127

Research Article
International Journal of
Pharmaceuticals and
Available Online at: www.ijphr.com
Health care Research

ISSN: - 2306 – 6091

PRE AND POST EVALUATIONS OF HEMATOLOGICAL AND SERUM

BIOCHEMICAL PARAMETERS OF RUMENOTOMY IN CATTLE
*1
Mulat Asrat, 1Murali Manohar, 2Ramaswamy Velappa, 3Samrawit Melkamu
1
Faculty of Veterinary Medicine, University of Gondar, Ethiopia.
2
Department of Clinical Studies, Faculty of Veterinary Medicine, University of Gondar, Ethiopia.
___________________________________________________________________________
Abstract
This study was aimed at investigating the pre and post rumenotomy evaluations of 13 cattle with various
ruminal disorders at University of Gondar veterinary clinic, Gondar town, Ethiopia from September 2013 to
May 2014. Hematological and serum biochemical parameters were studied in all the cattle. The comparisons of
the means between different stages of hematological and serum biochemical parameters of different ruminal
disorders were determined by repeated measure ANOVA to evaluate pre and post rumenotomy changes. In
haematology Hb, PCV and TLC levels increased significantly from the presurgical values up to 24 hrs and 48
hrs after rumenotomy. Leukogram revealed significant neutrophilia and lymphopenia from the presurgical
values up to 24 hrs and 48 hrs. Biochemical parameters revealed significant increase in ALT, AST and serum
creatinine from the presurgical values up to 24 hrs and 48 hrs. Serum TP significantly decreased from the
presurgical values up to 24 hrs and 48 hrs.

Keywords: Cattle, Ruminal disorders, Foreign body, Hematology, Rumenotomy, Serum biochemistry.
___________________________________________________________________________
Introduction
Hematological and serum biochemical profiles erythrocytes following increased levels of
provide reliable information on the health status of circulating catecholamine which will increase
animals. Besides, examination of blood, blood during stress.3
constituents and rumen fluids has been used to
monitor and evaluate health and nutritional status A significant drop in total erythrocytes count in
of animals1. cases of foreign body syndrome in bovine indicate
anaemia, which attribute to the loss of blood during
The physiological responses to surgical stress are penetration of the reticulum or the chronic
leukocytosis, neutrophilia, lymphopaenia and inflammatory process which may depress bone
eosinopaenia in cattle after rumenotomy. Decrease marrow.4 A significant increase in total white blood
in the mean values of haemoglobin concentration in cell counts after rumenotomy in cattle is due to post
cattle with foreign body rumen impaction indicates operative inflammation.5
anaemia.2 An increase in haematocrit values in
cattle affected with foreign body syndrome is due Leukocytosis and neutrophilia are indicative of
to contraction of spleen and release of sequestered inflammatory responses in bovine affected with
_________________________________

Author for Correspondence:

Mulat Asrat,
Faculty of Veterinary Medicine,
University of Gondar, Ethiopia.
Email: mullur1974@gmail.com
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traumatic reticuloperitonitis which may be due to
infection associated with the penetration of the
reticulum and diaphragm. Lymphopenia is caused
by sloughing, erosion and inflammatory response
due to pressure on the wall of the rumen by foreign
bodies.6, 7
Hepatic damage due to absorption of toxins from
the putrefied rumen ingesta and gastrointestinal
stasis cause elevation of liver enzymes in cattle.8
Serum hepatobiliary enzyme activity increases
because of leakage from damage of hepatobiliary
cells, elution from damaged cell membranes, or
increased synthesis of biliary epithelium.9 Increase
in the level of serum total protein from 7.69
to10.13 g/dl and creatinine from 1.17 to 2.11 mg/dl
are observed from the onset of gastrointestinal
obstruction in cattle.10 The decrease in blood total
protein concentrations is associated with reduction
of feed intake and to dietary protein degradability
in cattle.11 ALT activity increases with severe
muscle necrosis, but simultaneous evaluation of
serum creatine kinase activity can rule out muscle
damage.12
The absorption of toxic products from the rumen or
alimentary tracts, starvation and constipation will
lead to cellular disturbances of liver parenchyma
leading to increase in levels of plasma aspartate
amino transferase.13, 14 The increase serum creatine
phosphokinase activity generally indicates skeletal
and cardiac muscle damage. The level of this
enzyme is significantly elevated in cattle with
traumatic reticulopericarditis which can indicate
damage to myocardial cells.7, 15
Rumenotomy is a routine procedure for many
diseases in cattle, such as, traumatic
reticuloperitonitis; ingestion of toxic plants,
chemicals, spoiled roughage, or foetal membranes
after parturition; acute and recurrent bloat;
placement of a temporary or permanent rumen
cannula to relieve bloat; creation of a permanent
rumen fistula; and impactions.16
Ruminal surgeries in bovine presently create many
challenges for the large animal practices.
Therefore, early diagnosis and prompt surgical
intervention not only reduce the economic loss but
also save life of the animal. The present study was
designed to investigate the pre and post
rumenotomy changes in hematological and serum
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biochemical parameters of ruminal disorders in
cattle.
Materials and methods
Preoperative evaluations
All the cattle confirmed for ruminal disorders were
subjected to pre surgical evaluation in the clinic.
The cattle were examined for approval before
surgical management. Rehydration electrolyte
imbalance was corrected during preoperative
stabilization for surgery. The feed was withheld for
24 hrs to 48 hrs and water for 12 hrs prior
rumenotomy to reduce post operative
complications.
Hematological parameters
The hematological parameters were estimated by
collecting 5 ml of venous blood from the external
jugular vein in ethylene diamine tetra acetic acid
(EDTA) coated 10 ml sterile tube.
Haemoglobin
Haemoglobin (Hb) value in g/dL was estimated as
per the methods described1 and Sahli’s method was
used. The graduated measuring tube was filled with
one tenth of normal hydrochloric acid up to
graduation mark 2 and placed in the haemometer.
After mixing the blood sample, it was drawn up to
20 mark in the pipette. The blood was then
transferred into the acid in the measuring tube and
the pipette was rinsed by drawing the solution in to
it three times. The haemoglobin was converted into
brown colour acid haematin within 5 to 10 minutes.
After 10 minutes one tenth of normal hydrochloric
acid was added drop by drop, mixing the solution
with the rod. It was added slowly till the colour
matches with the standard on either side of the
haemometer. The level of the solution in the tube
(upper meniscus) was read and haemoglobin value
was expressed as g/dL.
Packed cell volume
The packed cell volume (PCV) in percentage (%)
was determined by Hawskeymicrohematocrit
method.17 The capillary tubes were filled with
blood up to 3/4 of its length. The tubes were sealed
at one end with clay and arranged in a special
microhaematocrit centrifuge which was fitted with
a head for carrying up to 24 capillary tubes. The
capillary tubes were arranged in a circular manner
with the sealed end outward and the open end

