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Surgical management of common intestinal conditions in adult cattle
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The objective of this presentation is to present some basic intestinal conditions that can be handled in field situation with emphasis on duodenum and jejunum.
Surgical approach: The most common surgical conditions reported in the literature are: intussusception, volvulus of the jejunum, incarceration and jejunal hemorrhage syndrome. Other less frequent conditions are: gut tie in steers, duodenal obstruction, trichobezoar, ileal impaction and sigmoid flexure volvulus of the duodenum. Since the last few years, we have more sigmoid flexure volvulus than any other intestinal surgical condition combined. Intestinal surgeries are performed usually through a right flank incision while the animal is standing. Preoperative analgesia is provided to the patient before invading the abdomen. Mild sedation might be necessary. Broad spectrum antibiotics must be given before the surgery. The flank is anesthetized by linear infiltration of lidocaine or with a paravertebral block.
In cattle, the mesentery is short and fatty rendering vessels ligation difficult. It is recommended to infiltrate the mesentery with lidocaine before resection to alleviate the pain from pulling on the mesentery. Only the affected portion of the intestine is exteriorized. End-to-end anastomosis is more commonly done than side-to-side. Doyen forceps, silicone or rubber tub- ing, and umbilical tape have been used to keep the resected section tight while suturing. The anastomosis is sutured with one layer of full thickness simple interrupted sutures with 2-0 absorbable suture on a swaged on needle. Simple continuous suture can be used but should be interrupted at one point to avoid a purse string effect (2X 180o). The mesentery should always be sutured to avoid incarceration.
Specific intestinal diseases.
Intussusception is reported to be more common in young cattle and Brown Swiss. The most common site of intussusceptions is jejunum followed by colocolic. Effective reduction of the intussusception in surgery is rarely feasible therefore, surgical resection is indicated. The prognosis is fair.
Intestinal volvulus is rapidly fatal if not treated. Volvulus can involve either the ileal flange of the jejunum or the root of the mesentery. Surgery is an emergency. Exteriorization of a portion of the jejunum is necessary to reduce the volvulus. Resection of the jejunum will be performed if the ileal flange underwent irreversible vascular damage. The prognosis is 86% if the ileal flange is involved and 44% with a volvulus of the root of the mesentery.
Jejunal Hemorrhage Syndrome has a high mortality rate (60-100%). Although medical assistance is necessary in all animals, surgery is indicated only if there are signs of obstructions: scant feces, distended jejunum with or without intraluminal mass at rectal palpation and transabdominal ultrasound findings. Otherwise the animal is treated medically with 2-4 liters of mineral oil orally, IV fluids or blood transfusion and systemic antibiotics (β-lactam). The affected segment of jejunum is easily identified at surgery. There are 3 surgical options: aborad massage of the clot, enterotomy and resection anastomosis. Decision is based on the length of the clot and the integrity of the jejunal wall. Prompt laparotomy and manual massage had a higher survival rates in one study. Medium and long term survival rate was higher in cattle referred 24 to 48 hours after onset of signs. The recurrence rate although was high.
Duodenal obstruction should be suspected if there is a severe hypochloremic metabolic alkalosis with a small ‘ping’ behind the last right rib and absence of intestinal distension at the rectal palpation. If the cause cannot be determined, a temporary diagnosis of ileus is given and large volume of intravenous fluids is administered for 12 to 24 hours. Enterotomy can be performed on the cranial and descending duodenum to remove a foreign body or trichobezoar. However, any obstruction involving the sigmoid flexure of the duodenum is difficult because it cannot be exteriorized.
The volvulus of the sigmoid flexure of the duodenum is a surgical condition and diagnosis is confirmed during the laparotomy. The sigmoid flexure is severely distended with gas and a volvulus is palpated at its root close to the neck of the gall bladder on the visceral part of the liver. The volvulus is reduced and cranial duodenal content is milked through the flexure to ensure that it’s functional. The prognosis is good if the sigmoid flexure is not necrotic.
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Affiliation of the authors at the time of publication
Université de Montréal, Canada
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