Primary Repair of Abomasal Fistulae Resulting From Right Paramedian Abomasopexy in Eight Adult Dairy Cattle

Abomasal fistulae resulting from right paramedian abomasopexy in eight adult dairy cattle were treated by primary closure of the abdominal wall after surgical resection of the fistulae. The median elapsed time from the abomasopexy to recognition of fistula formation was 16 days (range, 10 to 90 days). All cows had normal electrolyte values, and five cows had mildly increased base excess values (range = 4.0 to 7.8 mEq/L). Surgery was performed with the cows in dorsal recumbency using general anesthesia. The fistulated tissue was resected and the abomasum and body wall were closed primarily. One or two layers of appositional sutures using #2 or #3 polyglactin 910 were used to close the body wall. Mean surgical time was 2.2 hours (range, 1.8 to 2.9 hours). Two cows were lost to follow-up. Five of the remaining six cows returned to production (range, 5 to 30 months). Primary closure of the abdominal wall should be considered in the surgical repair of abomasal fistulae in cows that do not have diffuse peritonitis.     

Retrospective study on the outcomes and risk factors of right paramedian abomasopexy for right abomasal disorders in 47 dairy cows

Very few epidemiologic studies have verified the utility of the right paramedian abomasopexy (RPA) technique in cows with right abomasal disorders. This study aimed to investigate the outcomes and risk factors for non-survival in the herd within 30 days of surgery in cows with right abomasal disorders who underwent the RPA technique. Forty-seven Holstein cows with right abomasal disorders (25 with right abomasal displacement [RDA] and 22 with right abomasal volvulus [RAV]) were included. Twenty-two cows with RDA (22/25, 88.0%) and 10 cows with RAV (10/22, 45.5%) survived at 30 days post-surgery. Multivariate logistic regression analysis indicated that hyponatremia, hypokalemia, and the presence of abomasal volvulus were the major risk factors associated with non-survival.     

Ventral laparoscopic abomasopexy in 18 cattle with displaced abomasum

OBJECTIVE: To evaluate the feasibility and outcome of a technique for laparoscopic abomasopexy in cattle with displaced abomasum (DA). STUDY DESIGN: Retrospective study. ANIMALS: Dairy cattle (n=18). METHODS: Retrieved data included signalment, clinical findings, treatments, and outcome. Laparoscopic abomasopexy was performed with the sedated cow in dorsal recumbency. The pexy site was determined after identification of the antrum and the greater curvature of the abomasum. Three or 4 absorbable sutures were passed through the body wall and abomasal wall for abomasal fixation. Wound complications, DA recurrence, food consumption, owner satisfaction, and long-term survival were assessed. RESULTS: Left DA was diagnosed in 17 cows and right DA in 1 cow. Abomasal decompression was performed in 12 cows and abomasopexy was achieved in all cows. Surgical wounds healed without complication, except in 4 cows that had mild periportal swelling. Postoperative return to normal appetite occurred quickly except for 2 cows with concurrent diseases. Owner satisfaction varied from good to excellent. DA did not recur. CONCLUSION: Ventral laparoscopic abomasopexy was successfully performed in 18 cows with DA. Abomasal decompression was necessary for adequate abomasal manipulation and identification of landmarks for pexy. An adequate return to food consumption and no recurrence of DA occurred (mean follow-up, 15.5 months). CLINICAL RELEVANCE: Ventral laparoscopic abomasopexy is technically feasible and an effective method for surgical treatment of DA.     

One-step laparoscopic abomasopexy for correction of left-sided displacement of the abomasum in dairy cows

Four adult dairy cows in which a diagnosis of left-displaced abomasum (LDA) had been made underwent a 1-step laparoscopic abomasopexy (LA). The technique was performed with each cow positioned in dorsal recumbency. Two laparoscopic portals were created in the right paramedian area to identify the abomasum and direct insertion of the steel trocar and cannula into the abomasal lumen. A stainless steel toggle pin (with 2 lengths of suture attached to its midpoint) was inserted via the cannula into the abomasal lumen while the excess suture material remained exterior to the abdomen. The abomasum was deflated, and the excess suture material was withdrawn up to a preset marker on the suture to position the abomasum adjacent to the body wall. The suture was then tied to secure the abomasum in place. By use of this 1-step LA technique, LDA was successfully corrected in all 4 cows. The procedure is minimally invasive and allows viewing of the abomasum for correct positioning and fixation; it can be accomplished with the speed associated with the blind roll-and-tack technique. The 1-step LA technique may reduce the incidence of complications associated with traditional laparotomy and the blind roll-and-tack technique and could be a useful alternative procedure for the treatment of LDA in dairy cows.     

