Surgical affections of Ruminant stomach
Surgical affections of Ruminant stomach are Bloat, Traumatic Reticuloperitonitis (TRP) and Reticulopericarditis (TP), Omasal impaction, Reticulo-omasal and Pyloric stenosis, Abomasal displacement, Abomasal impaction, Abomasal ulcers, Abomasotomy etc.
Surgical affections of Ruminant stomach in ruminant animals are-
- Bloat
- Traumatic Reticuloperitonitis
- Traumatic Reticulopericarditis
- Rumenotomy
- Omasal impaction
- Reticulo-omasal and Pyloric stenosis
- Abomasal displacement
- Abomasal impaction
- Abomasal ulcers
- Abomasotomy
Bloat
Bloat is one of the major problems of the GI tract of cattle and buffaloes. Bloat can either be acute or chronic. In both cases, it is either accumulation of free gases in the dorsal part of the rumen or gases are dispersed throughout the rumen contents to cause frothy bloat.
Acute bloat
Rapid feeding and sudden change of diet appear to predispose cattle and buffaloes to development of acute bloat.
Presence of amphistomes at the cardia of the stomach is also contribute in bloat in animals.
In small ruminants, ingestion of large quantities of cereals causes development of acute bloat which can be of serious nature. The increased intra-ruminal pressure due to accumulation of gases exerts pressure over the diaphragm and the ribs, which results in reduced respiratory movements. This will resulting hypoventilation and reduced venous return to heart.
The increased intra-ruminal pressure also causes absorption of gases, particularly poisonous methane which has a deteriorating effect on the the animal.
The clinical signs include bulging of the paralumbar fossa in the early stages and entire abdominal distention in the later stage. Abduction off the forelimbs, especially at the elbows and reluctance to move are the other clinical features. There will be also absence of rumen motility.
The mucous membranes are found cyanotic. In advanced stages, the animal keeps the mouth open and tongue protruded. Tachycardia in the initial stages many change later into a weak, slow pulse.
Most common practices in relieving acute bloat is to insert a trocar and cannula into the upper flank region of rumen. In the case of simple tympany, trocarisation alone may be enough to relieve the gas. But, if the bloat is frothy, administration of anti foaming drugs into the rumen is mandatory inorder to free the gas eiether through a probang or trocar.
Oral administration of 80 ml of turpentine mixed with 500 to 1000 ml of mustard oil is found to be very effective. Antifroth agents like dimethicone also can be used for this purpose.
After severe bloat, concentrates should be avoided for at least two days and the animal should be fed with non leguminous hay. In goat and sheep, the mortality rate is high, if the treatment is delayed and emergency rumenotomy also fail to save small ruminants.
Chronic bloat
The most common cause of recurrent tympany in cattle and buffaloes is foreign body syndrome.
Traumatic reticulitis and diaphragmatic hernia are the two common conditions in buffaloes where recurrent and chronic bloat in observed. Large omental, spleenic and hepatic cysts in bullocks have also been observed to cause recurrent lympany.
Other conditions in which chronic bloat occur in bovine include functional reticulo-omasal and pyloric stenosis (vagus indigestion), liver abcesses, enlarged mediastinal lymph nodes pressing oesophagus, mega oesophagus stricture at the cardia and neoplasms.
The treatment in such causes is directed at the primary cause. Rumen fistulation (Rumenostomy) may be done.
Per rectal findings of a collapsed dorsal sac of the rumen along with ventral displacement of left kidney in the mid abdomen, the treatment is purely medical and aimed at correction of primary disease and also the correction of fluid, acid-base and electrolyte imbalances.
Click here to read Bloat or Tympany treatment by medicine use.
Traumatic Reticuloperitonitis
Traumatic reticulitis is a common surgical condition affecting the bovine. The condition is rare in camels despite the habit of ingesting foreign bodies and seldom seen in sheep and goats.
