12. Rumenotomy in cattle Flashcards
Special Indications of rumentomy?
Special indications
- Ruminal–reticular disease (e.g., Rumenitis)
- Foreign bodies → traumatic reticulitis or traumatic reticuloperitonitis
- To remove ruminal contents:
o Rumen impaction
o Toxic indigestion
o Omasal impaction
o Reducing a ruminal mass: before a pericardiotomy
General steps?
General steps:
- Surgical restraint
- Presurgical procedure
- Anaesthesia
- Incision site and technique
- Abdominal cavity manipulation,
- Abdominal wall suturing
- Postoperative care
Surgical restraint?
Surgical restraint
• Standing restraint!!!
o Advantages: less assistance, minimal tension on suture line, good for adult dairy cows (udder)
o Disadvantages: Contamination of peritoneal cavity, physical strength required
- Approaches in standing restraint:
- Left paralumbar fossa approach- Left flank (same as in C section)
o Gives access to the caudo dorsal sac of the rumen
• Also used in:
o Right uterine horn pregnancy
o Rumen inhibiting evisceration of intestine
o Minimizes prolapse of abdominal organs
• Dorsal and left lateral recumbency restraint
o Indicated only if the dam cannot stand up (not really in rumenotomy)
Presurgical procedure?
Presurgical procedure
• Instrument tray
o Sterile instruments and a scalpel blade
o Isolation large enough to cover the entire surgical area
o Sterile gloves
o Suture material
o Sterile saline: for washing the serosa surface of the abdominal organs
Preparation of the skin and availability of pharmaceuticals?
Preparation of skin
- Clip and prepare the skin for aseptic surgery=
- From dorsal midline to the level of the flank
- From 12th rib (not the last one as in pic???) to tuber coxae along with the lateral sides of the lumbar
vertebrae’s
Availability of pharmaceuticals
• LA long-acting ab’s, respiratory stimulants
Anaesthetia?
Anaesthesia
• Required (left paralumbar fossa):
o Proximal (preferred) or distal lumbar paravertebral
o Local (line infiltration) block
o Inverted L
• Optional:
o Caudal epidural to control tenesmus
o usually not indicated as the volume of lidocaine used is only 4ml and this volume anaesthetises the
caudal
o part of cows including labia, vagina, and cervix- so this is not enough to anaesthetise the uterus. You
could
o inject more but it will cause recumbency which is not preferred
o In all cases we want to only give analgesia postoperatively as these are dangerous to the foetus.
Immediately
o give NSAIDs once calf is out
o IV sedation and analgesia if it is indicated:
o Drugs cross the placenta (CS)
o Cow may lie down
Standing restraint?
Standing restraint!!!
Approach: left paralumbar fossa=left flank, not right!!!
Dorsal and left lateral recumbency: if dam can’t stand up!
Contraindications: weak status of the dam
Incision technique (any kind of laparotomy) ?
1: skin and subcutis cut but external oblique muscle still intact (horizontal fibres)
2: external cut but internal still intact (vertical fibres visible)
3: external and internal both cut, transverse muscle visible
4: all three muscle layers cut
5: no picture but when peritoneum is cut you enter the cavity
Important?
Important:
- Look at the fibre direction of the muscle layers
- external: horizontal fibers
- internal: vertical fibers
- Helps us to know how far we are from the abdominal cavity: minimize the injury of the internal organs!
Gotze method?
Abdominal cavity manipulation for rumenotomy
Götze Method
- Isolation of ruminal caudo-dorsal (blind) sac
- Suture the rumen to the skin: a seal between the rumen serosa and the skin
- Monofilament noncapillary suture material
- Continuous or interrupted horizontal mattress sutures
- We do this to avoid contamination of the muscle and the abdominal cavity from the abdominal juice which
can lead to peritonitis
• It is not optional; it is obligatory to do this or the next method
Weingarths method?
Weingarth’s Method
• Isolation of ruminal caudo-dorsal (blind) sac
• Stabilize the rumen with more hooks to the metal ring
• Does not require any suturing
Suggested procedure after rumen is open?
Suggested Procedure After Rumen is Open
- Ruminal content: appearance, odour, consistency, and impaction
- Impaction: remove the ingesta until fluid is visible and palpate the reticulum only after content is removed
- Acidosis: remove most of the content
- Evaluate the rumen and reticulum for foreign bodies and disease
- Before removing foreign bodies, you must localise the area, degree, and direction of penetration. This
information is very important for diagnosis and prognosis:
o Simple ventral penetration: favourable
o Deep anterior penetration: unfavourable (pericarditis)
o Cranio-medial penetration: questionable (Vagus indigestion)
Intraruminal medication?
Suggested Intraruminal Medication as Needed
- Alkalizers (e.g., magnesium hydroxide preparations)
- Rough hay
- Water with or without electrolytes
- Mineral oil- softens impacted omasal content
Suturing the rumen?
Suturing the Rumen
- Flush the area
- No. 2 or 3 absorbable suture materials
- Continuous inverting pattern: - Cushing or Lembert
- The ruminal incision with a second layer
- Use same suture pattern for both layers
Abdominal wall suturing?
Abdominal Wall Suturing
- Three-layers:
- Layer 1:
- Peritoneum and transverse and internal oblique abdominal muscles together
- Simple continuous pattern
- Monofilament absorbable No. 2 or 3
• Layer 2:
- External oblique abdominal muscle and subcutaneous tissue
- Bite into the internal oblique muscles dead space (suture second layer into first layer)
- If you have too large a dead space it leads to seroma which is fluid accumulation under the surface
of the skin, it can become infected and pathological leading to abscess formation
- Simple continuous pattern
- Monofilament absorbable No. 2 or 3
• Layer 3:
- Skin
- Continuous interlocking or interrupted suture pattern
- Synthetic nonabsorbable suture material No. 3
