Intestinal Surgery

Small intestinal volvulus in 47 cows

Objective

To describe the findings, treatment, and outcome of small intestinal volvulus (SIV) in 47 cows.

Animals and procedure

Retrospective analysis of medical records. Comparison of the findings for 18 surviving and 29 non-surviving cows.

Results

The most common abnormal vital signs were tachycardia (68.0%), tachypnea (59.6%), and decreased rectal temperature (51.1%). Signs of colic occurred in 66.0% of cows in the study. Rumen motility was reduced or absent in 93.6% of cows, and intestinal motility in 76.6%. Clinical signs on ballottement and/or percussion and simultaneous auscultation were positive on the right side in 78.7% of cows. Transrectal examination showed dilated small intestines in 48.9% of cows. The rectum contained little or no feces in 93.6% of cows. The principal laboratory abnormalities were hypocalcemia (74.1%), hypokalemia (73.8%), azotemia (62.8%), hypermagnesemia (61.6%), and hemoconcentration (60.0%). The principal ultrasonographic findings were dilated small intestines (87.1%) and reduced or absent small intestinal motility (85.2%). Forty-one of the 47 cows underwent right flank laparotomy and the SIV was reduced in 21 cows. When comparing the clinical and laboratory findings of 18 surviving and 29 non-surviving cows, the groups differed significantly with respect to severely abnormal general condition (16.7 versus 37.9%), rumen stasis (22.2 versus 79.3%), intestinal atony (16.7 versus 48.3%), serum urea concentration (6.5 versus 9.8 mmol/L), and serum magnesium concentration (0.98 versus 1.30 mmol/L). In summary, 38.3% of the cows were discharged and 61.7% were euthanized before, during, or after surgery.

Conclusion and clinical relevance

An acute course of disease, little or no feces in the rectum, and dilated small intestines were characteristic of SIV in this study population.

Long-Term Survival in 241 Cases of Intussusception in Cattle and Factors Associated with Mortality

Intussusception is a frequent cause of mechanical ileus in cattle. Long-term survival has never been described and risk factors for mortality are scarcely documented. A retrospective cohort study on 241 cattle was conducted to determine survival of intussusception and identify risk factors for mortality. Clinical records were matched with the national cattle identification database. Information on possible predictors including clinical examination, ultrasonography, blood-gas analysis and surgery were collected. Survival analysis and decision tree analysis were used. Overall survival was 44.8% until discharge. Of all animals, 39.0% could complete their life cycle and were eligible for slaughter. Male animals and cattle < 226 days old experienced a significantly higher mortality risk (hazard ratio [HR] = 2.1; 95% confidence interval [CI] = 1.4-3.0 and HR = 2.4; 95% CI = 1.7-3.4, respectively). The final model consisted of heart rate (>95 beats per minute) and packed cell volume (<36.5%) with sensitivity and specificity of 60.4% and 49.4%, respectively. A second model consisted of sex (male) and time to referral (>4.5 days) with sensitivity and specificity of 88.0% and 65.6%, respectively. The long-term prognosis for intussusception in cattle appears to be fair. Factors identified in this study may aid in the decision-making process in cases with presumed intussusception to perform the surgery or opt for euthanasia.

A retrospective review of small intestinal intussusception in 126 cattle in Switzerland

Background

Intussusception is a form of ileus of the intestines in which an oral intestinal segment slides into the adjacent aboral intestinal segment, causing obstruction of the bowel.

Methods

We analysed the medical records of 126 cattle with intussusception of the small intestine.

Results

Demeanour and appetite were abnormal in 123 cattle. Non-specific signs of pain occurred in 26.2%, signs of visceral pain in 46.8% and signs of parietal pain in 56.4%. Intestinal motility was decreased or absent in 93.7% of the cattle. The most common findings of transrectal palpation were rumen dilation (37.3%) and dilated small intestines (24.6%). In 96% of the cattle, the rectum was empty or contained little faeces. The principal laboratory findings were hypokalaemia (89.6%), hypocalcaemia (76.5%), base excess (72.9%), hypochloraemia (71.8%), azotaemia (62.1%) and haemoconcentration (61.1%). The main ultrasonographic findings were reduced or absent intestinal motility (98.2%) and dilated small intestines (96.0%). A diagnosis of ileus was made in 87.8% and a diagnosis of ileus attributable to intussusception was made in another 9.8%. Right-flank laparotomy was carried out in 114 cattle. Fifty-six (44.4%) cows were discharged.

Conclusions

Clinical findings of intussusception in cattle are often non-specific. Ultrasonography may be required to diagnose ileus.

Efficacy of Abdominal Ultrasonography for Differentiation of Gastrointestinal Diseases in Calves

Simple Summary

Gastrointestinal diseases represent one of the common causes of bovine acute abdomen, such as abdominal distention, abdominal pain, and cessation of defecation. In addition to the observable signs when performing routine auscultation, rectal palpation, and biochemical examinations of ruminal fluid and blood, these clinical observations can provide evidence suggestive of these diseases, but they generally result in an inconclusive diagnosis. Therefore, exploratory laparotomy is often used because it facilitates both diagnosis and therapeutic decisions. For bovines, abdominal ultrasonography is frequently utilized as a convenient imaging modality to assist accurate diagnosis and contribute to subsequent appropriate therapeutic choices for bovine gastrointestinal diseases. According to recent trends in human medicine and small animal practice, technical improvements have led to developments in the diagnostic value of abdominal ultrasonography, including scanning methods and the establishment of valuable diagnostic signs specific to a particular disease, e.g., a target sign for intussusception.