Thoracotomy in adult dairy cattle: 14 cases (1979-1991).

Fourteen cows were subjected to thoracotomy as an aid in the treatment of either septic pericarditis (n = 7) or unilateral pleuritis (fibrous or purulent; n = 7). Thoracic lesions were primary in 4 cows, secondary to traumatic reticuloperitonitis in 9 cows, and secondary to extension of a liver abscess in 1 cow. Thoracotomy was performed on 9 cows under local anesthesia. Surgery was performed on 5 cows under general anesthesia; 2 died during anesthesia, and 2 others were euthanatized. Of the 10 cows allowed to recover from surgery, 4 had pericarditis and 6 had pleuritis. Four cows with pleuritis had thoracic abscesses. All but 1 cow with pericarditis died or were euthanatized, and 5 of the 6 cows with pleuritis were discharged from the hospital. A year after surgery, 1 cow was culled because of infertility, and the other 5 cows were returned to production.     

Comparison of laparoscopic-guided abomasopexy versus omentopexy via right flank laparotomy for the treatment of left abomasal displacement in dairy cows

OBJECTIVE: To compare results obtained by use of laparoscopyassisted abomasopexy versus omentopexy via right flank laparotomy for the treatment of dairy cows with left displaced abomasum (LDA). ANIMALS: 120 dairy cows with an LDA. PROCEDURE: In a prospective clinical trial, cows were randomly allocated to the abomasopexy group (laparoscopy-assisted abomasopexy) or to the control group (omentopexy via right flank). Data were obtained during the first 5 days after surgery and 6 weeks and 6 months after surgery. RESULTS: 59 of 60 cows in the abomasopexy group and all 60 cows in the control group were treated successfully. Median duration was shorter for the laparoscopic procedure (27.5 minutes), compared with that for the control group (38 minutes). Five cows in the abomasopexy group had wound complications and 2 had LDA relapses, compared with 2 wound complications and no relapses in the control group. During the 5 days after surgery, the abomasopexy group had a significantly higher increase in rate of energy intake and milk yield and a more rapid return to reference range for serum glutamic dehydrogenase activity and total bilirubin concentration, compared with results for the control group. CONCLUSIONS AND CLINICAL RELEVANCE: Success rates were almost equal for both methods. Advantages of the laparoscopic abomasopexy procedure include practicality, low risk of complications, and rapid postoperative recovery. Contraindications are cardiopulmonary diseases. Other disadvantages include the cost of the instruments and inability to perform the procedure in cows with abomasal adhesions.     

A comparison in 101 dairy cows of right paralumbar fossa omentopexy and right paramedian abomasopexy for treatment of left displacement of the abomasum

Right paramedian abomasopexy and right paralumbar fossa omentopexy appear to be the most widely used means of correcting left displacement of the abomasum in dairy cattle. We compared these two procedures in a prospective study of 101 cows with uncomplicated left displaced abomasum. The surgical treatment (right paramedian abomasopexy, n = 48; or right paralumbar fossa omentopexy, n = 53) was assigned randomly. Follow-up information was obtained, at regular intervals, from one week through six months following discharge from the hospital. Milk production, reproductive performance, surgical complications, and length of time retained in the herd after surgery were obtained for each animal. There was a trend in favor of the abomasopexy group in the one-month milk yield. There were no differences between procedures either in incisional complications, other problems noted at follow-up, or in the proportion dead/culled. Based on the milk yield at one month after surgery, we concluded that there may be a slight advantage to right paramedian abomasopexy in cows with uncomplicated left displaced abomasum.     

Bar suture (toggle pin) vs open surgical abomasopexy for treatment of left displaced abomasum in dairy cattle

Fifty-nine dairy cows with left displacement of the abomasum were randomly assigned to receive 1 of 2 treatments. Twenty-eight were treated by right paramedian abomasopexy via laparotomy, and 31 were treated by percutaneous fixation of the abomasum, using the bar suture or toggle pin technique. Comparisons of the 2 groups, at 4 follow-up examinations, yielded no significant differences in return to normal milk production, return to normal feed intake, mortality, culling rate, tissue reaction at the surgical site, or redisplacement up to 60 days into the subsequent lactation.     