Cattle and buffaloes ingest foreign bodies due to their indiscriminate feeding habits. Animals with nutritional deficiencies may ingest various types of foreign bodies deliberately. Small ruminants with nutritional deficiency may consume ropes, plastic sheets etc.
On rare occasions, metallic foreign bodies also have been recovered from the reticulum and abomasm of goats.
In bovines, foreign bodies are swallowed straight into the reticulum where they inflict trauma to the reticulum and peritoneum causing traumatic reticuloperitonitis.
The incidence among buffaloes is found higher than in cattle.
Pathophysiology
When a foreign body is ingested, it gets lodged into the honey comb structure of the reticulum. Foreign bodies with smooth, rounded edges like nuts, coins and stones, lie harmless and may pass out ultimately through the faeces. However, foreign bodies with sharp pointed edges, like nails, needles, metallic wires etc may cause other complications apart from causing reticulitis.
In both cattle and buffaloes, foreign body reticulitis may extend into traumatic pericarditis, vagal indigestion, pyothorax, abscessation of the liver and spleen, diaphragmatic hernia, traumatic pneumonia, pleurisy etc. Rarely, a foreign body may get lodged into the omasal orifice or intestine.
Reticular and diaphragmatic abscesses many develop often. The foreign bodies may penetrate the lateral or ventral, abdominal wall and form abscesses. Foreign bodies are found within the abscess while opening the abscess or they may fall down themselves.
Extensive adhesions develop between reticulum and diaphragm or other structures which interfere with the reticular contractions and eructation process.
In ruminants, the peritonitis caused by the foreign bodies are often localised . But, on rare occasions, large abscess were formed in the abdominal cavity.
Clinical signs
The most common clinical manifestation in cattle and buffaloes are recurrent tympany, complete or partial anorexia, retarded or suspended rumination and reduced milk yield. However, chronic tympany may be absent in many cases of foreign body syndrome. The reduction in milk yield is sudden in acute cases.
Stiffness of forelimbs and abducted elbows may be seen in cattle and buffaloes in order to reduce diaphragmatic movements and Grunting is seen in bovines.
Heart rate is usually normal in buffaloes and slightly accelerated in cattle. Some animals may show distressed respiration and regurgitation in buffaloes.
Regurgitation occurs in cases of advanced cases. There are other associated symptoms also like diarrhoea, constipation, scanty pasty faeces, diarrhoea alternation with constipation, regurgitation, cough, pyrexia, brisket edema etc and many of these symptoms are seen in most of the cases along with other more consistent signs.
Clinical signs in small ruminants are almost similar. However, distension of the rumen and suspension of rumination are the only clinical signs exhibited by camels. In camels, suspension of rumination is usually the first sign of any systemic disease.
Diagnosis
Diagnosis is mostly based on history and clinical signs. The pole test recommended to detect pain due to foreign body syndrome in cattle is not usually suitable and satisfactory for buffaloes and camels. Neutrophilia with shift to left is observed in cattle and buffaloes, though it cannot be relied upon for diagnosis.
A lateral plain radiograph of the reticular area is a useful diagnostic tool , not only for locating the foreign bodies, but also for predicting information regarding the mixture and extent of damage caused by potential foreign bodies. However, in the case of nonmetallic, radiolucent foreign bodies, radiograph will fail to locate them and such materials are recovered during rumenotomy.
Dorsal reticulography may also be useful for detecting penetrating type of foreign bodies.
Treatment
- Reducing the intrapericardial pressure is the primary goal
- Fifth rib resection and pericardiocentesis using a IV tube in slow manner is attempted as sudden relieving of pressure leads to cardiac arrest
- Removal of the foreign body if encountered is done
- Pericariectomy is done as salvage procedure in severely affected cases.
