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![Predisposing Factors
Abomasal atony
High grain/low roughage diets
[VFA] Gas accumulation Distention
Roughage (large particles)
Stimulates rumination via touch receptors
Increases salivary buffer action
Hypocalcemia
Milk fever
smooth muscle tone and motility
4.8 x risk of developing LDA than normocalcemic](https://image.slidesharecdn.com/abomasaldisplacmentsandvolvulus-130628101821-phpapp01/85/Abomasal-displacements-and-volvulus-8-320.jpg)
Uploaded bySatyajeet Singh
Abomasal displacements and volvulus
This document discusses abomasal displacements and volvulus in cattle. It begins with the normal anatomy of the abomasum and surrounding structures. It then discusses left displacement of the abomasum (LDA), including risk factors, clinical signs, diagnosis, treatment options such as medical techniques and surgical procedures like right paralumbar fossa omentopexy. Right displacement of the abomasum (RDA) and abomasal volvulus (AV) are also covered, explaining their clinical signs, diagnosis, and surgical treatment approaches. The document provides detailed descriptions of surgical techniques like proximal and distal paravertebral nerve blocks, omentopexy procedures, and abomasopexy. It concludes with advantages
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Abomasal displacements and volvulus
- 1. Abomasal Displacments andVolvulus Dr. Satyajeet Singh
- 2. Greater Omentum Consistsof 2 leaves Superficial leaf (1) Left longitudinal groove of rumen Greater curvature of abomasum and duodenum (2) Deep leaf (3) Right longitudinal groove of rumen Decending duodenum Both leaves form sling for intestine 1 3 2 2 2
- 3. Lessor Omentum (1) Connects peritoneum between Liver (2) Lesser curvature of abomasum (3) Cranial duodenum (4) Covers right side of omasum Key to other structures Mesoduodenum (5) Greater omentum (6) 2 3 4 1 5 6
- 4. Normal Anatomy –Left Flank
- 5. Normal Anatomy –Right Flank
- 6. Normal Anatomy -Ventral
- 7. Incidence of AbomasalDisplacement 10% RDA 90% LDA 91% occur within first 6 weeks of calving Most likely to occur Adult diary cattle in early postpartum period Prevalence in well managed herd varies 0.2 – 2.5%
- 8. Predisposing Factors Abomasalatony High grain/low roughage diets [VFA] Gas accumulation Distention Roughage (large particles) Stimulates rumination via touch receptors Increases salivary buffer action Hypocalcemia Milk fever smooth muscle tone and motility 4.8 x risk of developing LDA than normocalcemic
- 9. Predisposing Factors Abomasalatony Metritis, retained placenta, severe mastitis Endotoxins and endogenous pyrogens (IL-1) depress motility Result in hypocalcemia Electrolyte disturbances Lack of exercise/confinement High producing diary cows Large abdominal cavities more room for displacement Genetic selection
- 10. LDA Clinical Signs Anorexia fecal output rumen motility milk production 2o ketosis Sunken left paralumbar fossa
- 11. LDA Clinical Signs Percussion left paralumber fossa Above/below line from point of elbow to tuber coxae Ping over gas filled portion of abomasum
- 12. LDA Differential Diagnosis Rumen tympany Peritonitis Pneumoperitoneum Physometra
- 13. LDA Diagnosis Clinicalsigns Percussion Liptak test Centesis area below gas ping in “abomasum” Fluid pH < 4.5 Abomasum Burnt almond odor of gas Abomasum
- 14. Normal Transit SimpleLDA cases normal serum electrolyte levels Normal acid/base balance Anion Gap H2CO3 - Cl- K+ Na+
- 15. Normal Transit Nota complete obstruction Chloride secreted in abomasum Absorbed in small intestine + Mild hypochloremia + Mild metabolic alkalosis
- 16. LDA – RightFlank
- 17. LDA – LeftFlank
- 18.
