2011, Vol. 6 No. 1, Article 83

Umbilical Hernia with Abomasal-Umbilical Fistula in a Cow Calf

Vandana Sangwan*¹, Ashwani Kumar², Kiranjeet Singh² and Shashi Kant Mahajan²

¹Department of Teaching Veterinary Clinical Complex

²Department of Veterinary Surgery and Radiology, College of Veterinary Science

College of Veterinary Science,
Guru Angad Dev Veterinary and Animal Sciences University,
Ludhiana -141004, Punjab, INDIA

*Corresponding Author; e-mail address: [email protected]

ABSTRACT

An unusual case of Umbilical hernia with umbilical-abomasal fistula at two sites in a two months old female calf was reported. Uneventful recovery was observed following successful surgical management of the ailment.

KEY WORDS

Umbilical hernia, abomasal fistula, calf, surgery.

INTRODUCTION

Umbilical hernia with entrapment of abomasum in the hernial ring in cow calves is not uncommon but its incarceration and necrosis resulting in formation of abomasal fistula is rare. Umbilical-abomasal fistula may be critical as there is continuous loss of digesta along with digestive secretions from an unusual site which may further alter the electrolyte and acid base status of the calf. The present report describes the successful surgical management of an umbilical hernia with an umbilical-abomasal fistula in a 2 month old female calf.

CASE HISTORY AND CLINICAL SIGNS

A two month old female cow calf was presented to the Teaching Veterinary Hospital with a swelling at the umbilical region and two red coloured masses protruding out of it from two sites (Fig. 1). Green coloured digesta was leaking out from these sites. History revealed presence of small umbilical swelling since one month which was gradually increasing in size. The swelling ruptured a day before presentation. Clinically, the calf was partially anorectic, thin, depressed and severely dehydrated. The umblical mass was big and no attempt to see the reducible character was made to avoid contamination to the peritoneal cavity. The pH of the green digesta leaking from the wound was noted to be acidic (pH 2) in nature.

DIAGNOSIS AND TREATMENT

On the basis of history, clinical signs and pH of the contents, the case was diagnosed to be umbilical hernia with umbilical-abomasal fistula at two sites. Intravenous fluid therapy was started with Inj. NSS (0.9%). The animal was put in dorsal recumbency and prepared aseptically for surgery. Local anesthesia was given by infiltrating inj. lignocaine hcl 2% around the swelling. An elliptical skin incision was made to resect the infected tissue. A 12 cm long segment towards the pyloric end of abomasum (between body and pyloric end of abomasum) was found adhered to the hernial sac (Fig. 2). The other side of the abomasal wall was healthy. The abdominal cavity was packed with drapes to avoid contamination. The abomasum adhering to the hernial sac was carefully dissected out and a wedge shaped resection of the necrosed portion was done (Fig. 3). To avoid reducing the lumen size of the pyloric end the abomasum the abomasotomy wound was sutured perpendicular to the abomasal axis (Fig. 4) using a double layer of lambert suture pattern using Catgut No. 1-0. The sutured part of the abomasum was thoroughly flushed using normal saline solution and placed back into the abdomen. The hernial ring was closed by applying vest over pant pattern using silk No.2. Skin was closed using horizontal mattress sutures with silk No.2.
Postoperatively, the owner was advised to keep the animal off-feed and off-water for 3 days. The calf was administered intravenous fluids (inj. 0.9% NSS 1L and inj. 5% DNS 1L) for 3 days. Other postoperative care included inj. Amipox 500mg (Ampicillin 250 mg and Cloxacillin 250 mg) bid, IM, for 7 days, inj. Gentamicin 3ml bid, IM, for 5 days and inj. Melonex 2ml (meloxicam) od, IM, for 3 days. Milk feeding was started on 4th post-operative day. The calf showed uneventful recovery and skin sutures were removed on 14th postoperative day.

DISCUSSION

The pyloric part of the abomasum is usually herniated in umbilical hernia in cow calves but presence of umbilical-abomasal fistula is rare (Fubini and Ducharme 2004). Abomasal fistulas have also been reported to occur as a technique related complication of abomasopexy in cattle (Parker and Fubini 1987; Fubini and Ducharme 2004). From the history, the present case appeared to have an umbilical hernia with incarceration of abomasal wall which gradually developed into a fistula which is similar to findings by Fubini and Smith (1984). Since the present calf was on green fodder diet, the pressure of food in the pyloric part of abomasum might be responsible for its simultaneous rupture at two sites. Such rupture at two sites has not been reported in the literature. Umbilical-abomasal fistula has also been reported in calves from an umbilical infection invading the underlying tissue and eventually the abomasum (Newcomb and Mortom 1970) which was not apparent in this case.
Local infiltration anesthesia with 2% lignocaine hydrochloride was sufficient to perform surgery in the present case, using an enbloc surgical resection of the infected abdominal wall and a wedge shaped resection of the necrosed abomasal wall. Rose et al., (1998) reported that in cases where ischemic / necrosed bowel is relatively small and confined to an area of intestine a wedge resection or segmental resection can be done. Vertenten et al., (2009) treated a case of abomasal fistulation and herniation by end to end anastomosis of the abomasum in cattle. The abdominal wall in the present case was closed using vest over pant suture pattern with silk No.2 as recommended previously (Krishnamurthy 1993). A method to correct the hypochloremic metabolic acidosis in cases of abomasal fistula by applying bandages for few days to stop loss of abomasal contents has been suggested (Fubini and Smith 1984). But, in the present case the size of two fistulas was too big (more than 5 cm) to be obliterated by bandaging and surgery was planned on the same day to prevent further deterioration of the metabolic condition.

REFERENCES

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FIGURES

Figure-1: Photograph showing swelling at the umbilical region and protrusion of red colored mass out of it from two sites

Figure-2: Photograph showing adhesions of a segment of pyloric part of abomasum to the hernial sac or skin

Figure-3: Photograph showing abomasotomy wound after resection of necrotic tissue

Figure-4: Photograph showing sutured abomasotomy wound