Mulat Asrat., et al., Int. J. Pharm. & H. Care Res., Vol.–02 (02) 2014 [127 - 136]
towards the centre. The properly covered
microhaematocrit centrifuge was set to rotate for 5
min. at 12,000 rpm. The PCV value was read using
microhaematocrit reader in percentage.
Total erythrocyte count
The total erythrocyte count (TEC) in millions per
cubic millimetre (106/ mm3) was calculated by
using Hayem’s diluting fluid as per the methods
described.18 Blood sample was initially drawn into
the red blood cell pipette up to the 0.5 mark on the
stem. Then the diluting fluid was drawn into the
pipette up to the 101 mark. The content in the
pipette was further gently mixed for about 2 min
and discarding the excess blood was expelled by
gently stroking the tip of the pipette on a glass slide
and blood was charged in to haemocytometer. The
total number of RBCs counted in 5 small squares (4
corners and 1 center) out of 25 small squares and
the total number was arrived by multiplying the
total number of RBCs by 1000 and result expressed
by 106/ mm3.
Total leukocyte count
The total leucocytes count (TLC) in thousands per
cubic millimetres (103/ mm3) was counted by
standard dilution technique using Thomas fluid as
per the method.19 Blood sample was drown up to
0.5 mark in to WBCs pipette followed by Thomas
diluting fluid up to 11 mark and mixed well.
Discarding the excess blood was expelled by gently
stroking the tip of the pipette on a glass slide and
blood was charged in to haemocytometer. The
number of cells was counted in each of the four
corner squares of the hemocytometer. The total
number of WBCs in 4 corners was multiplied by 50
to arrive at the blood count of WBCs/ mm3.
Differential cell count
A peripheral blood smear was taken from the ear
tip from each animal for differential leukocyte
count before, 24 hrs and 48 hrs after rumenotomy
in all the cattle. The smears were stained by
Giemsa stain. Stained smear was examined to
determine the percentage of each type of leukocyte
present. Each white cell was recorded on a
differential cell counter, until 100 white cells were
counted. The different types of WBC were
expressed as percentage.
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Biochemical parameters
Ten ml of blood was withdrawn from the external
jugular vein, into sterile acid free dry 10 ml glass
test tube without anticoagulant and allowed to clot
at room temperature. After clotting, serum was
separated by centrifugation at 3000 rpm for five
minute. The separated serum was collected and
stored in 2 ml vial at -20°C.20 The blood samples
was taken before, 24 hrs and 48 hrs after
rumenotomy. The serum total protein (g/dl),
aspartate amino traneferase (IU/L), alkaline amino
transferase (IU/L) and creatinine (mg/ dL) were
analyzed using standard diagnostic kits.
Serum total protein
The total protein (TP) level in g per dL was
analyzed by Modified Biuret, End Point Assay19
using commercial clinical kit (total protein test kit).
The result was expressed as serum total protein
g/dl.
Alanine amino transferase
The serum alanine amino transferase (ALT) level
was analyzed by Modified International Federation
of Clinical Chemistry (IFCC) method before, 24
hrs and 48 hrs after rumenotomy. A serum alanine
amino transferase activity was determined
according to recommendations of scientific
committee for the IFCC using commercial kit
(Kone Instruments Corp.). The result was
expressed as ALT IU/L.
Aspartate amino traneferase
The serum Aspartate amino traneferase (AST) level
was analyzed by Modified IFCC method 21 before,
24 hrs and 48 hrs after rumenotomy. Serum
aspartate aminotransferase activities were
determined according to recommendations of
scientific committee for the International
Federation of Clinical Chemistry (IFCC) by using a
commercial kit (Kone Instruments Corp.). The
result was expressed as AST IU/L.
Serum creatinine
The serum creatinine level was analyzed as per
Jaffe's Alkaline Picrate Method22 using commercial
clinical kit (Creatinine reagent set, India). The
difference in absorbance at fixed times during
conversion was proportional to the concentration of
creatinine in the sample. The result was expressed
as mg/ dL.
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Surgery
Preparation of surgical site
The left flank was prepared for aseptic surgery. It
was washed thoroughly using liquid soap and
water. A 30 cm hairless margin around the surgical