- 19. LDA Treatment Medicaltechniques Cast in right lateral recumbency Roll into dorsal recumbency/shake legs Roll over to left lateralrecumbency Stand Surgical techniques Right paralumbar fossa omentopexy Left paralumbar fossa abomasopexy Right paramedian abomasopexy Percutaneous abomasopexy
- 20. LDA Prevention Diet Prepartum introduction of ensiled/concentrate feeds Slowly introduce concentrates post-calving Increase particle size of forage Prevent hypocalcemia Manage periparturient inflammatory diseases
- 21. RDA Clinical Signsand DDx Clinical signs similar to LDA Differential diagnosis Cecal dilitation or volvulus Gas in spiral colon Small intestinal obstruction or volvulus Torsion about root of mesentery Pneumorectum Pneumoperitoneum Physometra Abomasal volvulus
- 22. RDA Diagnosis Clinicalsigns Precussion Ping under last 5 ribs in dorsal abdomen Rectal palpation
- 23. Slow Transit Potentialfor sequestration of HCl in abomasum Hyochloremia (loss of anions) Obstruction Reabsorption of Cl- by small intestine
- 24. Slow Transit Metabolicalkalosis Compensate for loss of Cl- kidney produces H2CO3 - Hypokalemia Stabilize blood pH K+ (extracellular) H+ (intracellular) Paradoxic aciduria Perfusion in peripheral tissue Aldosterone Reabsorb Na+ Secrete K+ Deplete K+ Reabsorb Na+ Secrete H+
- 25. RDA – RightFlank
- 26. RDA Treatment Medicaltechniques Rolling contraindicated Progression to Abomasal volvulus Surgical techniques Difficult to distinguish RDA vs. AV Right paralumbar fossa omentopexy or abomasopexy Right paramedian abomasopexy
- 27. AV Clinical Signs Colic Tachycardia (> 100 bpm) Dehydration Bilateral abdominal distention Feces abscent or watery but scant AV Compete obstruction of flow of ingestia through duodenum
- 28. AV Differential Diagnosis Cecal dilitation or volvulus Gas in spiral colon Small intestinal obstruction or volvulus Torsion about root of mesentery Right abomasal displacement
- 29. AV Diagnosis Clinicalsigns Precussion Ping Extends from 8th rib to middle of right paralumbar fossa Ventral border is horizontal Fluid in abomasum Ballottement Rectal palpation
- 30. AV Clinical Pathology Similar to RDA but more severe Hypochloremia Hypohalemia Metabolic alkalosis Metabolic acidosis More chronic cases Dehydration Poor peripheral perfusion Shock
- 31. AV – RightFlank Typical orientation Counterclockwise viewed from right flank
- 32.
- 33. AV - Cranial Typical orientation Clockwise viewed from cranial
- 34. RDA Treatment SurgicalEmergency Preoperative IV fluids with KCl Hypertonic saline Normasol 0.9% NaCl NSAIDs Broad spectrum antibiotics
- 35. RDA Treatment Surgicaltechniques Right paralumbar fossa omentopexy Best choice Integrity of abomasum often compromised Abomasopexy procedures do not work well Progniosis Depends on degree of damage to abomasal mucosa Vagal indigestion syndrome common
- 36. Proximal Paravertebral NerveBlock T13, L1, and L2 Sensory and motor to Skin Fascia Muscle Peritoneum
- 37. Proximal Paravertebral NerveBlock Nerve most localized Intervertebral foramen Walk needle of caudle edge of transverse process Single site rather than dorsal and ventral branches individually Transverse process slopes forward Technique Injection site 3 – 4 cm from midline Local bled of 2% lidocaine hydrochloride Use 1 in 16-ga needle as trocar for 10 cm 20-ga needle
- 38. Proximal Paravertebral NerveBlock Technique Once transverse process encountered Needle walked off caudle border and advanced 0.75 cm 10 ml 2% lidocaine hydrochloride Temporary lateral deviation of spine Lumbar muscle paralysis
- 39. Distal Paravertebral NerveBlock Branches of T13, L1, and L2 blocked at ends of transverse processes of L1, L2, and L4 (not L3) Technique 25 ml 2% lidocaine hydrochloride per site 18-ga needle inserted under each transverse process 10 ml 2% lidocaine hydrochloride
- 40. Distal Paravertebral NerveBlock Technique Withdrawn short distance and redirected craniad and caudad 2% lidocaine hydrochloride Infiltration of ventral branches