Ultrasonographic assessment of change in abomasal position during the last three months of gestation and first three months of lactation in Holstein-Friesian cows

OBJECTIVE: To determine changes in abomasal position and dimensions during the last 3 months of gestation and first 3 months of lactation via transabdominal ultrasonography and determine whether surgical correction of left-displaced abomasum (LDA) by right flank omentopexy alters abomasal position within the abdomen in Holstein-Friesian cows. DESIGN: Observational study. ANIMALS: 20 heifers and 20 cows with no history of an LDA and 7 cows that had been treated for LDA via right flank omentopexy during an earlier lactation. Procedure-Ultrasonographic measurements were obtained 8 times during the last 3 months of gestation and first 3 months of lactation. Abomasal length, width, and volume were calculated from these measurements. RESULTS: The abomasum was always wider than it was long and located predominantly to the right of the midline. The presence of a right flank omentopexy had no effect on the measured parameters. Abomasal length decreased and width increased during the last 3 months of gestation, resulting in a more transverse orientation of the abomasum within the abdomen. These changes appeared to be in response to cranial expansion of the gravid uterus. The abomasum returned to a more caudal and right sagittal position within 14 days after parturition. CONCLUSIONS AND CLINICAL RELEVANCE: Abomasal dimensions, position, and volume change markedly during the last 3 months of gestation and first 3 months of lactation. Results permit detection of abnormal abomasal position in ill cows and indicate that the preferred location for abomasopexy is 20 cm caudal to the xiphoid process and 5 to 10 cm to the right of the ventral mid-line.     

Right displacement of the abomasum and abomasal volvulus in dairy cows: 458 cases (1980-1987)

Clinical and surgical findings in 458 dairy cows with right displacement of the abomasum or abomasal volvulus (AV) were analyzed to determine the association between these variables and the outcome (productive, salvaged, or terminal) of the affected cow. Heart rate at initial examination was higher in the salvaged and terminal groups of cows (P less than 0.0001) than in the productive group. The plasma Na+ concentration was lower in the salvaged and terminal groups of cows (P less than 0.0001) than in the productive group. The plasma C1- concentration was lower in the salvaged group of cows than in cows with either productive or terminal outcomes (P less than 0.0001). Anion gap was significantly higher (P less than 0.0001) in the salvaged and terminal groups than in cows classified as productive. On the basis of surgical findings, cattle with right displacement of the abomasum were more likely to survive than cows with AV. Cows that required fluid decompression of the abomasum via abomasotomy were less likely to survive than those in which gaseous decompression was performed. Cows with evidence of vascular compromise of the abomasal wall were less likely to survive than those with normal abomasal serosa. Preoperative heart rate and anion gap had positive correlations with the presence of abomasal necrosis, whereas temperature, venous blood pH, plasma bicarbonate, and base excess concentrations had negative correlations. Cows in terminal stages of AV were likely to have a mixed primary acid-base disturbance, consisting of metabolic alkalosis with superimposed metabolic acidosis. These findings were highly correlated with abomasal necrosis.     

Displacement of the abomasum in the cow. Incidence, etiological factors and results of treatment.

Fiftynine cases of abomasal displacement were registered during a 10 year period in a veterinary district in Norway with a dairy cow population of approx. 2500. Of these, 88% were left displacements and 12% right displacements. Ten per cent recovered spontaneously without subsequent relapse. Corrective surgery was performed on the remainder, and 92% of these recovered completely. Surgery was, in most cases, performed on the same day as the diagnosis of abomasal displacement was made. The displacements occurred at all times of the year: 86% of cases involved cows in third or subsequent lactation 95% were diagnosed within the period 4--64 days after calving, and 70% of the cows had been treated for other illness with disturbance of digestion during the week immediately prior to the demonstration of the displacement. In a further 25%, ketosis was diagnosed at the same time as the displacement. Etiology and pathogenesis are discussed.     

Comparison of 2-step laparoscopy-guided abomasopexy versus omentopexy via right flank laparotomy for the treatment of dairy cows with left displacement of the abomasum in on-farm settings

OBJECTIVE: To compare characteristics and results of 2-step laparoscopy-guided abomasopexy versus omentopexy via laparotomy in the right paralumbar fossa for the treatment of dairy cows with a left displaced abomasum (LDA). DESIGN: Prospective clinical trial. 253 dairy cows with an LDA. PROCEDURES: All cows that were treated with omentopexy (n = 101) or 2-step laparoscopy-guided abomasopexy (152) from July 2005 through December 2006 were included. Presurgical, perisurgical, and postsurgical information was recorded by attending veterinarians. Producers were interviewed by telephone 7 and 60 days after surgery regarding the response of cows to surgery. Characteristics of and responses to the 2 surgical techniques were compared. RESULTS: At 7 days after surgery, the 2 groups of cows were not significantly different with respect to appetite, comfort, and milk yield; at 60 days after surgery, groups were similar with respect to milk yield, cull rates, and risk of relapse of LDA. Antimicrobial treatment in response to postsurgical pyrexia was necessary in only 20.4% (31/152) of cows that were treated with 2-step laparoscopy-guided abomasopexy. Mean duration (preparation and surgery) of 2-step laparoscopy-guided abomasopexy was significantly less than that of omentopexy (36 vs 74 minutes, respectively). CONCLUSIONS AND CLINICAL RELEVANCE: Results of 2-step laparoscopy-guided abomasopexy and omentopexy via laparotomy in the right paralumbar fossa were not significantly different. Compared with omentopexy, laparoscopy-guided abomasopexy was performed more quickly and required postsurgical administration of antimicrobials less frequently. Although these factors may be of economic consequence to veterinarians and producers, other aspects must also be considered when choosing between techniques.     

