Laparo-hysterotomy for Management of Dystocia due to Uterine Torsion - A Clinical Study of Six Buffaloes.
Dystocia is difficulty in parturition which necessitates manual assistance in relieving and may be due to maternal or foetal abnormalities. Different maternal causes of dystocia previously reported include uterine torsion (Jeengar et al., 2015), narrow pelvis (Kamalakar et al., 2016a, 2016b), incomplete cervical dilatation (Mahesh et al., 2015), etc. Uterine torsion is twisting of uterus on its longitudinal axis leading to stenosis of birth canal (Roberts, 1986). Torsion may be resultant of weak broad ligament, sparse foetal fluids, reduced uterine tone precipitated with uncoordinated foetal movements. Torsion may be post-cervical or pre-cervical, right or left sided, but out-numbered by the earlier (Ghosh et al., 2013). Manually, traditional rolling or Schaffer's method would relieve the condition but difficult in torsion with greater than 180[degrees] and caesarean is the only effective alternative to Schaffer's method (Dhaliwal et al., 1993). In the present report, we put forth surgical management of uterine torsion in six buffaloes.
History and Clinical Observations
Six full term buffaloes were presented with signs of dystocia for a period of 24-52 hours. Their details are given in Table 1. History could not reveal actual etiology of torsion, but in case 1, discomfort started after prolonged wallowing and in case 2, after brief running due to frightening. Clinically all animals except case no. 4 were dull, depressed, dehydrated, anorectic and poor in condition. They were showing signs of colic like abdominal straining (Fig. 1), uneasiness, frequent getting up and lying down. Apart from this, severe straining in case 3 and 4, oedematous and congested vulval lips, shrinkage of udder, shivering of hind quarters in case 5 were observed. All animals showed hypothermia, bradypnoea, bradycardia and signs of shock. Per rectal and per vaginal examination confirmed right sided uterine torsion at varying degrees (Table 1).
Treatment and Discussion
An attempt was made to clear the condition either by simple rolling or by Schaffer's method, but in vain. Hence, emergency caesarean section was planned and executed. Pre-operatively, animals were administered with Ringers lactate 4 lit, DNS 2 lit and Dexamethasone @ 25 mg I/V. Sedation and local anaesthesia were achieved with Xylazine hydrochloride @ 0.01mg/kg b. wt. and 2% Lignocaine hydrochloride respectively. Left paramedian site was prepared asceptically and laparo-hysterotomy was performed as per standard procedure (Fig. 2). After retrieving calf, the whole uterus was irrigated with normal saline and inserted with Furazolidone plus Metronidazole bolus. Uterus was closed in double inversion manner using chromic catgut no.2 (Fig. 4). Peritoneum and linea alba was closed in continuous lock pattern with chromic catgut and skin in horizontal mattress pattern using black braided silk. Post-operatively, all animals were administered [Intalyte.sup.a] (20% Dextrose with electrolytes) 3 lit, Metronidazole 800ml, Intacef [Tazo.sup.a] (Ceftriaxone and Tazobactam) 3.375g, Meloxicam ([Melonex.sup.a]) 20ml, [Tribivet.sup.a] (Vitamin [B.sub.1],[B.sub.6] and [B.sub.12]) 15ml I/V and Intavita [H.sup.a] (Vitamin A, [D.sub.3] and H) 5ml and [Anistamin.sup.a] (Chlorpheniramine maleate) 15ml I/M.
All calves retrieved were dead, of these five were males and one was female. Calves of cases 4 and 5 were in posterior presentation. In cases 1, 2 and 6 calves were emphysematous. Uterine endometrium was slightly congested in case 4, but others showed colours varying from dark red to blackish green (Fig. 3). In case 2, uterus has developed thick adhesions with surrounding peritoneum and viscera that made detorsion impossible. Cases 2 and 5 succumbed within a day post surgery.