site was shaved using shaving blades to remove
hair. The proposed skin was wiped with clean
moist gauze sponge to remove all hair and debris in
all the cattle. Scrubbing was done by providone
iodine (Betadine®).23 The scrubbed skin was wiped
and checked for remaining dirt and debris by using
white gauze sponges soaked in isopropyl alcohol
(70%). Gauze containing debris was discarded once
it reached the periphery and it was repeated again
at the proposed incision site with a new gauze
sponge till debris was removed. Ten millilitres of
or providone-iodine was added to each time
sponges. Scrubbing was continued until the area
was free of surgical scrub residue. Finally the entire
scrubbed area was sprayed with tincture iodine.
Left paravertebral anesthesia
In the entire cattle anesthesia was achieved by left
paravertebral nerve block with 2% lignocaine
hydrochloride solution.24 Standing position with
free spaced crush was used which provided less
stress and more room for movement.
Left mid flank laparotomy
A 25-30 cm long vertical skin incision starting
from 6-8 cm below the left transverse process of
the lumbar vertebrae was made 4 cm caudal and
parallel to the last rib using scalpel handle No.4
with blade No. 24. The subcutaneous tissues,
external and internal oblique muscles, transverses
abdominis muscle and peritoneum were incised in
the same plane. The pressure on the scalpel to
incise the skin was adequate enough to ensure
complete penetration of the skin. Dissection of the
subcutaneous fascia and oblique muscles were
made and the glistening aponeurosis of transverse
abdominis muscle was exposed.24 Muscles along
with their fascia were grasped with large animal 20
cm allis tissue forceps and separated by blunt
dissection after incised one by one. The peritoneum
was grasped with allis tissue forceps and incised
taking care not to cause any injury to underlying
rumen. The skin incision was long enough to allow
the surgeon’s arm inside the abdomen.
The dorsal and ventral sac of rumen, urinary
bladder, uterus, left kidney and intestinal masses
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were explored thoroughly. The right cranial
abdomen was explored by passing the arm ventral
to the superficial layer of greater omentum and
directing cranially to locate the pylorus, body and
fundus of the abomasum, the omasum, right wall of
the reticulum, and left lobe of the liver. A thorough
search was made by inserting right hand in the
abdominal cavity through the incision and rolling
over the rumen on all sides to rule out any
herniation, abcessation or foreign bodies.2
Rumenotomy
Rumen exteriorization was done to prevent spilling
out of rumen contents into the abdominal cavity by
light traction with arms and fixing with Weingarth
ring to dorsal commissure of the rumen incision by
its thumb screw which was anchored to the ring
with the help of two strong rumen forceps placed at
dorsal and ventral aspect.25 The rumen opening was
made at the middle portion of an incision 20 cm
long, to allow passage of the hand, forearm and
arms surgeon. Thick gauze was used to cover the
grasping edges of the tissue over the forceps before
applying it to minimize trauma. After the rumen
was stabilized and incised, enough contents were
emptied to permit a through exploration.
Transruminal exploration was done to find out the
position, size and consistency of contents of rumen,
reticulum and abomasum by palpation.
Ruminoreticular fold, oesophageal orifice and
reticuloomasal orifice were also examined for
lesions and the reticulum for foreign bodies.26
Closure of rumen and abdomen
The ruminal cut edge were thoroughly cleaned with
saline solution and sutured by a double row of
continuous inversion suture patterns (Cushing
followed by Lembert) using chromic catgut No. 2
in all the cattle.27 The abdominal musculature was
closed in three layers by using a simple continuous
pattern of absorbable sutures in the muscle layers.
Simple continuous suture pattern was applied on
peritoneum and transverse abdominis muscle. The
two oblique muscles were sutured together in
second layer with simple continuous pattern using
No. 3 catgut. The skin was closed with cross
mattress with cotton thread.28
Post operative management
The animals were administered with antibiotic
8000IU Penicillin G sodium and 10 mg
streptomycin per kg body weight for 3-5 days.29

