Puthuppally Sadhu is one of the iconic domesticated elephants alive in southern India. The gentle giant, who famously fled to the woods to avoid a clash with another elephant on the sets of a Vijay Devarakonda movie last year, is often called 'Aranya Prajapati' for his majesty. The 55-year-old Sadhu fell sick on July 27 and soon lost his appetite. Within days, the animal stopped eating completely. The lack of bowel movement was a symptom of colon impaction, locally called 'Irandakkettu' — a clinical condition with only a 50 per cent survival rate among Kerala's domestic elephants, most of whom are sexagenarians. Treatment usually involves elephants being given medicines to help faecal discharge. Since they cannot take food or water orally, Hermin, protein and calcium supplements of up to 100 litres are administered daily through IV. If the intestines are infected, antibiotics are also given. The key is to ensure that the elephant is not dehydrated, as hydration is crucial for the intestine to function normally and allow discharge.
Despite the best efforts by veterinarians to stabilise him, Sadhu did not eat any food for about a month and survived on IVs alone. There was reason for concern, as iconic elephants such as Guruvayur Gopikannan, Omallur Manikandan and Kiran Narayankutty had recently died of the same condition. These jumbos were beloved, just like Sadhu, but the authorities could not save them from the painful fate caused by colon impaction.
Sadhu's owner, Pothan Varghese of Pappalaparambil in Kottayam district’s Vakathanam, was not fully convinced with the way things were progressing. He had read about Vantara, India’s largest wildlife rehabilitation centre, running a free rescue initiative. The centre, established by Reliance Industries and Reliance Foundation, is widely recognised as the country’s most advanced facility for wildlife rescue and rehabilitation. Varghese asked the Kerala Forest Department to reach out to the facility in Jamnagar. As a result, Sadhu became the very first elephant to benefit from Vantara’s free rescue initiative. In nine days, the team from the Vantara Animal Rescue Centre released Sadhu from the jaws of death by removing 32 kilograms of fibrous lumps that were stuck in his intestine. By then they had administered 490 litres of fluids, including medicines, vitamins and minerals, to the animal. Once the discharge happened, the jumbo started drinking and feeding again, before regaining full health.
“The team arrived on the night of August 15 and camped beside the elephant. They were available 24x7 for the next ten days and kept checking on him every hour or so. They scanned and confirmed it was colon impaction,” said P. S. Raveendranath, General Secretary, Kerala Elephant Owners Federation.
“There was also a chance of the elephant suffering a stroke due to the shrinking of intestines, but they were able to figure it out too...” he added.
In India, colon impaction is reported mostly among elephants in Kerala, particularly due to the high concentration of fibre in their food. Kerala jumbos in captivity are fed palmyra leafstalk in plenty, which is rich in fibre. “Owners are now aware that too much palmyra is not good for elephants. So we are now switching to grass. Impaction can also be caused by indigestion and acidity. When they consume a lot of leafstalk and travel long distances, or are fed water immediately after labour, it can also cause it,” Raveendranath said.
Dr Vaishakh Vishwam from Vantara’s Rapid Response Team, who led the four-member group including two veterinary assistants and a communications team member to Kottayam, agreed. He said that as the elephant ages, recovery chances for the intestine diminish as it takes a long time for damage to revert. Initially, upon request, the Vantara team gave technical input. On August 14, he requested on-ground service by telephone. “Vantara management approved the mission immediately. Getting the flight booked was the only delay, if any. We reached around 1 am on August 15 and started treatment by 7 am on August 16,” said the vet, who is native to Kerala’s Thrissur district.
What is Colon Impaction and how is it treated?
The colon, situated in the centre of the intestine, helps elephants retain the largest amount of water. It even reabsorbs water from the faeces after it passes through the intestinal tract post-digestion. The process is also called hindgut fermentation, and it is mostly here that the obstruction happens, Dr Vaishakh explained. It is hazardous for elephants if the colon malfunctions, and this region is most prone to impaction, making it extremely challenging to cure an elephant that suffers from the condition, he added.
Colon impaction causes faecal balls to become stuck in the colon, leading the intestine to cease functioning and stopping discharge.
As the mass of waste builds up, it eventually reaches a point where the elephant can no longer bear it. When it strains, instead of discharge happening, the intestines may burst, leaking their contents into the peritoneum — the thin, double-layered, sensitive membrane that lines the abdominal cavity and covers the organs — causing peritonitis, which can kill the animal in four to six hours. This is how elephants most often die due to colon impaction.
Another problem is torsion caused by the faecal mass in the intestine. It is difficult to revive the animal if the torsion is above 180 degrees, as it can also lead to rupture.
“First, we need to confirm it is indeed colon impaction. Then we need to identify the position of the stuck faecal balls. There are small muscles and a mucus layer inside the intestine, and then there is the process of peristalsis — the coordinated, involuntary, wave-like contraction of smooth muscle layers that propels food and waste through the digestive tract. When peristalsis halts, it affects the discharge of faeces. If it is not corrected properly, it can cause death,” he explained.
Surgical procedures are impossible in elephants for obvious physical reasons, so the only chance is to stabilise the animal, as colon dysfunction can cause major dehydration.
“So we need to give it a lot of fluids. In the case of elephants, it is Ringer's lactate or RL and normal saline. Unlike humans, glucose is not the primary energy source for elephants. Volatile fatty acids (VFAs) — namely acetic acid, propionic acid, and butyric acid, formed through the digestion of grass — are their primary source of energy. Glucose may even cause reflex acidity, which may cause the stomach to bloat,” he said.
