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Surgical management of intestinal volvulus in a graded Murrah buffalo.

Introduction

Intestinal obstruction in ruminants is an uncommon condition and includes torsion, intussusception and volvulus that causes physical occlusion of lumen (Radostits et al., 2006) and may be simple or strangulated based on continuity of blood supply (Makhdoomi et al., 1995). Intestinal volvulus is rotation segment of small intestine with or without caecum and spiral colon or only the distal third of jejunum and proximal portion of ileum about its mesenteric axis (Anderson et al., 1993) resulting in distension of distal loops, compromising blood supply, necrosis and finally death of animal (Krishnamurthy et al., 1980). A study of Dharmaceelan et al. (2012) revealed that, incidence of intestinal obstruction was very less in buffaloes (7.69%). In field conditions, these cases are reported at an advanced stage that may or may not respond to treatment. In the present paper, a case of intestinal obstruction in a graded murrah buffalo and its successful surgical management are reported.

History and Clinical Observations

A graded Murrah she buffalo in its 3rd parity, weighing around 350 kg calved 1 month before was presented with history of colic, anorexia, passing hard dung mixed with mucus for previous 4 days. It was suffering from severe enteritis and suddenly fell down abruptly on an uneven floor and started showing signs of frequent getting up and lying down, severe colic, anorexia, paddling of limbs in recumbency and vocalization which subsided after 2 days. Signs like gradual reduction in quantity of faeces, agalactia and abdominal distension were also recorded.

Clinically the animal was dull, often kicking at its belly with arched back condition. Abdominal distension was more on right side. Borborygmi were clearly audible at right ventral abdomen. Temperature, respiratory and heart rates were 102.2[degrees]F, 40/ min and 90/ min. respectively. Rumen was doughy with motility rate of 1 in 3 min. Per rectal examination revealed almost empty rectum with foul smelling dark, hard pellety dung heavily coated with blood mixed mucus and hard ring like mass at right sub iliac region. Based on the above observations, the condition was confirmed as intestinal obstruction and emergency surgery was performed.

Treatment

Pre-operatively, the animal was rehydrated with 4 lit Ringers Lactate, 2 lit Dextrose Normal Saline, 450 ml of Calcium borogluconate and inj. (Maxxtola) Tolfenamic acid I/V @ 4 mg/ kg b.wt. Right paralumbar fossa was prepared aseptically. The animal was controlled in standing sedation after administration of Xylazine hydrochloride @ 0.01 mg/ kg b.wt. and regional analgesia was achieved by right para vertebral nerve block using 2% Lignocaine hydrochloride. The intestines were approached by right mid flank skin incision, followed by blunt dissection of the muscles and peritoneum.

Intestines were checked for obstruction and distended, incarcerated, ischemic and bluish necrosed loops at distal portion of jejunum that wasrotated on their mesenteric axis (Fig 1). The proximal loops were distended heavily with watery ingesta and gas whereas distal loops were empty, congested and collapsed. At the site of adhesion, the intestines became thin and porous leaking chyle into the peritoneum. The mesenteric blood vessels were engorged severely along with severe peritonitis. Resection was carried out up to the unhealthy portion along with obstruction and performed anastomosis using schmeiden's pattern using chromic catgut no. 2/0 after careful ligation of mesenteric vessels (Fig. 2). To check the patency, contents were milked to site of anastomosis and no leakage was observed. The laparotomy incision was closed with figure of eight pattern. Suture line was smeared with Loraxene (b) ointment and protective retention bandage was applied. Post-operatively the animal was administered with 3 lit Ringers lactate, 3 lit Dextrose normal saline, Ciprofloxacin 10 mg/kg b.wt., Metronidazole 20 mg/kg b.wt., 20 ml Tribivet (a) I/V, 20 ml Chlorpheniramine maleate and 10ml Vitamin A,[D.sub.3]E I/M. The treatment was followed for next 7 days. The animal passed loose dung within 4 hrs after surgery. The owner was advised to offer only liquid diet like raagi malt and concentrates in water for a week followed by chaffed green grasses. The animal recovered well by 10th post-operative day.

[FIGURE 1 OMITTED]

[FIGURE 2 OMITTED]

Discussion

Etiological factors for volvulus may be alterations in intestinal motility and excessive gas formation (Sharma et al., 2003) with concurrent jerks or falls on ground. History disclosed that animal was fed on more amounts of concentrates and lush green fodder for high milk yield and concurrent hyper motility of intestines might have predisposed to volvulus. The initial signs included anorexia, colic, kicking at belly, paddling of limbs in recumbency, frequent getting up and lying down which subsided after 2 days which might be attributed to stimulation of autonomic nervous system distended cranial loops of obstruction with chyle and fluids (Papadopoulos et al., 1985). Frequent passing of small quantity of dung and in later stages passing mucous and blood coated dung were also reported by Sharma et al. (2003). The obstruction was at distal jejunal region which is common site of obstruction (Constable et al., 1997).