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Sodium chloride 0.9% and glucose 5% i/v infusion
were given to correct the dehydration. The
laparotomy wounds were cleaned and dressed daily
with povidone iodine and the sutures were removed
on the 12-15th post operative day. The animals were
allowed to access liquid diet from the third day and
easily digestible feeds from the fourth day onwards
gradually.
Statistical analysis
The obtained data were stored in Microsoft excel-
2007 and analyzed by using STATA 11. The mean
and standard error were calculated to describe the
variables. Comparisons of hematological and
serum biochemical parameters between different
stages (before, 24 hrs and 48 hrs after surgery) in
all cattle managed under rumenotomy were
compared using repeated measure ANOVA. A
simple contrast was used in which the 24 hrs and
48 hrs after surgery were compared with the before
surgery parameters. Those differences with p value
<0.05 were considered statistically significant and
those differences with p value <0.01 were
considered as highly significance.
Results
Thirteen cattle suffering from major ruminal
disorders were underwent rumenotomy at UOG
veterinary clinic during September 2013 to May
2014. All the cattle were subjected to routine
clinical examination and consent was obtained
from the owners for surgical correction.
Hematological parameters
Haemoglobin (Hb)
The mean (±S.E) haemoglobin in g/dl before, 24
hrs and 48 hrs after rumenotomy in all cases were
8.3 ± 0.23, 9.2±0.34 and 10.6±0.43 respectively
(Table 1). The mean haemoglobin value showed a
highly significant (P<0.01) increase from the
presurgical values up to 24 hrs and 48 hrs in all the
cattle after rumenotomy.
Packed cell volume (PCV)
The mean (±S.E) packed cell volume (PCV) in
percentage before, 24 hrs and 48 hrs after
rumenotomy in all cases were 33.2±3.19,
35.0±3.95 and 38.2±2.96 respectively (Table 1).
The mean PCV value showed a significant
(P<0.05) increase from the presurgical values up to
24 hrs. However, a highly significant (p<0.01)
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131
increase was found from presurgical values up to
48 hrs in all the cattle after rumenotomy.
Total erythrocyte count
The mean (±S.E) total erythrocyte count (TEC) in
millions/ mm3 before, 24 hrs and 48 hrs after
rumenotomy in all cases were 6.8±0.33, 7.1±0.22
and 7.7±0.26 respectively (Table 1). The mean
TEC revealed a non significant increase from the
presurgical values up to 24 hrs and 48 hrs in all the
cattle after rumenotomy.
Total leukocyte count
The mean (±S.E) total leukocyte count (TLC) in
thousands / mm3 before, 24 hrs and 48 hrs after
rumenotomy in all cases were 6.0± 0.32, 6.9 ±0.14
and 7.6±0.13 respectively (Table 1). The mean
TLC revealed a highly significant (P<0.01)
increase from the presurgical values up to 24 hrs
and 48 hrs in all the cattle after rumenotomy.
Neutrophils
The mean (±S.E) neutrophil in percentage before,
24 hrs and 48 hrs after rumenotomy in all cases
were 44.0±3.41, 51.0±3.30 and 56.0±7.42
respectively (Table 1). Statistical analysis revealed
highly significance difference (p<0.01) increase
total neutrophil percentage from the presurgical
values up to 24 hrs and 48 hrs in all the cattle after
rumenotomy.
Lymphocytes
The mean (±S.E) lymphocyte in percentage before,
24 hrs and 48 hrs after rumenotomy in all cases
were 49.6±2.61, 44.8±3.68 and 38.9±10.22
respectively (Table 1). The mean lymphocyte count
indicated a highly significant (P<0.01) decrease
from the presurgical values up to 24 hrs and 48 hrs
in all the cattle after rumenotomy.
Monocyte
The mean (±S.E) monocyte in percentage before,
24 hrs and 48 hrs after rumenotomy in all cases
were 3.6±0.66, 3.2±2.73 and 2.6±0.49 respectively
(Table 1). The mean monocyte count indicated a
non significant decrease from the presurgical
values up to 24 hrs and 48 hrs after surgery in all
the cattle after rumenotomy.
Eosinophils
The mean (±S.E) eosinophil in percentage before,
24 hrs and 48 hrs after rumenotomy in all cases
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were 2.69±0.39, 1.85±1.38 and 1.46±0.21 presurgical values up to 24 hrs and 48 hrs in all the
respectively (Table 1). The mean eosinophil count cattle after rumenotomy.
revealed a non significant decrease from the