- Marsupialization (attaching the pericardial sac to skin wound) can also be attempted
- Surgical drain is a mandatory procedure
- High end antibiotics like tetracyclines are indicated following surgery
- Lavage of pericardium is done before closure
- Supportive therapy in form of diuretics, inotrpic agents like digoxin and fluid therapy is necessary following surgery
- Rumenotomy
Traumatic Reticulopericarditis
Traumatic Reticulopericarditis is also known as Hardware Disease in animals.
Etiology
- Perforation of the pericardium by the foreign body present in the reticulum
- Cattle do not discriminate metallic and non metallic objects while ingestion
- Cattle do not masticate before swallowing
Pathophysiology
- In a normal functioning heart the right side pressure is less than the left side during diastole
- When fluid accumulated in between heart and pericardium due to penetrating foreign body this pressure equilazes and results in Cardiac Tamponade
- Later penetration into myocardium results in death
Clinical signs
- Brisket edema
- High Temperature 104 F
- Pleuritis may manifest as shallow respiration muffled heart sounds (washing machine murmur) and pleuritic friction rubs
- Jugular vein distension and Jugular pulse
Diagnosis
- Clinical signs
- Neutrophilia and left shift in blood picture
- Radiography
- Ultrasonography
Treatment
- Reducing the intrapericardial pressure is the primary goal
- Fifth rib resection and pericardiocentesis using a IV tube in slow manner is attempted as sudden relieving of pressure leads to cardiac arrest
- Removal of the foreign body if encountered is done
- Pericariectomy is done as salvage procedure in severely affected cases.
- Marsupialization (attaching the pericardial sac to skin wound) can also be attempted
- Surgical drain is a mandatory procedure
- High end antibiotics like tetracyclines are indicated following surgery
- Lavage of pericardium is done before closure
- Supportive therapy in form of diuretics (frusemide), inotropic agents like digoxin and fluid therapy is necessary following surgery
- Rumenotomy
Rumenotomy
Rumenotomy is indicated to remove foreign bodies from the reticulum.
Rumenotomy is done through an incision in the left flank and the site of incision is equidistant from this tuber coxae and last rib beginning 5cm ventral to the lumbar transverse process, due to the voluminous abdomen and incision parallel to the last rib is preferred to provide an easy access to the reticulum.
Preparation of site
The whole dorsum and the left abdominal wall of the animal should be thoroughly cleaned with soap and water to remove all loose hairs, dirt and dust.
The left flank is shaved cleaned and the area should be scrubbed with antiseptic lotions like povidone iodine scrub or chlorhexidine. After drying the area with sterile mops, Povidone iodine should be painted.
Anaesthesia
Paravertebral nerve block is sufficient for rumenotomy and difficult cattle or buffaloes may be given mild sedation for restraint.
Paravertebral nerve block for Rumenotomy
Following painting the site with antiseptics the area should be covered with sterile draper, exposing the surgical site alone.
Surgical procedure
The laparotomy incision should be long enough to allow the surgeon’s arm inside the abdomen and the abdomen is opened through a standing laparotomy procedure. If the rumen is not full, the ruminal walls and abdominal cavity are explored thoroughly to examine, the diaphragm, outer wall of reticulum, spleen and liver for pathological lesions.
Rumenotomy Incision in a cow
The ruminal wall is brought to the laparotomy incision and fixed to it using a Weingarth’s rumenotomy frame or using a row of stay structures. The tense and exposed ruminal wall is incised and the cut edges of the rumen wall is everted and fixed to the skin edges.
Fixing the weingarth rumenotomy frame in a cow
After partial evacuation of the contents of the rumen, the ruminal floor and reticulum were explored with the hand to locate foreign bodies.
The sharp penetrating foreign bodies should be removed gently and small metallic materials may be retrieved by using a magnet inserted into the reticulum.
Rumenotomy frame in position in a cow
Before closure of the rumen, rumen pH should be corrected and transplantation also may be done in case of disturbed rumen microflora.