- 41. Distal Paravertebral NerveBlock Technique Needle redirected dorsal and caudal to transverse process 2% lidocaine hydrochloride Infiltration of dorsolateral branches No deviation of spine No lumbar muscle paralysis
- 42. Inverted L NerveBlock Vertical line passes caudal to last rib Horizontal line passes ventral to transverse processes 100 ml 2% lidocaine hydrochloride
- 43. Right Paralumbar FossaOmentopexy Vertical incision in middle of paralumbar fossa 3 – 5 cm ventral to transverse processes 20 – 25 cm long Skin SQ
- 44. Right Paralumbar FossaOmentopexy External abdominal oblique muscle Internal abdominal oblique muscle Aponeurosis of transverse abdominal muscle Peritoneum
- 45. LDA Decompression 14gauge needle attached to sterile suction hose
- 46. LDA Decompression 14gauge needle attached to sterile suction hose
- 47. LDA Manipulation Abomasumreturned to normal position Follow peritoneal surfaces ventrally Hand between rumen and body wall Elevate caudal ventral blind sac of rumen
- 48. LDA Manipulation Abomasumreturned to normal position Follow peritoneal surfaces ventrally Hand between rumen and body wall Elevate caudal ventral blind sac of rumen
- 49. Right Paralumbar FossaOmentopexy Gently pull omentum out through incision Retract dorsad and caudad until pylorus is visualized Omentum on both sides of pylorus Palpable firmness of torus pyloricus muscle Omentopexy Close to pyloroduodenal junction 3 – 4 cm caudal Appendage “sows ear” 6 – 8 cm vertical section of greater omentum Distribute pexy of wide area
- 50. Right Paralumbar FossaOmentopexy #2 or #3 chromic gut Incorporate omentum in peritoneum and transversus abdominal muscle closure
- 51. Right Paralumbar FossaOmentopexy External/internal abdominal oblique muscles closure Single layer, simple continuous pattern, #2 - #3 chromic gut Skin closure Ford interlocking pattern, #3 polymerized caprolactam (Vetafil)
- 52. AV Decompression 14gauge needle attached to sterile suction hose
- 53. AV Manipulation Typicalorientation Counterclockwise Viewed from right flank Viewed from rear
- 54. Advantages and Disadvantages: RightParalumbar Fossa Omentopexy Prognosis LDA 86% - 90% Complications Redisplacement 3.6% - 4.2% Incisional infection Peritonitis Advantages Animal in standing position Surgeon can perform procedure alone Allows abdomial exploration Used to correct LDA, RDA, and AV Disadvantages More skill Proper position of abomasum Proper area for fixation Abomasum position less anatomically correct than abomasopexy Not good if suspect adhesions beteen abomasum and left body wall
- 55. Left Paralumbar FossaAbomasopexy Identify abomasum
- 56. Left Paralumbar FossaAbomasopexy Well distented abomasum Along greater curvature 2 – 3 cm from attachment of greater omentum Ford interlocking pattern 5 – 7 cm Bites through submucosa #2 - #3 monofilament, non-absorbable 2 m long 2 long tags with straight needles Decompress abomasum
- 57. Left Paralumbar FossaAbomasopexy Anchor suture tags Cranial site 10 cm caudal/right of xiphoid process Pass cranial suture through ventral abdomin Assistant applies pressure of site with hemostats Assistant pulls needle through skin Repeat with caudal suture
- 58. Left Paralumbar FossaAbomasopexy Reduction of abomasum Each suture is placed through a sponge before being tied
- 59. Advantages and Disadvantages: LeftParalumbar Fossa Abomasopexy Prognosis 83.5% - 94% Complications Entrapment of small intestine between abomasum and body wall Abomasal fistula formation if Suture penetrates abomasal mucosa Suture not removed in 2 – 3 weeks Advantages Animal in standing position Best choice for cows in advanced pregnancy (> 7 months) Best choice for rumenotomy with concurrent TRP Disadvantages Only for LDA not for RDA or AV Requires assistant to guide needle placement
- 60. Percutaneous Abomasopexy Toggle 5 cm long plastic rod 30 cm long nylon suture Trocar with stylet Used to place toggle in the abomasum