Table No. 01: The mean (±S.E) values of hematological parameters

observed in cattle before and after rumenotomy
Hematological
Before Surgery 24 hrs after surgery 48 hrs after surgery
parameters
Hb (g/dl) 8.3± 0.23 a 9.2±0.34b 10.6±0.43b
PCV (%) 33.2± 3.19a 35.0±3.95b 38.2±2.96b
TEC (106/mm3) 6.8± 0.33 7.1±0.22 7.7±0.26
TLC (103/ mm3) 6.0± 0.32a 6.9±0.14b 7.6±0.13b
Neutrophil (%) 44.0± 3.41a 51.0±3.30b 56.0±7.42b
Lymphocytes (%) 49.6±2.61a 44.8±3.68b 38.9±10.22b
Monocyte (%) 3.6±0.66 3.2±2.73 2.6±0.49
Eosinophil (%) 2.6±0.39 1.8±1.38 1.4±0.21
a, b
Mean bearing different superscript in a row differs significantly.

Biochemical parameters Aspartate amino traneferase

Serum total protein
The mean (±S.E) serum protein (TP) in g/dl level
before, 24 hrs and 48 hrs after rumenotomy in all
cases were 7.4± 0.24, 7.3 ±0.26 and 6.5 ± 0.13
respectively (Table 2). The mean serum total
protein revealed a significant (P<0.05) decrease
from the presurgical values up to 24 hrs after
rumenotomy but highly significant (P<0.01)
reductions in serum total protein was found from
presurgical values up to 48 hrs in all the cattle after
rumenotomy.
Alanine amino transferase
The mean (±S.E) alanine amino transferase (ALT)
in IU/L before, 24 hrs and 48 hrs after rumenotomy
in all cases were 23.0±6.76, 27.3±5.65 and
35.0±3.25 respectively (Table 2). The mean ALT
level showed a highly significant (P<0.01) increase
from the presurgical values up to 24 hrs and 48 hrs
after surgery in all cattle underwent rumenotomy.
The mean (±S.E) serum aspartate amino transferase
(AST) level in IU/L before, 24 hrs and 48 hrs after
rumenotomy in all cases were 81.61±6.92, 85.56
±8.61 and 92.73 ±19.00 respectively (Table 2). The
mean AST level showed a highly significant
(P<0.01) increase from the presurgical values up to
24 hrs and 48 hrs after surgery in all cattle
underwent rumenotomy.
Serum creatinine
The mean (±S.E) serum creatinine in mg/ dL
before, 24 hrs and 48 hrs after rumenotomy in all
cases were 1.1±0.04, 1.4±0.02 and 1.9±0.07
respectively (Table 2). The mean serum creatinine
level revealed a highly significant (P<0.01)
increase from the presurgical values up to 24 hrs
and 48 hrs after surgery in all cattle underwent
rumenotomy.

Table No. 02: The mean (±S.E) values of serum biochemical analysis in cattle
observed before and after rumenotomy
Hematological parameters Before surgery 24 hrs after surgery 48 hrs after surgery
Total protein (g/dl) 7.4± 0.24a 7.3±0.26b 6.5± 0.13b
ALT (IU/L) 23.0±6.76a 27.3±5.65b 35.0±3.25b
AST (IU/L) 81.6±6.92a 85.5±8.61b 92.7±19.00b
Serum creatinine (mg/ dL) 1.1±0.04a 1.4±0.02b 1.9±0.07b
a, b
Mean bearing different superscript in a row differs significantly.

Discussion present study concurred with the records. Where in

In the present study increased mean haemoglobin the author stated that no variation in Hb level was
concentration at 24 hrs and 48 hrs after surgery had observed in bovine in response to ingestion of
been recorded in all the cattle. The findings in the foreign body. The observation disagreed with