The rumen wound edges should be thoroughly cleaned and the surgeon must rescrub before suturing the wound. The rumen is sutured with Cushing’s followed by Lemberts’ suture pattern using No 1 or 2 chromic catgut. All soiled instruments should be discarded and fresh set of instruments should be used for closure of the lapartomy wound.
Postoperative care includes dressing of the cutaneous wound, A course of antibiotics should be given for 5 to 7 days and the sutures are removed by 10th postoperative day. Any failure in asepsis during surgery might produce a discharging sinus at the operative site.
Omasal impaction
Omasal impaction occurs secondary to rumen impaction and may be a result of poor qualtity feed.
The omasum gets distended with stagnation of ingesta and its engorgement due absorption of fluids. Such animals are anorectic, listless and show signs of dehydration.
The auscultation at the level of right elbow at the 9th intercostal space will show complete absence of omasal sounds. Using a stomach tube, few litres of water and 4-5L of liquid paraffin or mineral oil are administered to soften the contents.
Two to three kg of sugar or jaggary is given along with about 50 tab of yeast and 2-3L of rumen liquor collected from a healthy animal, inorder to stimulate rumen flora. The rumen is then massaged with fist and knee.
In case of failure of this treatment, rumentomy is performed and solutions are injected directly into the omasum using a tube inorder to dislodge the contents.
Neglected cases may succumb with in few days due to the necrosis of omasal folds an account of pressure from its contents.
Reticulo-omasal and Pyloric stenosis
The Reticulo-omasal and Pyloric stenosis condition is also known as Hoflund’s syndrome or chronic indigestion or vagal indigestion or functional stenosis of the stomach.
Clinically there are two types of functional stenosis of the stomach. These include reticulo-omasal stenosis or cranial functional stenosis and pyloric stenosis or caudal functional stenosis. Usually animals suffer from either of them and rare cases suffer from both.
Etiology
Both Reticulo-omasal and Pyloric stenosis conditions are characterized by impairment of the passage of food either through reticulo-omasal orifice or across pylorus.
Clinical signs
The loss of body condition is rapid and the animal becomes dull and listless. Mild abdominal pain or discomfort exhibited by shifting weight from one leg to another.
The faeces is scanty and consistency varies from normal to diarrhoetic or constipated.
Rumen movements are sluggish and weak. The temperature, pulse and respiration rate are usually normal and dehydration occurs only in the last stages of the disease.
Abomasal displacement
Due to Abomasal loose attachment with greater and lesser omentum abomasum tends to be a wandering organ. It is common in animals fed on concentrates more than roughages and in dairy cows in the age group of 3 to 7 years. It is very rare in buffaloes. Left side displacement (LDA) is common in antepartum and right side displacement (RDA) in postpartum.
Etiology
- Atony of the abomasum with accumulation of gas
- High concentrate ration, Volatile fatty acids and gas
- Effect of pressure by the gravid uetrus on the rumen
Clinical signs
- Anorexia
- Decrease in milk production
- Ketosis
- Weight loss
- Shifting type of lameness
- Scanty faeces
- Dehydration
Auscultation
- LDA Ping sounds in 11th, 12th, 13th intercostal space
- RDA Ping sound in the cranial part of para lumbar fossa
- Liptak test-If pH is 1-4, abomasal displacement is suspected
Clinical pathology
Most animals with abomasal displacement have hypochloraemic, hypokalaemic metabolic alkalosis. But some animals have a normal acid-base status.
The metabolic alkalosis is more pronounced in abomasal volvulus than following left or right displacement of the abomasum alone.
The alkalosis occurs due to continuous loss of hydrochloric acid from the abomasum. Blood glucose values are highly variable. Dehydrarion is reflected by varying degree of haemoconcentration. Ketonaemia and ketonuria are also frequently present.
Diagnosis
The diagnosis of abomasal displacement is based on history, clinical signs detection of tympanic resonance on auscultation and percussion and laboratory findings.
Acuteness of the onset of clinical signs, especially rapid heart rate and drop in milk yield, help to differentiate abomasal volvulus from RDA.