Abstract

This study investigated the clinical efficacy of abdominal ultrasonography for abomasal dilation in three calves, intestinal volvulus in five calves, intussusception in one calf, and internal hernia in one calf. In the abdominal ultrasonograms of the abomasal dilation cases, this disease was commonly characterized by severely extended lumens, including heterogeneously hyperechoic ingesta without intraluminal accumulations of gas. In the animals with intestinal volvulus and intussusception, a to-and-fro flow was observed to be a common ultrasonographic characteristic that led to suspicion of an intestinal obstruction. The use of abdominal ultrasonography for five cases with intestinal volvulus gave no reason to suspect this disease, despite its efficacy in one case, based on an acutely angled narrowing. Although three of five animals with intestinal volvulus had intestinal ruptures, no ultrasonographic evidence could be obtained. When abdominal ultrasonography was used for one case with intussusception, this pathological condition could be strongly suspected, as a “target” sign was observed. This finding supported surgical intervention for this case, followed by treatment with manual reduction, resulting in a favorable outcome. In terms of the differential and definitive diagnosis for various intestinal diseases, abdominal ultrasonography may be poor at providing indicative evidence, but very helpful for confirming intestinal obstruction.

Additive prognostic value of preoperative plasma glucose concentrations in calves undergoing abdominal surgery

Surgical abdominal emergencies in calves are associated with a guarded prognosis, especially if neonates are affected. Because hypoglycemia has been associated with sepsis and endotoxemia, this study aimed to assess the prognostic relevance of preoperative plasma glucose concentrations (GLUC) in calves requiring surgery for an acute abdominal disorder. For this purpose, data from retrospective and prospective case series were analyzed, consisting of 586 and 83 hospitalized calves, respectively. The outcomes of calves were evaluated until hospital discharge (both study populations) and for 3 mo following discharge by a phone call to the farmer (prospective study population). For the retrospective study population, the overall survival rate was 31.2%. Calves with a negative outcome (NO) had significantly lower median GLUC (4.3 mmol/L) than calves with a positive outcome (PO; 5.0 mmol/L). The survival rates of calves with GLUC <2.4 mmol/L and 2.4 to 3.1 mmol/L were 3.6 and 8.3%, respectively. The inclusion of GLUC improved a previous prognostic model based on plasma l-lactate concentration and age. The resulting analyses indicated that NO was associated with low age (<7 d), hyper-l-lactatemia (>8.84 mmol/L), and GLUC <4.4 mmol/L (age 7-20 d) and <3.3 mmol/L (age ≥21 d), respectively. The area under the receiver operating characteristic curve of this model was 0.79 (95% confidence interval: 0.76-0.83) and the resulting sensitivity and specificity for NO at the optimal probability cut-point of 0.69 were 66.7 and 85.8%, respectively. For the prospective study population, the established model had sensitivity and specificity for predicting NO after 3 mo (proportion 24%) of 61.9 and 85%, respectively. In both study populations, hypoglycemia was significantly associated with intraoperative evidence of a septic process within the abdominal cavity. The present analyses show that hypoglycemia was highly indicative of a poor prognosis and serious intraoperative findings such as peritonitis. Determination of GLUC should therefore be part of the diagnostic work-up in calves suffering from an acute abdominal emergency.

Retrospective study on the use of lidocaine constant rate infusions for the treatment of ileus in ruminants and camelids

Limited knowledge exists regarding the use of lidocaine as a prokinetic in ruminants and camelids to treat gastrointestinal ileus. In this retrospective study, ruminant and camelid cases diagnosed with ileus and treated with a lidocaine constant rate of infusion were assessed for adverse reactions and medical outcomes. A review of medical records was performed to identify cases in which lidocaine was administered as a prokinetic. Ten cases were identified consisting of 8 cattle, 1 goat, and 1 alpaca. Nine animals improved with a lidocaine treatment. No adverse effects were reported during lidocaine administration. Nine animals were discharged, and 1 was euthanized.

Differential diagnosis of bovine intestinal diseases and their sequelae regarding ultrasonography and other diagnostic tools

Background and Aim

Intestinal disorders represented a large proportion of abdominal emergencies in bovine practice, and their definite diagnosis was a big challenge. The study described different intestinal disorders in cattle either in the small intestine (SI) or large intestine with their sequelae and peritonitis between SI loops.

Materials and Methods

This study involved healthy (n=20) and diseased (n=40) cattle with intestinal disorders. All animals were undergoing clinical examination, laboratory analyses, and ultrasonographic examination.

Results

Diseased cattle had monocytic leukocytosis as well as hypoproteinemia and hypoalbuminemia. The SI ileus of either proximal (n=12) or distal (n=15), intussusception (n=3), cecal, and/or colonal dilatation (n=10) were diagnosed by ultrasound and other diagnostic tools. Duodenum intussusception was imaged in cross-section as bull's eyes lesions. Animals with SI obstructions showed complete cessation (ileus with complete obstruction) or partial reduction of the peristaltic SI movement (ileus with partial obstruction), dilated duodenum (6.5-9.9 cm), and dilated jejunum and/or ileum (4.4-6.8 cm). Ultrasonography diagnosed SI ileus, due to either intestinal obstruction or peritonitis, and detected the ileus site, either proximal or distal. Cecal/colonal dilatation was detected using ultrasonography in which SI was not imaged and the peristaltic movements were completely reduced. The recorded intestinal disorders were associated with other disorders (e.g., liver cirrhosis or peritonitis).

Conclusion

Ultrasonography played an important role in the differential diagnosis of intestinal disorders in cattle. Peritonitis between SI loops and cecal and/or colonal dilatation was also diagnosed.