- 61. Percutaneous Abomasopexy Abomasumrepositioned Position of abomasum identified
- 62. Percutaneous Abomasopexy Trocarwith stylet inserted into abomasum Stylet removed Abomasal odor confirmed First toggle passed through cannula to abomasum
- 63. Percutaneous Abomasopexy Trocarwith stylet inserted into abomasum Stylet removed Abomasal odor confirmed Second toggle passed through cannula to abomasum
- 64. Percutaneous Abomasopexy Endsof suture tied around a sponge
- 65. Advantages and Disadvantages: PercutaneousAbomasopexy Prognosis 80% - 88% Complications Pexy viscera or omentum Abomasal rupture at suture site Peritonitis Abomasal obstruction Advantages Quick, inexpensive, easy to perform May be good choice for cows that are poor surgical candidates Disadvantages Requires dorsal recumbency Only for LDA not for RDA or AV Requires assistants Abomasum must be distended with gas
- 66. Laparascopic Assisted Abomasopexy Minimally invasive technique for surgical correction of LDA Developed to reduce incidence of complications Traditional laparotomy Percutaneous toggle placement
- 67. Laparascopic Assisted Abomasopexy Advantages Reduced surgical time and cost Reduced healing time Can immediately go back into production Reduced milk discarding Antibiotics not required Allows abdominal exploratory Any degree of gas distention Even minimally dilated
- 68. Laparascopic Assisted Abomasopexy Two-step technique Toggle placement – standing Suture retrieval – dorsal recumbency One-step technique Dorsal resumbency One-step technique Standing
- 69. Laparascopic Assisted Abomasopexy Single toggle Toggle bar Stainless steel with central recess Epoxy filling recess securing suture to toggle Suture Twin 80cm strands Marker 4.5 cm from toggle bar Marker
- 70. Two-Step Technique: Step1 - Standing Left paralumbar fossa and last 3 ribs aseptically preped 2 local blebs (5 ml) 2% lidocaine 2 stab incisions (1 cm) Laparascope portal (I) 10 cm caudal to last rib 10 cm ventral to transverse process Instrument portal (II) 11th intercostal space 20 cm ventral to spinous process II I
- 71. Two-Step Technique: Step1 - Standing Pneumoperitoneum Left paralumbar fossa Position I Veress needle with silicon tubing Insufflation pump
- 72. Two-Step Technique: Step1 - Standing Trocar-cannula assembly inserted in left paralumbar fossa (I) through stab incision Laparascope inserted into cannula Abdominal exploratory
- 73. Two-Step Technique: Step1 - Standing Endoscopic picture of LDA
- 74. Two-Step Technique: Step1 - Standing Trocar-cannula assembly inserted in 11th ICS (II) through stab incision Instrument portal
- 75. Two-Step Technique: Step1 - Standing Toggle trocar passed through instrument portal and inserted into abomasum Toggle bar passed through trocar into abomasal lumen
- 76. Two-Step Technique: Step1 - Standing Abomasum decompressed Excess toggle suture fully inserted into abdomen Toggle trocar & laparascope removed Skin incisions closed Single interrupted suture
- 77. Two-Step Technique: Step2 – Dorsal Recumbency Right parameadian area aseptically preped 2 local blebs (5 ml) 2% lidocaine 2 stab incisions (1 cm) Laparascope portal (III) 5 cm lateral from midline 20 cm distal to xyphoid Instrument portal (IV) 5 cm lateral from midline 10 cm distal to xyphoid
- 78. Two-Step Technique: Step2 – Dorsal Recumbency Laparascope and grasping forceps inserted through portals
- 79. Two-Step Technique: Step2 – Dorsal Recumbency Abomasum and suture material identified Suture retrieved using grasping forceps
- 80. Two-Step Technique: Step2 – Dorsal Recumbency Excess suture withdrawn through instrument portal up to preset marker on suture Abomasum in proper anatomical position Remove laparasope and cannulas Skin incisions closed Single interrupted suture
- 81. Two-Step Technique: Step2 – Dorsal Recumbency Suture ends each passed through separate 14 ga needles inserted through gauze stent Needles removed Suture tied over gauze stent Leave 3 cm of play in suture Suture removed after 3 – 4 weeks