“Liptek Test” is used in diagnosis of abomasal displacement. A 18G needle is inserted aseptically just below the area of resonant ping in the left abdominal wall in cases of LDA and in the right abdominal region in cases of RDA and the fluid is aspirated. If the pH of the fluid is around 4, abomasal displacement is suspected and a pH of 5 to 7 indicate ruminal contents.
Treatment
The aim of treatment of abomasal displacement is correction of the displaced abomasum, and fixing the displaced abomasum to prevent reccurence, restoration of gastro intestinal motility, rehydration and correction of metabolic disorders.
Conservative treatments aim at the release of gases from the abomasum, relief of abomasal impaction and restoration of GI tract motility so that the abomasum return to its normal position.
Calcium borogluconate, neostigmine, saline cathartics etc improve the GI tract motility in general. Repeated oral administration of mineral oils and warm salines may help in evacuation of the contents. Repteated intravenous isotonic fluid therapy is used to correct dehydration.
Surgical Correction
Abomasum is a wandering organ due to its loose attachments with the greater and lesser omentum. So it will be easily displaced to left or right.
Surgical Correction of Abomasal displacement in animals is done by-
- Left flank omentopexy (Utrecht method)
- Right abomasopexy
Left flank omentopexy (Utrecht method)
Laparotomy is performed in a standing animal through a long vertical incision (20 cm) in the left paralumbar fossa. Usually the abomasum lies under the incision.
The attachment of the greater omentum along the abomasum is located and the needle threaded with about two meters of heavy nonabsorbable suture material is passed in and out of the omentum in the form of a mattress suture over a length of about 7-10 cms. About a metre of the suture material should extend and from each end of the suture line.
The abomasum is decompressed using a needle of 14 G and syringe attached to a rubber tube. The abomasum is then carefully pushed to its normal position.
The cranial end of the suture is attached to a large cutting needle which is carried along the internal body wall and forced through the ventral mid line, 10 to 15 cm caudal to the xiphoid and held by the assistant.
A second needle in then threaded on the caudal end of the suture material and similarily placed through the ventral body wall 8 to 12 cm candal to the cranial suture.
Both the suture ends are pulled up and tied outside the body. The suture is retained in position for about four weeks and after that the ends are cut as close to the skin as possible.
Right abomasopexy
The procedure is basically similar to omentopexy and the suture is placed in the musculature of the greater curvature of the abomasum.
The suture ends are then brought through the ventral wall as for omentopexy.
The left flank approach is used for LDA and right flank approach is used for RDA.
Abomasal impaction
Abomasal impaction is seen more frequently in dairy cattle, due to ingestion of rubber latex but also occurs in calves, goats, sheep and buffaloes.
Impaction may occur in camels following ingestion of hair balls, polythene bags and other material.
The primary cause is excessive consumption of poor quantity indigestible roughages and inadequate mineral supplementation with restricted access to water.
Foreign bodies such as phytobezoars and accumulation of sand may also cause impaction. Ocassionally, placenta eaten by recently calved animals may obstruct the pylorus and cause abomasal impaction.
The secondary impaction may occur due to any condition that may reduce abomasal motility. Conditions like traumatic reticulo peritonitis, abomasal lymphosarcoma etc are found leading to abomasal impaction.
Clinical signs and diagnosis
Complete anorexia, scanty faeces and moderate distension of the abdomen on the right side.
Marked dehydration and loss of body condition follows as the condition advances. The lower right abdominal quadrant of the affected cows appear distended giving a “pear” shaped appearance when viewed from behind.
Deep palpation cranial to mid-lower right quadrant abdomen reveals abomasum. Temperature, heart rate and respiration remain normal usually, but in the later stages heart rate may elevate considerably.
Laboratory findings include metabolic alkalosis, hypochoraemia, hypokalaemia and haemoconcentration.
Diagnosis is based on the history of feeding, clinical signs and laboratory findings.