“If there is colic, then we will administer anti-inflammatory medicines, B complex vitamins, and methylcobalamin injections for maintaining tonicity. If all these steps to stabilise the animal work and the intestine gradually starts functioning, the excreta gradually move towards the rectum. Once it reaches a distance accessible through the anus, we can remove it manually.”
The elephant vet team, which takes care of over 200 elephants in Vantara, is a strong group of nine who will take turns in leading rescue missions. Dr Vaisakh was entrusted with Sadhu’s case since he was a native of Kerala and spoke the local tongue. He joined Vantara in 2022 after a decade of experience in Kerala, following his graduation from the 2008 undergraduate batch of Mannuthy College of Veterinary and Animal Sciences and his postgraduate studies in the 2014 batch.
The team took over after they were given the first briefing by the local vet. “The first thing I did was stop the antibiotic course. The result was there to be seen on the third day as movement began in its tummy,” the expert, who holds a Masters in veterinary surgery and radiology, said. “Antibiotics are not advisable as they can restrict the movement of the intestines. This condition, called Paralytic ileus, is a temporary, non-mechanical stoppage of intestinal contents due to the muscles and nerves of the intestines failing to move food through the digestive tract,” he said.
Twenty-five grams of sodium bicarbonate powder was orally fed twice a day for two days to maintain the pH level in the tummy. “Acidity levels would have soared since the elephant was not eating anything for days, and this ensured that the jumbo regained its appetite,” Dr Vaishakh said.
Castor oil was applied and massaged using a sandbag from the head to the tail for forty minutes to stimulate the nerves emerging from the spinal cord. They then started the rectal rehydration procedure to feed the colon with ample water. “Many times, 20 litres of IV is given to elephants while it takes at least 100 litres to properly ensure fluid balance. Since it is a mega herbivore, there is only so much we can send in through the veins,” he pointed out.
While rectal rehydration is an internationally recognised method, it is still not conventional in India. In five minutes, an elephant can be given 30 to 40 litres of fluid through this method. “Doctors were against the method, and I had to convince them by saying it is done on a daily basis at Vantara and even in zoos in the US for over one and a half decades,” he said.
Vantara’s advanced equipment
“We have fine vet doctors in Kerala, but they are boxers without gloves in the ring... they can do wonders with the kind of experience they possess but lack the technology. We don’t have colonoscopy or endoscopy facilities for elephants. The association has tried to reach out to governments, but it never took flight. India usually lacks equipment, but Sri Lanka and Thailand are much more advanced in the field... our governments are not convinced to spend on it,” Raveendranath said.
Dr Vaisakh, who identifies himself as a third-gen elephant practitioner from the state, said many veterinary equipment and instruments have become available in the market in the past decade.
“In Kerala, the biggest issue is the challenges associated with the diagnosis phase as there is a lack of equipment designed for veterinary use. In Vantara, we have customised equipment meant for bigger patients. For humans, endoscopy machines need not be more than 2.5 m long in any case. But that is not the case with elephants. Thus, in Vantara, we get customised devices made for elephants, which need to be longer,” he explained. “While we (the state of Kerala) have a great legacy to boast about, the doctors are forced to depend on the known symptoms alone to assume the illness. Where Vantara stands out is in its understanding of the scientific aspect of treatment and deploying the necessary instruments for accurate results.”
Conducting an ultrasound scan outside the impaction is of no real help. As long as it is not at a distance that can be reached by a human’s hand, there is no point, and endoscopy is the best option, Dr Vaisakh said. “Vantara’s endoscopy device, 3.5 m long, is very expensive and is one of the few customised pieces available in the world. German medical device manufacturer Karl Storz shipped it in parts to us and it was assembled here (in India),” he said. “Using it for rescue missions is a big risk considering the fragility. So we use a portable wired video camera with LEDs. These flexible wires were put through a thick garden hose and inserted through the elephant’s rectum.”
Recollecting treating Sadhu, he said, “On the first day, there was no result, meaning the boluses were not close to the anal opening. We kept hydrating the animal and trying until, on the third day, the boluses were finally found five feet away from the opening. This was the breakthrough.
“There was a big bulge on the right side of its abdomen. On the third day, it was gone — meaning the stabilisation efforts were working and the stuck waste was gradually moving. This gave me the hope to try the device again, and we got the first visual. Later, we found it 2.5 m away from the anal opening, but the movement slowed down in the next three days, keeping the boluses away from the reach of my hands. So we asked one of the mahouts who had longer hands than me to attempt to drag it out. He managed to break it and take it out in pieces. Once the volume was reduced, peristalsis happened and the remaining portion was pushed further out. On the ninth day, the two mahouts together pulled out the entire 32 kg of the stuck faeces.”
Although not needed in Sadhu’s case, Vantara also possesses a portable X-ray, thermal imaging camera, and ultrasound device apart from the endoscopy facility.
Once the “Irandam” discharge happens, the elephant is allowed to rest for as many days as it suffered, and the medicines and prescribed diet are followed. “Sadhu was unwell for over a month and he will remain rested at Vakathanam for a few more weeks,” Raveendranath said.
If elephant owners and mahouts can improve husbandry practices, “Irandakettu” can be avoided, Dr Vaishakh Vishwam vowed. “There is a divine aura always around them; if properly cared for, domesticated elephants will live well for at least 90 years in Kerala.”
How can one seek Vantara’s help?
“If the concerned government official reaches out officially with a rescue or service request, an on-ground mission will be launched immediately — including the necessary medical, scientific, and machinery input needed to assist the personnel,” Dr Vaishakh said. The chief wildlife wardens of the respective states are the legal custodians of elephants despite private ownership. It was through Kottayam Assistant Conservator of Forests K.B. Subhash that Sadhu’s case was presented.