Though the exact etiology of uterine torsion in present cases is obscure, history of cases 1 and 2, confirm that prolonged wallowing and horrid running respectively. Purohit et al. (2011) reported that in buffaloes, torsion appears to be due to capacious abdomen and inordinate foetal or dam movements. Posterior presentation of foetus in cases 4 and 5 also might have resulted in torsion as indicated by Aubry et al. (2008). 4 out of 6 dams were pluriparous weighing around 450 kg, in which laxity of broad ligament might be there as reported by Sharma et al. (1995). In case 3 and 4, oedema and congestion of vulva might be due to forceful careless traction and shrinkage of udder might be due to delay in delivery or correcting dystocia in time.
Per rectal examination revealed tense and twisted broad ligament and uterine adhesions with surrounding viscera in case 2 and per vaginal examination in all animals confirmed torsion of uterus (Srinivas et al., 2007). All six animals were diagnosed with right sided uterine torsion which was most common (Aubry et al., 2008). Incidence of precervical uterine torsion is less than post-cervical (Jeengar et al., 2015) and is highly detrimental to life as it may be confused with incomplete cervical dilatation which delays treatment. Similarly in this report also, only one out of six was pre-cervical torsion. The degree of torsion in pluriparous buffaloes varied from 180[degrees]-360[degrees] and in heifers (cases 4 and 5) it was 180[degrees] or less which was in accordance with findings of Aubry et al. (2008).
Uterus became thin, inelastic, anoxic, ischaemic and green or blackish green, which might be due to limited arterial perfusion and venous outflow in twisted uterus causing irreversible damage to endometrium, mesometrium and ultimately foetal death (Ghuman, 2010). Laparo-hysterotomy was opted as a final resort after futile rolling (Purohit et al., 2014). Left paramedian site was chosen against the flank (Singh et al., 1978), oblique left ventro-lateral approach (Pattabhiraman et al., 1979). Formation of extensive adhesions of uterus with peritoneum in case 2 prevented complete detorsion of uterus. Adhesion formation might be attributed to inert, inelastic uterus for more than 36 hours in fixed position (Dhaliwal et al., 1991). In spite of extreme care, two dams succumbed owing to delay in presentation to clinic, dehydration, shock, toxaemia, tissue anoxia, serosal injury following careless rolling or surgery induced stress (Henderson, 1982).
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G. Kamalakar (1), R. Mahesh (1), N. Sumiran (1), J. Devarathnam (1) and K. Rambabu (2)
Department of Veterinary Surgery and Radiology College of Veterinary Science Sri Venkateswara Veterinary University (SVVU) Proddatur, Dist. Y.S.R. Kadapa - 516360 (Andhra Pradesh)
(1.) Assistant Professor and Corresponding author.
(2.) Assistant Professor
(3.) Assistant Professor and Head
(a) - Brand of Intas Animal Health, Ahmedabad
Table 1: Details of animals and type of torsion. Sr. Type of animal Age Time since No. (parity) signs of labour started manual (hrs) 1 She buffalo, GMB 11 yrs (5th) 40 2 She buffalo, GMB 9 yrs (4th) 52 3 She buffalo, ND 6 yrs (2nd) 26 4 Buffalo heifer, GMB 4 yrs (1st) 24 5 Buffalo heifer, ND 5 yrs (1st) 36 6 She buffalo, GMB 8 yrs (3rd) 38 Sr. Side and degree Manual No. of torsion manoevour 1 Right side Traditional 270[degrees] post-cervical rolling 2 Right side Schaffer's 270[degrees] post-cervical method 3 Right side Traditional 180[degrees] post-cervical rolling 4 Right side Traditional 180[degrees] post-cervical rolling 5 Right side Traditional 360[degrees] pre-cervical rolling 6 Right side Schaffer's 180[degrees] post-cervical method
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|Title Annotation:||Clinical Article|
|Author:||Kamalakar, G.; Mahesh, R.; Sumiran, N.; Devarathnam, J.; Rambabu, K.|
|Date:||Jul 1, 2017|
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