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Mulat Asrat., et al., Int. J. Pharm. & H. Care Res., Vol.–02 (02) 2014 [127 - 136]
earlier reports in cattle30 who reported decreased
mean values of haemoglobin concentration in
animals with foreign body rumen impaction
indicate anaemia during penetration of the
reticulum. The increase in the level of haemoglobin
could be due to chronic nature of the disease and
degree of dehydration.
In the hematological profile in PCV values were
increased at 24 hrs and 48 hrs after surgical
procedure. This could be attributed to the stress
associated with surgery. Similar observations were
reported.3 The increase in the PCV might be due to
depressed appetite nature and duration of the
disease condition and dehydration status of the
animal.
The non significant increase in the mean total
erythrocytic count was observed in the present
study.29 reported similar observations higher TEC
values in foreign body syndrome affected cases in
cattle where as reported a significant drop in TEC
values in cases of foreign body syndrome in bovine
indicate anaemia, which could be attributed to the
loss of blood during penetration of the reticulum or
the chronic inflammatory process.2, 4, 31, 32 The
increased TEC in animals of this study could be
due to careful surgical procedure without much
bleeding.
Significant increase in the mean total leukocyte
was observed in the present study at 24 hrs and 48
hrs post rumenotomy. Similar observations were
reported.5, 7 This marked increase in TLC, observed
in diseased cattle could be attributed to tissue
injury leading to inflammation and purulent
exudation after the surgical management.
In the hematological profiles, neutrophilic
leukocytosis at 24 hrs and 48 hrs after surgery was
noticed in the present study. This was in
accordance with5-7 who attributed neutrophilia due
to the inflammation in the surgical condition and
stress.33, 34 reported similar findings of neutrophilia
which have been indicative of diffuse traumatic
reticuloperitonitis and extra-reticular fibrous
nodules. Neutrophilia might be due to the surgical
trauma and subsequent surgical stress and
inflammatory process after the surgical procedure
and appearance of immature neutrophil in blood
during acute inflammatory disease.
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133
The highly significant decrease in mean values of
lymphocyte with a significant increase in mean
neutrophils values noticed at 24h and 48h after
surgery. In the hematological profiles, lymphopenia
were evident in cattle with ruminal affections.
These findings were in agreement with3, 7, 35 who
reported that endogenous corticosteroid release
secondary to stress may cause lymphopenia by cell
redistribution; circulating lymphocytes do not re-
enter the lymphatics but become sequestered in
lymphoid tissue and bone marrow. The observed
decrease in mean lymphocytic values might
suggest increased susceptibility to infection in
cattle with foreign body impaction and could be
due to a reduction in cellular immunity associated
with the stress of penetration or impaction.
Lymphopenia with leukocytosis may be due to the
inflammatory surgical conditions, surgical trauma
and wound infection due to release of
corticosteroids as a result of stress.
Monocyte count did not show any significant
difference before and after surgery. Similar
findings were reported.35 Monocytopaenia might be
due to acute inflammation caused by surgical
trauma.
Eosinophilia and eosinopenia were difficult to be
evaluated in large animals but stress induced
eosinopenia may occur secondary to increased
circulatory catecholamine and corticosteroids.
During inflammatory and infectious process
eosinopenia followed administration of
corticosteroids.36 Eosinopaenia could be due to
acute infection during surgical management.
The decrease in the total protein (TP) from normal
values in this study could be due to lack of proper
diet or poor absorption of dietary constituents from
gastrointestinal tract. Similar findings were
reported.11 On the contrary13, 10 who reported that
an increased level of TP was due to release of some
acute phase proteins and increased globulin
concentration in response to inflammation, stress,
or dehydration. The decrease in TP levels in
surgical conditions might be due to progressive loss
of appetite and reduced intake of feed and water.
The increase in ALT activity suggests that ruminal
affections associated with impaired hepatic
function that might be due to hepatic damage
secondary to foreign bodies which were in
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agreement.8, 12 The increase in liver enzymatic
activity suggests that foreign body syndrome was
associated with impaired hepatic function that
might be due to hepatic damage secondary to
ruminal disorders.
Elevations of AST above the base levels at 48 h
after surgeries were in accordance28, 13, 25 who
reported an increased level of AST might due to
tissue damage that occurred during handling and
surgical procedures. The elevation of aspartate
aminotransferase was suggestive of inflammatory
changes in the body not only traumatic
reticuloperitonitis or pericarditis. This could
provide important clues for the presence of
inflammatory changes. Furthermore, the enzymatic
activity of AST and ALT was significantly
suggestive of more severe damage to the liver and
muscles with ruminal affections.
The increased creatinine levels could be attributed
to decrease in renal blood flow as a part of
compensatory mechanism to maintain circulation in
hypovolemia associated with dehydration, leading
to azotemia.7, 15 The CK was elevated in the
majority of patients with muscle disease but may
be normal in slowly progressive myopathies.
All the animals with different ruminal disorders
were subjected to laprorumenotomy. Rumenotomy
performed with Weingarth apparatus provided
adequate fixation of rumen and prevented spillage
of ruminal contents in to peritoneal cavity.25, 37
have stated that the recommended techniques for
rumenotomy were suturing the rumen to the skin,
prior to rumenotomy, or using fixation devices,
such as, a Weingarth's ring later being better
technique. On contrary5 reported that skin suture
fixation was superior to Weingarth's ring and the
stay suture techniques. However in the present
study the use of Weingarth's ring prevented the
spillage of ruminal contents into the peritoneal
cavity and development of peritonitis.
In the present study post operative care was aimed
to prevent surgical infection, correct dehydration,
acid base and electrolyte disturbances and
restoration of normal ruminal motility. Intravenous
fluid, dextrose normal saline in the present study to
correct electrolyte loss and dehydration favoured
wound healing and recovery as similarly
suggested.9 Post operative management especially
www.ijphr.com
daily wound dressing and lavaging with
disinfectants, provision of balanced ration and
sufficient drinking water were given for normal
recovery as reported.9, 38 Post operative care given
in the present study was helpful for complete
recovery of all cattle following rumenotomy.
Conclusion and recommendations
This study was aimed at investigating the pre and
post rumenotomy outcomes of 13 cattle with
various ruminal disorders. Hematological and
serum biochemical parameters were studied in all
the cattle.
In haematology Hb, PCV and TLC levels increased
significantly from the presurgical values up to 24
hrs and 48 hrs after rumenotomy. Leukogram
revealed significance neutrophilia and lymphopenia
from the presurgical values up to 24 hrs and 48 hrs.
However, monocyte and eosinophil count indicated
non significant decrease from the presurgical
values up to 24 hrs and 48 hrs after surgery.
Biochemical parameters revealed significant
increase in ALT, AST and serum creatinine level
from the presurgical values up to 24 hrs and 48 hrs
after rumenotomy. Serum TP significantly
decreased from the presurgical values up to 24 hrs
and 48 hrs.
Rumenotomy through left flank approach using
paravertebral nerve block by lignocaine 2% was
safe for surgical intervention of various ruminal
disorders. Streptopenicillin, dextrose normal saline
favoured wound healing and recovery.
Therefore, based on the above conclusions, the
following recommendations are forwarded:
 Farmers/livestock owners should be
cautioned against unsupervised grazing of
cattle as there in danger of accidental
ingestion of disposed vegetable
waste/kitchen waste in plastic bags.
 The cattle owners should strictly follow the
post operative management advices given by
the surgeon.
 The preoperative correction for dehydration,
antimicrobials to prevent possible infection
and replenishing the ruminal content to
restore the ruminal ecosystem should be
taken into consideration for successful
rumenotomy.