Intraluminal hemorrhage from small intestinal ulceration in two cows.

Two adult Holstein cows were admitted with signs of acute gastrointestinal hemorrhage. Abomasal ulceration was diagnosed tentatively in both cows, but was later ruled out in 1 cow that had an abomasotomy performed through a right paramedian approach. Both cows failed to respond to treatment of blood loss and hypovolemic shock and became recumbent; one cow died and the other was euthanatized. Post-mortem examination determined the source of hemorrhage in both cows to be ulcerated small intestine with severe intraluminal hemorrhage. The cause of ulceration was undetermined. Small intestinal hemorrhage should be considered in cattle with signs of acute gastrointestinal hemorrhage.     

Complications of blind-stitch abomasopexy: 20 cases (1980-1985)

Over a 5-year period, 20 adult Holstein cows were admitted to the New York State College of Veterinary Medicine because of complications following blind-stitch percutaneous abomasopexy for correction of left-displaced abomasum. Of the 20 cows, 16 were treated surgically, 2 were treated medically, and 2 were admitted to the pathology service for necropsy. Complications associated with the blind-stitch technique included peritonitis, cellulitis, abomasal displacement or evisceration, complete forestomach obstruction, and thrombophlebitis of the subcutaneous abdominal vein. Because of the various complications associated with blind-stitch percutaneous abomasopexy, we concluded that it is not an appropriate procedure for correction of left displaced abomasum in valuable cattle, but may be used as an alternative for salvage in less valuable cows.     

Abomasal volvulus in cattle following correction of left displacement by casting and rolling

Seven adult cows developed abomasal volvulus immediately following correction of left displacement by casting and rolling. Three cows were rolled to provide temporary relief from left displaced abomasum because of concurrent disease and 4 were rolled as the principal therapy for left displacement. In each animal surgical correction of abomasal volvulus was accomplished via right paralumbar fossa celiotomy and inclusion of an omentopexy during abdominal closure. Surgery was performed within 24 hours of casting and rolling. All 7 cows recovered after surgery and were reported to have satisfactory milk production and appetite 6 weeks later.     

Prevalence of endotoxemia in healthy postparturient dairy cows and cows with abomasal volvulus or left displaced abomasum

Left displaced abomasum (LDA) and abomasal volvulus (AV) occur most commonly in postparturient dairy cows. Our main hypothesis was that endotoxemia occurred more frequently in the peripheral blood of cows with LDA or AV than in healthy cows because increased luminal pressure in AV or LDA, or the presence of a hemorrhagic strangulating obstruction in AV, may have injured the abomasal mucosa, thereby facilitating translocation of luminal endotoxin into the circulation. Therefore, our main objective was to compare the prevalence and magnitude of endotoxemia in healthy postparturient cows with the prevalence and magnitude of endotoxemia in cows with AV and LDA. We examined 60 adult dairy cows in early lactation that were diagnosed with AV (n = 15) or LDA (n = 15) or were healthy on physical examination (control group, n = 30). Jugular venous blood was obtained from cows in all 3 groups, and right gastroepiploic venous blood was obtained during surgical correction of AV and LDA immediately after repositioning of the abomasum. Platelet-rich plasma endotoxin concentrations were measured with a chromogenic limulus amoebocyte lysate assay. Endotoxin was detected in jugular vein plasma in 50% (15/30) of control cows; however, the prevalence of endotoxemia was significantly lower (P < .05) in cows with AV (7%, 1/15) or LDA (20%, 3/15). Endotoxin was detected simultaneously in right gastroepiploic and jugular vein plasma in only 1 cow with LDA and 0 cows with AV. Contrary to our hypothesis, we conclude that endotoxemia is infrequently present in postparturient dairy cows with AV or LDA.     

