	3.8	ND	3.6	3.8	3.8	ND	ND	ND	4.4	3.8-5.1
Na:K ratio	32.4	41.3	ND	42.2	40.5	41.3	ND	ND	ND	34.5
Ca (mg/dL)	8.3	9.1	ND	10.6	10.3	10.7	ND	ND	ND	10.3	4.8-9.2
P (mg/dL)	4.4	5.7	ND	5.0	4.0	6.5	ND	ND	ND	5.3	4.6-6.8
Na (mg/dL)	149	157	ND	152	154	157	ND	ND	ND	152	140-153
Alb (g/dL)	2.1	2.8	ND	3.8	3.9	4.1	ND	ND	ND	4.4
Glob (g/dL)	4.7	3.8	ND	4.5	4.6	4.9	ND	ND	ND	3.7
A:G ratio	0.4	0.7	ND	0.8	0.8	0.8	ND	ND	ND	1.2
ALT (IU/L)	43	28	ND	24	29	25	ND	ND	ND	29	76-179
BUN (mg/dL)	47	42	ND	32	22	44	ND	ND	ND	33	8.7-20.2
Crea (mg/dL)	0.6	0.4	ND	0.5	0.8	1.1	ND	ND	ND	0.8	0.9-1.2
Glu (mg/dL)	165	158	ND	113	114	151	ND	ND	ND	116
TB (mg/dL)	0.4	0.4	ND	0.6	0.3	0.4	ND	ND	ND	0.4	0.1-0.2
Amy (IU/L)	391	395	ND	404	405	405	ND	ND	ND	480
ALP (IU/L)	23	22	ND	27	32	43	ND	ND	ND	26	5-479

Day 0 is the first day of the rescue. WBC, white blood cells; Neu, neutrophils; Lym, lymphocytes; Mon, monocytes; RBC, red blood cells; PCV, packed cell volume; Hgb, hemoglobin; MCV, mean cell volume; MCH, mean cell hemoglobin; MCHC, mean cell hemoglobin concentration; PLT, platelets; TP, total protein; Alb, albumin; Glob, globulin; ALT, alanine aminotransferase; BUN, blood urea nitrogen; Crea, creatinine; Glu, glucose; TB, total bilirubin; Amy, amylase; ALP, alkaline phosphatase; ND, not derived. *The day of endoscopy. **The day of enucleation. ^#Nájera F et al. 2014 (12)..

Figure 1. Healing process of left facial laceration in the Amur leopard cat (Prionailurus bengalensis) involved in a road accident. (A) Day 6, (B) day 22, (C) day 54, (D) day 83.

Figure 2. Transpalpebral enucleation surgery on the oculus sinister (OS) of the Amur leopard cat (Prionailurus bengalensis). (A) OS before surgery. (B) Nerves, blood vessels, and other tissues were excised using an electrothermal vessel sealer. (C) Postoperative suture status. (D) The overall shape of the enucleated OS.

On the 6th day of hospitalization, melena and diarrhea were observed. A fecal microscopic examination revealed numerous rod-shaped bacteria and roundworms, and CBC revealed anemia (Table 1). Amoxicillin/clavulanate (Amocla; Kuhnil Corp., 62.5 mg/kg IV), metronidazole (Metrynal; Dai Han Pharm, 15 mg/kg IV), and iron dextran (Samu IRON 12; Samu Median, 10 mg/kg IM) were prescribed for 13 days for the correction of the symptoms. However, the patient’s melena, diarrhea, and anemia did not improve.

On the 20th day, a fracture of the third sternum and the presence of foreign bodies (FBs) in the stomach were confirmed by radiographic examination (Fig. 3). Besides, the lesion in the OS gradually deteriorated, and the lens spontaneously detached. Melena was also observed intermittently. Thus, removing the FBs, fixation of the sternum fracture, and enucleation of the OS were necessary. However, since the patient’s general condition was poor, a decision to first remove the FBs using an endoscope was made. If the patient’s general condition improved, sternum fixation and enucleation could be performed subsequently.

