Successful management of intussusception in a cow under double drip anaesthesia

Intussusception in a crossbred cow
surgical treatment, double drip anaesthesia and complete recovery of animal with case discussion

1. SURGICAL MANAGEMENT OF INTUSSUSCEPTION IN A COW UNDER DOUBLE DRIP ANAESTHESIA ARULRAJ BVN20007

2. Weight : 245 kg Age : 3 year Sex : Female Breed : HF cross Species : Bovine Address : Tirupanjali,Thiruchirapalli Owner’s name : Mr. Mathivanan Case number : C48699 SIGNALMENT

3. ANAMNESIS Anorexia Not voiding Dung Since 4 days Milk yield reduced Inseminated 1 month before Abdominal kicking

4. GENERAL CLINICAL EXAMINATION Appearance : Normal Posture : Standing Behaviour :Dull & depressed Expression : Woebegone CMM : Pale pink & Dry Temperature : 38.2°c H/R : 84 beats/min R/R : 60 breaths /min Eyeball : sunken

5. GENERAL CLINICAL EXAMINATION Examination of Abdomen : Bilateral Abdominal distension Examination of Rumen : Rumen motility Sluggish,Rumen protozoa slightly present

6. RECTAL EXAMINATION RECTAL EXAMINATION Sausage m ass like structure could be felt on the right paralumbar fossa

7. RECTAL EXAMINATION Empty rectum with blood tinged mucous (“ RASPBERRY JAM APPEARANCE DUNG” )

8. HAEMATOLOGICAL PARAMETERS HAEMATOLOGY PARAMETERS REFERENCE VALUE OBSERVED VALUE Total RBC (x10 6 /µl ) 5.0 – 1 0. 7.8 Total WBC (x/µl) 4.0 – 12.0 7 PCV (%) 2 4 – 4 6 3 1 Haemoglobin (g/dl) 8. 0 – 15.0 1 2 Neutrophils (/µl) 1 5 – 45 4 Lymphocytes (/µl) 4 8 – 75 3 5 Monocytes (/µl) 2 - 7 5 Thrombocytes (/µl) 1 - 8 6.5

9. BIOCHEMICAL PARAMETERS BIOCHEMICAL PARAMETERS REFERENCE VALUE OBSERVED VALUE Glucose (mg/dl) 45-75 62 Total protein (g/dl) 6. 7 – 7. 4 5.7 Albumin (g/dl) 3.0 – 3.5 2. 4 Calcium (mg/dl) 9.7 – 12. 4 7.5 Phosphorus (mg/dl) 5. 5 – 8.0 4.5 Sodium (mEq/L) 126 – 1 44 126 Potassium (mEq/L) 3. 6 – 5. 8 2.5

10. RADIO GRAPHY No Radio opaque Foregin Body could be detected H R L

11. ULTRASON O GRAPHY Distended intestinal loops was noticed Reveals Bull’s eye appearance

12. DIAGNOSIS Clinical signs USG History INTUSSUSCEPTION

13. ANAESTHESIA ANAESTHESIA Regional Anaesthesia : • Paravertebral Nerve block Maintanence • Double drip Anaesthesia – 10.71 ml/kg/hr maintained Ketamine – 2mg/ml and Guaifenesin – 50mg/ml

14. SURGICAL PROCEDURE Preparation of surgical site ( Aseptic surgery)

15. SURGICAL PROCEDURE Incision – Right flank region Surgical site was draped

16. SURGICAL PROCEDURE Muscle Incision Peritoneal Incision

17. SURGICAL PROCEDURE Exploration of Intestine Intussusception Mass

18. SURGICAL PROCEDURE Ligation Intussusception mass Enterectomy

19. SURGICAL PROCEDURE Enteroanastomosis ( End to End) Skin closure Muscle closure

20. POST OPERATIVE CARE Inj. Ringer’s Lactate Inj. Dextrose Normal saline Inj.Metronidazole Inj. Streptopenicillin Inj. Cholrpheneramine maleate Inj. Flunixin meglumine Name D ose Rate(/Kg.b.wt) No.of days Inj. Ringer’s Lactate 10 mL 5 days Inj. Dextrose Normal saline 10 mL 5 days Inj.Metronidazole 5 mL 3 days Inj. Streptopenicillin 2000 I.U 5 days Inj. Cholrpheniramine maleate 0.5 mg 3 rd -5 th Inj. Flunixin meglumine 1.1 mg 2 days Name D ose Rate(/ Kg.b.wt ) Route Inj. Ringer’s Lactate 10 mL I/V Inj. Dextrose Normal saline 10 mL I/ V Inj.Metronidazole 10 mg I/ V Inj. Streptopenicillin Streptomycin 10 mg I/M Inj. Chlorpheniramine maleate 0.5 mg I/M Inj. Flunixin meglumine 1.1 mg I/V

21. POST OPERATIVE CARE • Introduction of water – 3 rd day Introduction of feed – 5 th day • Voiding large amount of semi solid dung within 12 hrs after the surgery • After 12 days the suture was removed.

22. RECOVERY On 3 rd day

23. RECOVERY On 5 th day

24. RECOVERY After 15 days

25. CASE DISCUSSION INTUSSUSCEPTION Intussusception is the invagination of portion of intestine into the lumen of adjacent bowel. ✓ Telescoping of bowel ✓ Invagination of bowel

26. CASE DISCUSSION Etiology • Abnormal – peristalsis • GI disease, Enteritis • FB • Heavy parasitism • Previous intestinal surgery • Intramural abscess/ Tumour • Motility disorde rs • Sudden change in diet

27. CASE DISCUSSION Treatment Medical management : Fluid therapy NSAIDs Calcium solutions A ntibiotics Prokinetics Surgery management : Right flank laparotomy Enterectomy Enteroanastomosis End to end End to side Side to side Differential Diagnosis Diaphragmatic hernia , C aecal dilatation , Abomasal impaction , Abomasal displacement, Rumen impaction, Intestinal obstruction

28. SUMMARY • Intussusception was surgically treated by enterectomy followed by end to end enteroanastamosis in a HF cow • Paravertebral nerve block and double drip infusion were found to be adequate throughout the enterectomy procedure

29. R EFERENCE Farm animal surgery by SUSAN L. FUBINI and NORM G . DUCHARME. Ruminant surgery by R.P.S. TYAGI & JIT SINGH.