Mulat Asrat., et al., Int. J. Pharm. & H. Care Res., Vol.–02 (02) 2014 [127 - 136]
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 Bovine rumenotomy: Comparison of
four surgical techniques
Seifollah N. Dehghani, Amir M. Ghadrdani
Abstract
Rumenotomy in cattle is a routine procedure for
treatment and diagnostic purposes. A comparative
study of different rumenotomy techniques is lacking
in the veterinary literature. Four rumenotomy tech-
niques were compared in 20 cattle: skin suture fixa-
tion, Weingarth's ring, stay suture, and skin clamp
fixation. Results indicated that skin suture fixation
was superior to Weingarth's ring and the stay suture
techniques. Skin clamp fixation was comparable
with skin suturing and required a shorter opera-
tive time. Rumenotomy using the stay suture tech-
nique was followed by postoperative inflammatory
complications, as indicated by significant (P < 0.05)
increases in mean body temperature and total white
blood cell counts of 39.3, s = 0.56°C and 12.6 x 109,
s = 1.57 X 109/L, respectively, on day 4. Therefore,
rumenotomy using the skin clamp fixation technique
could be considered as an alternative to the more
commonly used skin suture fixation technique.
Resume
Comparaison de quatre techniques chirurgi-
cales de rumenotomie chez le bovin
La rumenotomie est une procedure chirurgicale
courante utilisee comme moyen de diagnostic et de
facon therapeutique. Toutefois, la documentation
ne compte aucune etude comparative de l'efficacite
des differentes techniques chirurgicales. Les auteurs
ont e'value quatre methodes de rumenotomie uti-
lisees sur 20 animaux : la fixation de la suture du
rumen ai la peau, I'anneau de Weingarth, la suture de
retention et la fixation du rumen 'a la peau par des
agrafes. Les re'sultats montrent que le fixation de
la suture du rumen a la peau est superieure a la
methode de Weingarth et aux sutures de retention.
De plus, la technique de fixation par des agrafes se
compare a celle de la suture du rumen 'a la peau
tout en diminuant le temps chirurgical. Une reaction
inflammatoire postoperatoire a ete notee lors de
rumenotomie combinee a une technique de suture de
retention. Dans ces cas, il y avait une elevation sig-
nificative (p < 0,05) de la temperature corporelle
Department of Veterinary Surgery, School of Veterinary
Medicine, Shiraz University, 71365 Shiraz, Iran.
Funded by Shiraz University research program.
Can Vet J Volume 36, November 1995
moyenne et une augmentation significative du compte
leucocytaire au quatriieme jour, soit respectivement
39,3, S = 0,56 °C et 12,6 x 109, S = 1,57 x 109AL. Les
auteurs concluent que lors de rumenotomie, la
methode de fixation du rumen a la peau au moyen
d'agrafes peut etre une alternative 'a la technique plus
conventionnelle de suturer le rumen a la peau.
(Traduit par docteure Therese Lanthier)
Can Vet J 1995; 36: 693-697
Introduction
umenotomy is a routine procedure for many dis-
eases in cattle, such as, traumatic reticuloperitonitis;
ingestion of toxic plants, chemicals, spoiled roughage,
or fetal membranes after parturition; acute and recurrent
bloat; placement of a temporary or permanent rumen can-
nula to relieve bloat; creation of a permanent rumen fis-
tula; and impactions (1). Other reasons include ingestion
of materials, such as, baling twine or plastic bags that are
obstructing the reticulo-omasal orifice, foreign bodies
lodged in the distal esophagus, and rumen overload
(2). Rumenotomy can also be used for the diagnosis of
intraruminal diseases other than those associated with
foreign bodies (3). The recommended techniques for
rumenotomy are suturing the rumen to the skin, prior to
rumenotomy (2), or using fixation devices, such as, a
Weingarth's ring (4). An alternative technique for
rumenotomy involves the use of stay sutures. The tech-
nique selected depends on the personal preference of the
veterinarian. A comparative study of these techniques has
not been made. The purpose of this study was to compare
the available rumenotomy techniques and describe the
intraoperative and postoperative complications. Also, a
new technique, using towel clamps, is introduced and
compared with the other techniques.
Materials and methods
Twenty mixed Iranian cattle of both sexes, weighing
between 200 and 415 kg (mean 304.5, s = 63.5 kg) and
aged between 1.5 and 4 y (mean 2.7, s = 0.8 y), destined
for slaughter were used. Animals were fed identical
rations and kept under identical conditions. Prior to
starting the study, a thorough physical examination
was carried out, including collection of venous blood for
total and differential white blood cell (WBC) counts. The
animals were randomly allocated to 4 groups of 5 and
deprived of food for 24 h and water for 12 h before the
693
 b c