The condition should be differentiated from diffuse peritonitis, acute intestinal obstruction and functional pyloris stenosis.
Treatment
The success of treatment depends on early diagnosis. Animals with tachycardia -heart rate of 100 or more per minute have poor prognosis.
Treatment should be directed at softening of the impacted contents with lubricants or physical emptying of the abomasum along with correction of dehydration.
Oral cathartics like magnesium hydroxide or magnesium sulphate are used along with lubricants such as mineral oils and 10-15L of warm water administered directly into the rumen by probang for 3-5 days may produce beneficial response.
Intravenous fluid therapy containing sodium, potassium, calcium and chloride along with glucose is important.
Abomasotomy may be indicated if the animal does not respond to conservative treatment.
Abomasal ulcers
Abomasal ulcers occurs in suckling calves and adult cattle and may cause abomasal haemorrhage, indigestion, melena and in some cases of perforation with acute local or diffused peritonitis.
The course of abomasal ulcers is not clearly known. In calves, sudden change from milk to high dry matter content
Abomasal ulcers are seen concomitant with trichobezoars. All the cases of abomasal ulcers are associated with hyperacidity and increased mucosal permeability to hydrogen ions.
Clinical signs and diagnosis
Abdominal pain, melena and pale mucous membranes are the common clinical signs. Bleeding ulcers cause sudden onset of anorexia, ruminal stasis and tachycardia in addition to abdominal pain and melena.
Calves become recumbent suddenly, with cold extremities.
Subnormal temperature, tachycardia and dehydration which subsequently lead to a state of hypovolemic shock.
Death occurs with acute local peritonitis closely resemble that of traumactic reticuloperitonitis. However, the localized pain will be on the right side instead left of Xiphoid in the case of TRP.
The diagnosis of bleeding ulcers is based on the typical signs where as the diagnosis of non bleeding ulcers in an intact animal is difficult.
Treatment
Treatment of affected animals include change of diet from high to low concentration. Antacids such as magnesium hydroxide (500 to 800g) or magnesium trisilicate administrated orally for 2- 4 days are found beneficial.
In cases of bleeding or perforated ulcers, the treatment should be directed to control the bleeding and to check the dehydration with adequate volumes of fluid administration
Surgical treatment involves radical excision of ulcerative patches following abomasotomy. But the success is limited in the case of multiple ulcers.
Animals with perforated abomasal ulcers and diffused peritonitis usually have poor prognosis.
Abomasotomy
Site of Abomasotomy
4 to 10 cm long paracostal incision invade about 2 inches behind the costal arch beginning at about 6 inches away from the mid ventral line and extending cranio dorsally.
The lower commisure of the incision may be extended ventro medially when found necessary to operate on the fundus.
Another approach is through the linea alba at the mid ventral line and the incision start about 4 cm behind xiphoid cartilage of the sternum and extend up to the umbilicus. This is a rarely used site.
Technique of Abomasotomy
The abdominal cavity is entered by incising the skin, abdominal muscles and parietal peritoneum. Grasp the greater curvature of the abomasum and it is pulled out through the incision.
The abomasum is held in position at the laparotomy wound by means of 4-6 stay sutures passed through the abomasal wall and the abdominal wall.
Any space left between the abomasam and the lips of the abdominal wound is packed off with moist sterile towels to prevent escape of abomasal contents into the peritoneal cavity. Incise the abomasam to a length of 6 – 10 cm and the cavity is explored with the hand introduced through the incision.
In the case of bleeding abomasal ulcers, the ulcers are either dissected out or the bleeding vessels are ligated. The abomasal incision in closed by a row of connel’s sutures followed by Lemberts. The temporary stay sutures are released and the organ is deposited back into the abdominal cavity.
The laparotomy wound is closed in the standard pattern after cleaning and irrigation of the abdominal cavity with normal saline and antibiotic or antimicrobial solutions.