Constable et al. (1997) reported, that the resected length of intestine was at range of 15cm-3.8 m. In this case, the length of obstructed intestine was about 3.5 feet shorter length of volvulus could be attributed to a larger amount of mesenteric fat and lesser degree of rotation of intestine around mesenteric axis as opined by Anderson et al. (1993) owing to early lactation and concurrent flushy feeding. At the point of adhesion and before the obstruction, luminal wall became thin due to ischemia, decomposition of ingesta and distension which led to leakage of ingesta into peritoneum causing peritonitis. Metronidazole was used to counteract anaerobic bacteria and adhesion formation. The animal was rehydrated before and after surgery with more of electrolyte solutions like Ringers lactate and Calcium borogluconate as cases usually suffers from hypochloremic, hypokalemic and hypocalcaemic metabolic alkalosis as stated by Peshin et al. (1993). The animal passed loose dung after 4 hrs of surgery indicating good peristaltic activity of intestines. By 3rd day, it started taking feed. It was concluded that survival in present case might be attributed to early presentation, adequate pre and post operative fluid and anti bacterial therapy.

References

Anderson, D.E., Constable, P.D., Jean G.S. and Hull, B.L. (1993). Small intestinal volvulus in cattle: 35 cases (1967-1992). J. Am. Vet. Med. Assoc. 203: 1178-83.

Constable, P.D., Jean, G.S., Hull, B.L., Rings, D.M., Morin, D.E. and Nelson, D.R. (1997). Intussusception in cattle: 336 cases (1964-1993). J. Am. Vet. Med. Assoc. 210: 531-36.

Dharmaceelan, S., Rajendran, N., Nanjappan, K., Subramanian, K. and Balasubramaniam, G.A. (2012). Incidence of gastro intestinal obstruction in a Teaching Veterinary Hospital of Tamil Nadu. India. Inter. J. Vet. Sci. 1: 112-14.

Krishnamurthy, D., Gera, K.L., Singh, J. and Nigam, J.M. (1980). Experimental strangulated intestinal obstruction in buffalo calves. Peritoneal fluid and blood/ serum alterations. Ind. Vet. J. 52: 155-59.

Makhdoomi, D.M., Singh, A.P., Singh, M. and Krishnamurthy, D. (1995). Intestinal obstruction in ruminants: A review. Ind. J. Vet. Sur. 16 : 81-88.

Moll, H.D., Juzwaik, J.S., Santschi, E.M. and Slone, D.E. (1991). Small intestine volvulus as a complication of inguinal hernia in two horses. J. Am. Vet. Med. Assoc. 198: 1413-14.

Papadopoulos, P., Raptopoulos, D., Dassidis, A. and Tsimpoulos, G. (1985). Zbl. Vet. Med. A. 32: 276-88.

Peshin, P.K., Singh, J. and Tyagi, R.P.S. (1993). General Surgical Considerations and Fluid therapy. In Ruminant Surgery, Ed. by Tyagi RPS and Singh J, CBS Publishers and distributors, New Delhi, p. 40.

Radostits, O.M., Gay, C.C., Hinchcliff, K.W. and Constable, P.D. (2006). Veterinary Medicine--A Textbook of the Diseases of Cattle, Horses, Sheep, Pigs and Goats. Elsevier Publications, Philadelphia, p. 376.

Sharma, A., Kumar, U., Gupta, A. and Ryot, K.D. (2003). Clinical observations on intestinal obstruction in cattle A field study of 12 cases. Ind. Vet. J. 80: 265-67.

(a)--Brand of Intas Animal Health, Ahmedabad

G. Kamalakar (1), V. Devi Prasad (2) and R. Mahesh (3)

College of Veterinary Science Sri Venkateswara Veterinary University (SVVU) Proddatur District YSR Kadapa--516360 (Andhra Pradesh)

(1.) Assistant Professor and Corresponding author. E-mail: drkamal_vet@yahoo.co.in

(2.) Associate Professor

(3.) Assistant Professor
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Title Annotation:Short Communication
Author:Kamalakar, G.; Prasad, V. Devi; Mahesh, R.
Publication:Intas Polivet
Geographic Code:9INDI
Date:Jan 1, 2016
Words:1377
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