Volume 38 | Issue 1 Article 7

1976 Four Methods of Surgical Correction of Abomasal Displacement in the Cow Jim Connell Iowa State University

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Recommended Citation Connell, Jim (1976) "Four Methods of Surgical Correction of Abomasal Displacement in the Cow," Iowa State University Veterinarian: Vol. 38 : Iss. 1 , Article 7. Available at: https://lib.dr.iastate.edu/iowastate_veterinarian/vol38/iss1/7

This Article is brought to you for free and open access by the Journals at Iowa State University Digital Repository. It has been accepted for inclusion in Iowa State University Veterinarian by an authorized editor of Iowa State University Digital Repository. For more information, please contact [email protected]. Four Methods of Surgical Correction of Abomasal Displacement in the Cow by Jim Connell* The purpose of this paper is to compare paralumbar fossa is clipped and surgically and contrast various surgical methods of scrubbed. Either a paralumbar nerve block correction of displaced abomasum in cattle. or inverted "L" block is placed with 2% Points to be considered include: The lidocaine to anesthetize the site of the relative ease of the procedure; the exposure incision. A 20 cm skin incision is made afforded if complications arise; and, of vertically in the center of the paralumbar course, the chances of success. fossa. The external and internal oblique . The abomasum normally lies slightly to muscles are incised as they are encountered the right of the midline on the floor of the as is the transversus abdominis. The abdominal cavity extending fr,om the peritoneum is carefully incised so as not to xiphoid to the ninth or tenth rib with the cut any underlying structures. At this point body between the ventral sac of the rumen the surgeon inserts his arm and passes and the omasum. The superficial part of the posterior to the intestinal mass and the greater omentum is attached to the greater rumen to the left abdominal wall where he curvature of the abomasum and to the should be able to palpate the gas-filled transverse duodenum.10 When the abomasum. Then using a large bore needle abomasum is displaced to the left it is and rubber tubing the abomasum is usually found in or just anterior to the left deflated to expidite return to the right side. paralumbar fossa between the rumen and The abomasum is sw:~pt ventral to the the body wall. In a displacement the greater rumen by the surgeons hand and forearm omentum is stretched ventral to the rumen until it can no longer be detected on the since it also attaches to the duodenum. The left. At this point the duodenum is located proximal portion of the abomasum near the in the superficial layer of the greater omaso-abomasal orifice will be stretched omentum. It should be running tran­ and could be torsed. sversely across the area of the incision. The object of any surgery to correct a Trace it anteriorly to the pylorus to verify displaced abomasum is to return it to a the presence of abomasum on the right normal postition. It is also important to side. A fold of this omentum is then at­ stabilize it in that position to prevent tached to the edge of the incision with a recurrence of the problem. At the present staple suture of #3 gut. The omentum is time there are four methods of correction included in the first layer of the standard that are used regularly by veterinarians: three layer laparotomy closure thereby left paralumbar a bomasopexy, right establishing an omentopexy to stalilize the paralumbar omentopexy, right ventral abomasum. 3,4 abomasopexy and closed suture This operation can be done by one man abomasopexy. working alone and can be done in a short To prepare for the right paralumbar period of time. If adhesions are present omentopexy3,4,a the cow is restrained in a they must be broken down blindly hoping head-gate or stocks and given tranquilizers not to perforate the abomasum. If there is a as is seen fit by the surgeon. The perforating ulcer or a rent is made in the abomasum a left flank laparotomy is in­ dicated to attain exposure to effect repairs *J. Connell is a fourth year student in the College of on the abomasum. There is also a chance of Veterinary Medicine, Iowa State University. peritoneal contamination when the needle