Figure 3. Radiographs of the Amur leopard cat (Prionailurus bengalensis) involved in a traffic accident. (A) Sternum fractures were found (arrows). (B) Linear-shaped radiopaque foreign bodies were found in the leopard cat’s stomach (asterisk).

With a packed cell volume (PCV) of 23.8%, anesthesia for more than 30 minutes still posed a risk. However, since the removal of FBs in the stomach could no longer be delayed, an endoscopy was conducted using the standard method prescribed for domestic cats (16) with some modifications, on the 33rd day. Briefly, anesthesia was induced with 6% isoflurane in 100% oxygen delivered via a mask. The patient was intubated with a 4 mm (inner diameter) endotracheal tube with an inflatable cuff (Sheridan tube, Jorvet). The tube was connected to a semi-closed re-breathing system (Multiplus-MEVD, Royal med) and the pop-off valve was opened (maintenance; 3% isoflurane in 100% oxygen). For flexible gastrointestinal (GI) endoscopy, the patient was positioned in left lateral recumbency. This position could help the operators evaluate the gastric mucosa and the stomach passage and also improve the opening of the gastric antrum and pylorus by insufflated air. The operator inserted the endoscope (PENTAX EPK-1000) with an insertion tube (EC-3890LK) with a diameter of 13.2 mm (PENTAX Medical; Tokyo, Japan) through the mouth into the stomach and the presence of a large quantity of bandage material and hardened infusion lines in the stomach was confirmed (Fig. 4A, B). They were removed using an endoscope and grasping forceps (Fig. 4C) in 42 minutes and the total anesthesia time was 62 minutes. During endoscopy, the mean heart rate (HR), respiratory rate (RR), rectal temperature (RT), and blood oxygen saturation (SpO₂) were 138 beats/minute, 20 breaths/minute, 37.2°C, and 92%, respectively.

Figure 4. (A, B) Foreign bodies in the stomach confirmed by endoscopy, (C) Gastric foreign bodies were removed from the Amur leopard cat (Prionailurus bengalensis) using endoscopy. Surgical tape, control gel formula dressing, and hardened infusion lines were identified.

On the 38th day, five days after the endoscopic procedure, the patient’s general condition and appetite improved. The white blood cell count (WBCs) decreased (29.5 × 10³/μL to 19.1 × 10³/μL), PCV increased (23.7% to 28.7%), and melena was absent in the feces. Hence, it was decided to proceed with the OS enucleation and correction of the sternum fracture.

On the 50th day, general anesthesia was administered by the process mentioned above and the patient was given glycopyrrolate (Mobinul; Myungmmon Pharm, 0.01 mg/kg, intramuscularly) and meloxicam (Metacam; Boehringer Ingelheim, 0.2 mg/kg, subcutaneously). Lactated Ringer’s solution (Hartmann’s Sol.; Daihan Pharm) was administered via the venous catheter at a rate of 10 mL/kg/hour. The enucleation was carried out using the transpalpebral method for cats (2), but with a modification in the resection of the blood vessels and nerves using an electrothermal vessel sealing system, LigaSure^TM (Covidien; Dublin, Ireland). Then, thoracic skin and muscle incisions were performed in the dorsal recumbency position to correct the sternum fracture. However, the fractured sternum had healed naturally and was fairly stable. Considering that the patient had not shown any respiratory discomfort and as the union had already taken place in the fracture area and was stable, the opened area was closed without corrective surgery. During the operation, the mean HR, RR, RT, and SpO₂ were 118 beats/minute, 15 breaths/minute, 36.8°C, and 90%, respectively.

On the 83rd day, the PCV of the patient showed a continuous increase (23.7% on the 33rd day to 33.2% on the 83rd day), WBCs decreased (29.5 × 10³/μL on the 33rd day to 11.7 × 10³/μL on the 83rd day) to the reference interval (Table 1) after the endoscopic removal of the FBs. The appetite and vitality gradually increased, and as no abnormal clinical findings were observed, the patient was transferred to a training facility for nature adaptation that minimizes contact with people (Fig. 5).

Figure 5. The Amur leopard cat (Prionailurus bengalensis) was released into the wild after treatment and nature adaptation training.

