A 55 g, 7 mo old Chinese three-striped box turtle ( Cuora trifasciata ) was presented with a 2 wk history of lethargy and anorexia. The owner attempted various antibiotic treatments without clinical improvement. A cystoscopic evaluation of the coelom was performed. The liver appeared dark red-to-brown presenting multifocal irregularly shaped white-to-tan and roughly round areas of discoloration on the capsular surface. An adult keeled box turtle (Pyxidea mouhotii), which died in the same facility at the same time, had similar hepatic lesions detected upon necropsy. From hepatic lesions, an antibiotic-resistant Escherichia coli was isolated. Antibiotic treatment based on sensitivity testing led to a rapid resolution of the clinical signs in the Cuora trifasciata , with gain of appetite 4 days after the first antibiotic administration. A recheck cystoscopy demonstrated macroscopic resolution of hepatic lesions. This report demonstrates, to the best of the authors' knowledge, for the first time the clinical usefulness of cystoscopy for the diagnostic evaluation of the coelom of small chelonians. This minimally invasive technique is a valuable clinical tool in the medical approach to posthatchling chelonians.