- 82. One-Step Technique -Dorsal Recumbency Animal is sedated and placed in dorsal recumbency Area aseptically prepared from Xyphoid process to 10 cm caudal to umbilicus Width of 20 cm each side of ventral midline
- 83. One-Step Technique -Dorsal Recumbency 3 local blebs (5 ml) 2% lidocaine 3 stab incisions (1 cm) Portal site I (laparoscope) 2 cm left of umbilicus Portal site II (grasping forceps) 3 cm caudal and 7 cm right of xyphoid process Portal site III (needle holder) 5 cm right and 3 cm cranial to umbilicus
- 84. One-Step Technique -Dorsal Recumbency Fixation site IV 10 cm long line block using 2% lidocaine 3 - 5 cm right of linea alba Centered between umbilicus and xyphoid process Four 1-cm long skin incisions Perpendicular to ventral midline Spaced 2.5 cm apart
- 85. One-Step Technique -Dorsal Recumbency I II III IV
- 86. One-Step Technique -Dorsal Recumbency Grasping forceps used to locate abomasum Grasp abomasum in middle of greater curvature 2 – 3 cm from greater omentum attachment Fixation site
- 87. One-Step Technique -Dorsal Recumbency 2 PDS suture with curved needle (1/2, 40mm) is used Needle straightened to facilitate manipulation of needle Needle introduced into abdomen through one of cutaneous incisions Needle grasped intra-abdominally using needle holder
- 88. One-Step Technique -Dorsal Recumbency Needle and suture passed through serous and muscular layers of abomasum Stitch measuring 2 cm Running perpendicular to greater curvature Site inspected for gas or fluid leakage
- 89. One-Step Technique -Dorsal Recumbency 18 G needle inserted through abdominal wall Used as guide to exteriorize needle and suture Suture pulled out of abdominal cavity
- 90. One-Step Technique -Dorsal Recumbency 3 other sutures are placed in similar fashion Correct positioning of abomasum verified by pulling gently on sutures to approximate abomasum to body wall
- 91. One-Step Technique -Dorsal Recumbency Sutures are knotted Cutaneous incisions closed
- 92. One-Step Technique -Dorsal Recumbency Adhesions 3 months post-operatively
- 93. One-Step Technique -Dorsal Recumbency Follows two-step technique Except once toggle bar inserted into abomasum, suture ends not passed into abdominal cavity Specially designed instrument is used to drive toggle suture from left flank to ventral abdomen Suture is tied as in two-step technique
- 94. Right Paramedian Abomasopexy Incision 15 – 20 cm long, parallel and 3 – 4 cm right of midline Extending caudal from a point 4 – 8 cm caudal to xiphoid Six distinct layers Skin SQ fascia Deep pectoral muscle in cranial 1/3 External rectus sheath Rectus abdominus muscle Internal rectus sheath Peritoneum
- 95. Right Paramedian Abomasopexy Exploratory Decompress abomasum and exteriorize Identify pylorus Omentum on both sides of pylorus Palpable firmness of torus pyloricus muscle Identify greater omentum Greater curvature (arrow) Sweeps to left side of rumen Covering ventral surface of rumen
- 96. Right Paramedian Abomasopexy Abomasopexy 3 horizontal mattress sutures Lateral aspect of greater curvature of abomasum free of omentum Seromuscular layer Peritoneum and internal rectus sheath #2 chromic gut Simple continuous pattern Peritoneum and internal rectus sheath At least 6 bites incorporating abomasum Seromuscular layer
- 97. Right Paramedian Abomasopexy Closure External rectus sheath Horizontal mattress pattern #3 chromic gut Skin Ford interlocking pattern #3 polymerized caprolactam (Vetafil)
- 98. Advantages and Disadvantages: RightParamedian Abomasopexy Prognosis 83.5% - 95% Complications Incisional hemorrhage, dehiscence, herniation or fistulation Advantages Strong adhesions develop between abomasum and body wall Abomasum returns near normal position during placing in dorsal recumbency Correct LDA, RDA or AV Disadvantages Dorsal recumbency Bloat, regurgitation, aspiration Requires assistants