Peritoneal fluid analysis in dairy cows with left displaced abomasum and abomasal volvulus

Peritoneal fluid (PF) was evaluated in 40 cows with left displaced abomasum (LDA) and 15 cows with abomasal volvulus (AV). PF was obtained by abdominocentesis at the right ventral abdomen at admission. Simultaneously, a blood sample was taken from the jugular vein. Biochemical and cytological variables in blood and PF specific for ischaemia, inflammation and cell damage were compared. Total protein, albumin, glucose and cholesterol were normal in PF of cows with LDA and AV. Although L-lactate increased in both groups, cows with AV had significantly higher values (LDA: 1.47/0.69/2.68 mmol/l; AV: 6.45/4.55/12.89 mmol/l (median/1. quartile/3. quartile)). D-dimer (LDA: 0.50/0.22/0.88 mg/l; AV: 1.11/0.40/1.85 mg/l) and LDH (LDA: 663/437/943 U/l; AV: 1099/750/1439 U/l) were only increased in PF of cows with AV. The number of leucocytes was normal; however, significantly more peritoneal neutrophils appeared necrotic or apoptotic after AV. PF of cows with abomasal displacement showed distinctive features of ischaemia and inflammation. Characteristics of haemostatic dysfunction and cell damage were mainly evident in PF of cows with AV. The results suggest that anti-inflammatory therapy is indicated in each cow with abomasal displacement. Additionally, medical treatment should be directed to prevent complications of ischaemia and reperfusion in cows with AV.     

Abomasal impaction in Holstein-Friesian cows: 80 cases (1980-2003)

OBJECTIVE: To determine clinical examination findings, clinicopathologic abnormalities, and outcome of treatment in dairy cattle with abomasal impaction. DESIGN: Retrospective study. ANIMALS: 80 lactating Holstein-Friesian cows > or = 2 years old. PROCEDURE: Medical records of cattle with abomasal impaction admitted between 1980 and 2003 were retrieved, and data were extracted. RESULTS: All cows were reported to have decreased food intake; concurrent diseases were identified in 54 (68%). Seventeen cows did not have detectable ruminal motility, but physical examination findings were nonspecific and variable. In general, cattle had mild hypocalcemia, hyperbilirubinemia, and hyperglycemia, but serum potassium and chloride concentrations were typically within reference limits. Fifty-five (69%) cattle had impaction of the pyloric antrum alone, and 25 (31%) had impaction of the abomasal body and pyloric antrum. Right flank laparotomy and abomasal massage were performed in 73 cattle. After surgery, 54 (74%) cattle received 3 to 4 L of mineral oil, PO, daily for 1 to 5 days. Short-term (ie, discharged from the hospital) survival rate was significantly higher for cows with impaction of the pyloric antrum alone (42/45 [93%]) than for cows with impaction of the body and antrum (12/24 [50%]). CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that physical examination findings and results of serum biochemical analyses do not facilitate the diagnosis of abomasal impaction in lactating Holstein cows and that exploratory right flank laparotomy is necessary to make the diagnosis. Abomasal impaction should be considered as a differential diagnosis for inappetence and poor milk production in lactating dairy cows.     

Third-degree perineal lacerations and rectovestibular fistulae in cattle: 20 cases (1981-1988)

The case records of 20 cows with either a third-degree perineal laceration or rectovestibular fistula were reviewed to ascertain the signalment, history, treatment, and long-term result of treatment. Fifteen cows, including 10 first-calf cows, had third-degree perineal lacerations that occurred at calving. Surgery was done in 14 of 15 cows; 10 of the 14 (71%) remained fertile. The cow that was not treated surgically was culled after 24 months because of infertility. Five cows had a rectovestibular fistula; 4 of these were treated surgically. The cow that did not have surgery healed by second intention and remained fertile, and 3 of the 4 cows in which surgery was performed were fertile. None of the cows that produced calves after the initial injury suffered a perineal laceration at subsequent calvings. Single-stage surgical repair of third-degree perineal laceration or rectovestibular fistula appeared to have a good prognosis for subsequent fertility in cows.     

Relationship between halftime for sulfobromophthalein clearance and post-surgical prognosis in cows with abomasal displacement.

In 47 dairy cows with abomasal displacement, 34 (72%) cows were confirmed to have the lipid infiltration in liver by biopsy examinations. The pathological degree of the lipid infiltration was significantly higher in the cows with left abomasal displacement than in those with right one. The halftime for sulfobromophthalein clearance (BSP-T1/2) was markedly increased in nonrecovered cows with left abomasal displacement. In left abomasal displacement cases, cows with the T1/2 less than 11 min recovered regardless of the degree of liver lipid infiltration, but those with the T1/2 longer than 11 min showed a significantly lower recovery rate (44%). Therefore, it was concluded that the BSP-T1/2 was one of valuable parameters for predicting the prognosis of this disease.