Strangulation of the duodenum by the uterus during late pregnancy in two cows

Small intestinal strangulation in 60 cattle - clinical, laboratory and ultrasonographic findings, treatment and outcome

BACKGROUND

Intestinal strangulation is constriction of the intestine by a band of tissue, ligament or blood vessel causing partial or complete intestinal obstruction. This retrospective study describes the clinical, laboratory and ultrasonographic findings, treatment and outcome of 60 cows with intestinal strangulation.

RESULTS

The general condition was abnormal in all cows (60/60), 23.3% (14/60) had nonspecific signs of pain, 40.0% (24/60) had signs of colic and 48.3% (29/60) had signs of somatic (parietal) pain. The most common digestive tract abnormalities were, in decreasing frequency, reduced or absent intestinal motility (100%, 60/60), reduced or absent faecal output (98.3%, 59/60), reduced or absent rumen motility (93.4%, 56/60), dilated small intestines on transrectal palpation (63.3%, 38/60), positive ballottement and swinging auscultation (BSA) and/or percussion and simultaneous auscultation (PSA) on the right side of the abdomen (58.3%, 35/60) and at least one positive foreign body test, most commonly the back grip, in 33.9% (20/59) of the cows. Other common findings were reduced skin surface temperature (67.8%, 40/59), reduced skin turgor (51.7%, 31/60), prolonged capillary refill time (49.2%, 29/59), enophthalmus (48.3%, 29/60) and moderate to severe scleral injection (46.6%, 27/58). The most common laboratory findings were hypokalaemia (58.3%, 35/60), haemoconcentration (57.6%, 34/59), base excess (51.1%, 24/47), hyperproteinaemia (45.8%, 27/59), hyperbilirubinaemia (43.3%, 26/60), acidosis (42.6%, 20/47) and azotaemia (38.3%, 23/60). The principal ultrasonographic findings were subjectively reduced or absent small intestinal motility and dilated small intestines, but the strangulation could not be visualised by ultrasonography. With one exception, all cows underwent a right flank laparotomy to resolve the strangulation by transection or resection of the impinging tissue. Forty-nine (81.7%) cows were discharged and 11 (18.3%) were euthanized before, during or after surgery.

CONCLUSIONS

Without laparotomy, intestinal strangulation could be clinically (transrectally) diagnosed in only 10% of the cows. A laparotomy is therefore essential for the correct diagnosis. The prognosis is good with prompt surgical treatment.

Duodenoduodenostomy for obstruction of the sigmoid flexure of the duodenum in cattle

OBJECTIVE

To describe clinical findings, surgical treatment, and outcome associated with duodenoduodenostomy for treatment of duodenal obstruction secondary to adhesions associated with the sigmoid flexure of the duodenum.

STUDY DESIGN

Retrospective study (1996-2016).

ANIMALS

Fourteen Holstein cattle.

METHODS

Medical records of cows treated at 3 academic surgical referral centers with duodenoduodenostomy for duodenal obstruction secondary to adhesions associated with the sigmoid flexure of the duodenum were reviewed. Data that were collected included signalment, physical examination results, laboratory results, diagnostic findings, treatments, and survival to discharge. Owners were contacted for follow-up information.

RESULTS

Affected cattle ranged in age from 4 months to 5 years. Electrolyte abnormalities, including severe hypochloremia, were present in all cases. Abnormalities included cranial duodenal distension without concurrent distension of the descending duodenum and palpable focal adhesions in the region of the sigmoid flexure of the duodenum. Duodenoduodenostomy involved a stapled (n = 11) or sutured (n = 3) side-to-side anastomosis between the cranial duodenum and descending duodenum. Thirteen of 14 cattle that were treated with duodenoduodenostomy survived to hospital discharge. Long-term follow-up was available in 8 cows, and 7 of those 8 survived for at least 1 year.

CONCLUSION

Short- and long-term survival were favorable after duodenoduodenostomy in cattle with adhesions associated with the sigmoid flexure of the duodenum.

CLINICAL SIGNIFICANCE

Duodenoduodenostomy results in acceptable survival and future productivity in cows with obstruction at the sigmoid flexure of the duodenum.

Herniation of the gravid uterus through a mesoduodenal defect and concurrent omental hernia in a cow

OBJECTIVES

To describe surgical treatment of herniation of the gravid uterus through the mesoduodenum, displacement of the descending duodenum around the gravid uterus, and concurrent herniation of the small and large intestines into the omental bursa in a cow.

STUDY DESIGN

Clinical report.

ANIMAL

Three-year-old, five-month-pregnant Swiss Braunvieh cow.

METHODS

Repositioning of the displaced uterus and descending duodenum without transection and anastomosis of the duodenum was performed through a right flank laparotomy. Concurrent displacement of a large portion of the small and large intestines into the omental bursa was not associated with intestinal strangulation and was corrected manually. The defects in the omentum and mesoduodenum were sutured.