On the 97th day, the patient was finally released into the wild after treatment for all the injuries was completed.

This report describes the rehabilitation process of an Amur leopard cat with complex injuries caused by a road accident. The Amur leopard cat completely recovered with intensive treatment and was finally returned to its natural habitat. The rescued Amur leopard cat was successfully treated, however, some improvements in the process could lead to better outcomes.

First, precautions were not taken to prevent FB ingestion during hospitalization. Also, we did not immediately recognize that the patient had swallowed FBs. The ingestion of FBs is a common occurrence in veterinary clinics (7). Since wild animals tend to be more stressed than domestic animals during hospitalization, behaviors such as FB ingestion should be anticipated and more careful observation and preventive measures should be taken during hospitalization (e.g., intravenous line protected with inedible material, etc.).

Even though we failed to early recognition of FB ingestion, we believe that removing the FBs using an endoscope rather than a surgical approach was appropriate as it could reduce the stress of the injured wild animal. Besides, although GI endoscopy is commonly used in domestic cats (3), to our knowledge, this is the first report on the use of this technique for foreign body removal in a wild Amur leopard cat. Through this case, it was confirmed that the size of the GI endoscope used in domestic cats is also applicable to Amur leopard cats and that foreign bodies can be removed through endoscopy.

Second, although there were clinical signs of melena, the differential diagnosis of melena was omitted. There are several causes of melena, including ingestion of blood, inflammation or infection of the gastrointestinal tract, ischemia/trauma, and post-surgical complications. Thus, a CBC, serum biochemical panel, urinalysis, prothrombin time, activated partial thromboplastin time, and a fecal flotation test are required for the initial diagnosis of melena (17). Furthermore, because Amur leopard cats are carnivores, their intake of blood-mixed food may cause a false positive in the fecal occult blood test (FOBT). Thus, it is more important to detect the cause of melena in carnivores when the FOBT is positive. In this case, melena was confirmed, but the FOBT and other comprehensive tests for the differential diagnosis of melena were also not performed. Nevertheless, the melena may have been due to the FBs in the stomach, considering that it disappeared after removing FBs from the gastric wall.

Third, despite the successful treatment of skin wounds, the initial use of antibiotics was empirical. Bacterial culture of the wound sample was performed, and the presence of Acinetobacter spp. was confirmed. However, an antibiotic susceptibility test was not carried out and a microscopic examination was not performed at the time of sample collection. Fortunately, the first-line antibiotics which were administered were effective. The treatment time could have been extended if the patient had not responded to the first-line antibiotics.

Enucleation has been performed in domestic cats and dogs, and some wild birds (4,5,11). However, ophthalmic surgery is very rare in wild Felidae, and enucleation in a wild leopard cat has not been reported to date. In this case, we performed transpalpebral enucleation using LigaSure™ and thus confirmed that it could also be used on a wild leopard cat. This involves cutting blood vessels and nerves at the same time as hemostasis during surgery, even without the knowledge of the exact size and location of the orbital venous plexus, thus minimizing intraoperative and postoperative hemorrhage, and reducing the time for surgery.

Although there are some drawbacks in our management of this case, we achieved clinical success in the following aspects: The skin abrasions were successfully treated. FBs in the stomach were identified and removed successfully using endoscopy. The patient remained stable after OS enucleation. Additionally, by minimizing contact with humans during the natural adaptation period, it was possible to prevent habituation to humans and maintain the leopard cat’s wild nature until just before release.

Wild animals injured in road accidents are more likely to suffer multiple and complex injuries. If clinicians focus only on visible injuries and underestimate the initial diagnosis, the patient’s clinical symptoms may worsen, and the hospitalization periods may increase. A longer hospital stay for wild animals may increase human interaction and reduce the chances of a successful return to the wild. Thus, the management of wild animals injured in road accidents comes with several challenges which need to be addressed for achieving the ultimate goal of rapid recovery and successful release of the animal back to the wild.

The authors would like to thank all the staff at the Wildlife Center of Chungbuk.

The authors have no conflicting interests.