Issue No.1) 1976 21 is removed from the abomasum. Also, a a possibility of regurgitation and aspiration friable abomasum could easily tear in the of rumen content. This is a factor that must process of replacement. Gabel at Ohio State be considered as a risk when contemplating University claimed 86% success in 147 the surgery. cases operated in this manner.3 This is by A publication of this surgery from Cornell far the greatest number operated on in any University revealed 94% success in 82 published study of the right approach. cases? A good adhesion would be directly Recurrence was seen in fewer than 3% of formed between the abomasum and ventral the cases and involved an elongation of the abdominal wall thereby permanently omentum attached to the abdominal wall. establishing the abomasum in its corrcet Correction of a displaced abomasum via position. the right ventral abomasopexy7,a,9,12 Abomasopexy of the displaced requires that the animal be restrained on its abomasum can also be done from the left back with the fore and hind limbs stretched side by using a left paralumbar out. A tranquilizer is usually needed to laparotomy.S,a,ll In preparation for place the cow in this position. The surgical surgery the animal is clipped in the area of site is just posterior to, and to the right of the left paralumbar fossa. Another spot is the xiphoid, midway between the ventral also clipped and prepared for surgery just midline and the milk vein. The area is to the right of the ventral midline and clipped and scrubbed as is standard for posterior to the xiphoid area. A paralumbar surgery and a line block is placed with 2 % or field block is placed to anesthetize the lidocaine along the incision line. The in­ operative site in the paralumbar fossa. A 20 cision extends about 20 cm from just em vertical skin incision is made 5-6 cm posterior to xiphoid. The aponeurosis of the posterior to the last rib. The external external oblique is encountered and cut as oblique, internal oblique, transversus is the rectus abdominis muscle. Then the abdominis and peritoneum are each cut in transversus abdominis and peritoneum are turn as they are encountered. The carefully incised. The surgeon can now abomasum should be readily visible in the insert his arm into the abdominal cavity and incision or just anterior to it. Approximately reaching across the midline can palpate and two meters of heavy Vetafil is double armed retrieve the gas-filled abomasum. At this with straight cutting needles. The Vetafil is point decompression may rarely be passed through the muscle 6f the necessary to return the abomasum to a abomasum in a continuous in and out more normal position. Once the abomasum pattern over the greater curvature, being is in place, an abomasopexy is performed careful to avoid the omental attachments. by suturing the abomasum to the lateral With the needles held in the surgeons margin of the incision using simple in­ hand in a protective manner the surgeon terrupted or mattress sutures with .#3 gut. passes his hand along the abdominal wall Then the abomasal musculature is closed in ventral to the rumen and across the the first layer of the incision with the midline. Here he palpates with his finger peritoneum and transversus abdominis. until an assistant directs him to the The rectus, abdominal tunic and skin are all prepared site to the right of the midline. closed separately. One needle is pushed through the ventral This technique will cause two lines of abdominal wall and the second is placed 10­ adhesions of the abomasum to the right 15 em posterior. Then with hand and abdominal wall. We again are faced with forearm the surgeon forces the abomasum the possibility of tearing the abomasal wall ventrally until it is in contact with the body through blindly breaking down the wall while the assistant gently takes up the adhesions. In such a case the abomasum slack in the ventral suture. The suture is can be and should be inspected for ulcers tied on the outside by the assistant when that are nearing perforation. This surgery the surgeon has determined there are no can be done by one man, however, a structures between the abomasum and the minimum of three would have to be present body wall. The gas in the abomasum to adequately position the animal. With the generally passes off as it is manipulated animal tranquilized and on its back there is back into normal position. The laparotomy