RESULTS

There were no postoperative complications, and the cow was healthy at discharge from the clinic 1 week after surgery. Telephone follow-up revealed that the cow had delivered a live calf and was producing a normal amount of milk. The cow was slaughtered 14 months after the surgery because of an udder problem.

CONCLUSIONS

Herniation of the gravid uterus through a tear in the mesoduodenum with subsequent displacement of the descending duodenum around the uterus combined with internal omental herniation caused nonspecific clinical signs and no ileus. Exploratory laparotomy in an early stage of pregnancy facilitated reduction of the displaced uterus without transection of the descending duodenum.

Left abomasal displacement between the uterus and rumen during bovine twin pregnancy

Here, we describe two cases of left displaced abomasum (LDA) in Holstein cattle at 6 and 9 months of twin gestation. Clinical examination revealed signs of proximal ileus with marked abdominal distension, but no ping sounds. An unusually high position of the gravid uterine horn on the left side was observed with ultrasound. Left exploratory laparotomy confirmed that the abomasum was displaced to the left and entrapped between the rumen and twin gravid uterine horn. A left surgical approach was necessary to correct the condition. Both animals recovered and gave birth to healthy twins. The present cases indicate that the subomental position of a heavy twin gravid uterine horn is a possible mechanical cause of LDA.

Internal herniation of the small and large intestines in 18 cattle

Internal intestinal hernia was diagnosed during laparotomy in 18 cattle with a tentative diagnosis of ileus; the diagnosis was made during a second laparotomy in two cases. In 14 cattle, the hernial orifice was in the visceral layer of the greater omentum and the intestines had herniated into the caudal recess of the omental bursa. In two animals both the visceral and parietal layers had an opening; in one, the orifice was in the mesoduodenum, and in the other in the mesojejunum. The length of the hernial orifice ranged from 3 to >25 cm and the length of the herniated intestine ranged from 30 cm to the entire length of the small and large intestines. The omental rents were located near the caudal flexure of the duodenum (n=9), ventrally near the rumen (n=6) or in both of these locations (n=1). Seven cattle were euthanased intraoperatively because of incarceration of the jejunum; three of these had ruptured intestines and localised peritonitis; another animal was euthanased following a second laparotomy because of peritonitis. Ten animals, two of which underwent jejunal resection-anastomosis, recovered and were discharged. Nine of these survived a 6-month-postoperative period (mean ± SD: 27 ± 18 months) and remained free of colic, and one was slaughtered 3 months postoperatively because of rupture of the mammary suspensory ligament.

Duodenal ileus caused by a calf feeding nipple in a cow

Background

The aim of this report was to describe duodenal obstruction caused by a rubber foreign body in a cow.

Case Presentation

The clinical, biochemical and ultrasonographic findings in a five-year-old Swiss Braunvieh cow with duodenal ileus caused by a calf feeding nipple are described. The main clinical signs were anorexia, ruminal tympany, decreased faecal output and abomasal reflux syndrome. Ultrasonographic examination revealed reticular hyperactivity and a dilated duodenum. A diagnosis of duodenal ileus was made and the cow underwent right-flank laparotomy, which revealed a dilation of the cranial part of the duodenum because of obstruction by a pliable foreign body. This was identified via enterotomy as a calf feeding nipple. The cow was healthy at the time of discharge four days after surgery and went on to complete a successful lactation.

Conclusions

To our knowledge, this is the first description of duodenal obstruction by a calf feeding nipple. This is an interesting case, which broadens the spectrum of the causes of duodenal ileus, which is usually caused by obstruction of the duodenum by a phytobezoar.

Intestinal surgery of adult cattle

Surgical disorders of the gastrointestinal tract of cattle occur occasionally, and veterinarians are challenged to determine an accurate diagnosis and treatment for these conditions. Although surgical diseases most commonly occur in the forestomachs (dislocated abomasum, reticuloperitonitis) and the colons (cecal dilation), this article focuses n lesions in the small intestine (duodenum, jejunum, ileum).

Duodenal obstruction caused by malposition of the gallbladder in a heifer

A heifer with clinical findings suggesting obstruction of the proximal portion of the intestine was admitted for diagnostic evaluation. Ultrasonographic examination of the abdomen failed to locate the gallbladder in its normal anatomic position. Exploratory laparotomy and manual examination of the proximal portion of the intestine revealed obstruction of the duodenum caused by abnormal positioning of the gallbladder. The obstruction was relieved by replacing the gallbladder to its normal position; however, relapse occurred within 2 days. To resolve and prevent the recurrence of the obstruction without compromising gallbladder function, a novel surgical technique to provide fixation of the gallbladder to the liver was performed. The heifer recovered rapidly, proceeded to develop normally during the following year, and became pregnant.