22 Iowa State University Veterinarian incision is closed using a three layer sutures can be pulled too tight causing a technique. tearing of the abomasum. This is a valid The best exposure of the abomasum is technique that allows an economic break to probably gained using this technique. The the owner and a good chance of success. abomasum is readily inspected and repaired at the site of incision. The suture SUMMARY should be placed immediately in the abomasum so that through excessive Any of the procedures described in this manipulation it does not lose gas and slip paper can be done in a short time by a away. The ventral suture will cause a surgeon experienced with the technique. relatively firm adhesion between the body All the procedures offer a high rate of wall and the abomasum. Using this success when done in a competent manner. technique an 80% or better success rate can The surgeon should be well versed in each be obtained.' The surgeon will need an of the techniques since they all have their assistant to complete this operation. indications and contraindications depen­ Although the assistant need not know an ding on the specific case. They differ in excessive amount of surgical technique, he exposure in the event of complications. In must be able to tie a square knot. If the the event of a perforation of the abomasal suture is tied too tight there is a possibility wall be it an ulcer or iatrogenic the rent of tearing the abomasum before a firm must be repaired in order to insure success adhesion could be established. in the surgery. The right flank appraoch The closed suture technique6/13 for allows little or no exposure of the abomasopexy is a modification of a non­ abomasum. Even when it is returned to the surgical technique2 and the most inex­ normal position there is very little exposure pensive of the methods of correction of left of the body and fundus. The ventral ap­ displaced abomasum. It calls for the use of proach allows the abomasum to be ex­ two or three assistants since the cow must teriorized to repair any holes. The left flank be rolled about. In preparation the ventral approach allows the abomasum to be in­ abdomen must be clipped from xiphoid to spected in the displaced position. umbilicus between the midline and milk Therefore, if a rip is present it can be vein on the right side. The cow is then cast repaired with minimal contamination of the using a reliable rope technique and put on peritoneal cavity. Of course, the closed her right side. The fore and hind legs may suture allows no visualization of the ab­ be tied and the cow rolled on to her back. dominal cavity whatsoever. Then the surgeon using a stethoscope will The success of any operation to correct a locate the characteristic abomasal "ping." displaced abomasum is dependent on the Then by manipulation and ballottement the formation of an adhesion to hold the abomasum is positioned at the prepared abomasum in position. All but the right site. Using a 4 or 6 inch curved upholstery flank approach allows for the formation of needle armed with heavy Vetafil, a suture is an adhesion between the abomasum and placed through the body wall and the body wall by some type of abomasum. If a "ping" can still be heard a abomasopexy. The closed suture and left second suture is placed. The cow is allowed approach have a greater possibility of to roll onto her left side and rise at will. It is tearing the abomasum than the ventral very important to place the suture only while forming the adhesion. With the when the surgeon can hear the "ping" closed suture technique there is a otherwise one runs a higher risk of punc­ possibility of only getting an omentopexy, turing intestine or rumen. which is less desirable than the Obviously, this will not work on an abomasopexy. The omentopexy established abomasum that is adhered to the left body from the right flank approach has a wall and there is risk of puncturing possibility of stretching and allowing the something other than the abomasum. But, abomasum to move back to the left side, if done properly one can expect a high rate over a long period of time. If the omen­ of success in the range of 90-95%. Again, topexy is as close as possible to the pylorus as with the left approach the abomasopexy it will reduce the chances of recurrence.

Issue No.1) 1976 23 In the final analysis all of the techniques 5. Gertsen, K. E. Surgical correction of the displaced are workable and the decision must be abomasum. Veterinary Medicine-Small Animal Clinician, 62:679-682, 1967. made as to which the surgeon feels the 6. Hull, Bruce L. Closed suturing technique for most comfortable with. In the event of correction of left abomasal displacement. Iowa complications the left or ventral approach State University Veterinarian, 34:142-144, 1972. would be best. On an animal that is not very 7. Lowe, John E., Loomis, Wendell K., Kramer, valuable the closed suture technique should Larry L. Abomasopexy for repair of left abomasal displacement in dairy cattle. American Veterinary be tried, for economic reasons. In the event Medical Association Journal, 147:389-393, 1965. of failure of the closed suture for whatever 8. Oehme, Frederick W., Prier, James E. Textbook reason an open approach could be at­ of Large Animal Surgery, The Williams and tempted. The right flank approach remains Wilkins Company Baltimore, Maryland, 1974. pages 41 7-420. the best for one man working alone. 9. Robertson, J. M., Boucher, W. B. Treatment of left displacement of the bovine abomasum. BIBLIOGRAPHY American Veterinary Medical Association Journal, 149: 1423-1429, 196,6. 1. Ames, S. Repositjoning the displaced abomasum 10. Sisson, S. and Grossman, James D. The Anatomy in the cow. American Veterinary Medical of Domestic Animals Fourth Edition W. B. Association Journal, 153: 1470-1471, 1968. Saunders Company, Philadelphia, 1953, page 459. 2. Braun, R. K. Non-surgical correction of left 11. Steenhaut, M., DeMoor, A., Verschooten, F., abomasal displacement in the cow. Cornell Desmet, P., Delay, G. Surgical treatment of left Veterinarian, 58: 111-116, 1968. abomasal displacement. Veterinary Medicine­ 3. Gabel, A. A. and Heath, B. R. Correction and Small Animal Clinician, 69:161, 1974. right-sided omentopexy in treatment of left-sided 12. Straiton E. C. and McIntee, D. P. Correction of the displacement of the abomasum in dairy cattle. displaced abomasum. Veterinary Record, 71:871­ American Veterinary Medical Association Journal, 872, 1959. 155: 632-641, 1969. 13. Walton, J. F., Muir, R. M., Turbok, J. L., 4. Gertsen, K. E. Right-side omentopexy for Schroeder,D. L., Sears, P. M., Williamson, F. H. correction of left displacement of the abomasum. Roll-and-suture for displaced abomasum. Modern Veterinary Medicine-Small Animal Clinician, Veterinary Practice, 54:31-32, 1973. 63:867-871, 1969.

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