-1

Figure 2. Weingarth's ring rumenotomy. a) Application of

Weingarth's ring, the rumen is anchored to the ring dorsally and
a ventrally. b) Rumen is incised and fixed to either side of the ring
by hooks.
i in a Lembert pattern, using No. 2 chromic catgut. The
Figure 1. Rumenotomy by rumen skin suturing fixation. a) Skinincision site was rinsed with sterile saline, and the sur-
incision. b) First suture bite through the rumen and skin.
c) Completed suture, rumen is incised. Right square: Enlargedgeons rescrubbed and regloved. The rumen to skin
schematic of the suture pattern. Lower square: Suture patternsuture was removed and a 2nd layer of rumen closure was
at dorsal and ventral comissures for better peritoneal seal. placed using a Cushing pattern with the same type of
suture material, and inverting the holes made by the
rumen to skin suture. Following a final rinse of the
operation. They were restrained in a conventional stock. rumen with sterile saline, the laparatomy incision was
The left flank was clipped, washed, and disinfected. closed routinely. The transverse abdominis muscle and
Local anesthesia was carried out with a paravertebral peritoneum were sutured together in a simple continu-
nerve block. Nerves thoracic (T) 13, lumbar (L) 1, 2, ous pattern, using No. 2 chromic catgut. Before tying the
and 3 were blocked. The skin was aseptically prepared last suture, air was forced out of the abdomen by some-
by use of povidone iodine, and the animal was draped. one pushing into the opposite flank. The remaining
Sterile gowns and gloves were used. muscle layers and subcutaneous fascia were sutured
separately, but in the same manner as the 1st layer.
Rumen skin suturing fixation (RSSF) The skin was sutured using a lockstitch pattern with
Following laparotomy, the rumen was pulled slightly No. 2 silk.
toward the incision. The rumen was sutured to the skin
using No. 2 silk and a continuous Connell suture pattern. Weingarth's ring rumenotomy (WRR)
The suture pattern started midway down the caudal Following laparatomy, a Weingarth's frame was fixed to
side of the incision, continued ventrad to the ventral com- the dorsal commissure of the incision by its thumb
missure of the incision, dorsad on the cranial side of the screw. The rumen was fixed to the ring as described in
incision to the dorsal commissure, and then ventrad the literature (4). As the rumen wall was incised, hooks
again to the starting point (Figure 1). The suture was were placed into the cut edge of the rumen wall, pulled
pulled tight to invert the skin edges under the rumen for out, and hooked around the frame until the rumen had
a good seal. The rumen was incised and explored as been reflected outward all the way around the incision
described in the literature (2). The ruminal edges were (Figure 2). The ruminal cavity was explored as in the
then washed and the 1 st layer of the rumen was closed RSSF technique, using a rumen shroud. The closure
694 Can Vet J Volume 36, November 1995
 ,
suture

Figure 3. Stay suture rumenotomy. The rumen is sutured to the

skin ventrally, dorsally, cranially, and caudally prior to being
incised.
was similar to that for RSSF, including inversion of
the traumatized area of the rumen made by the forceps.
Abdominal wall closure was routine.
Figure 4. Rumenotomy by rumen skin clamp fixation. a) The
rumen is fixed to the skin dorsally and ventrally by 2 towel
clamps. b) The rumen is incised and fixed to skin on either side.
c) The ruminal incision is extended and fixed to the skin by
more clamps. Lower square: Towel clamps properly applied to
overlap rumen wall over the skin.

Stay suture rumenotomy (SSR) total and differential leukocyte counts. The animals
Following laparatomy, the rumen was gently pulled were slaughtered 2 mo following the operation.
out of the incision, and the rumen wall was anchored to The statistical calculations were made using one-
the incision dorsally, ventrally, cranially, and caudally way analysis of variance followed by the Dunkan pro-
by 4 sutures into the skin and rumen wall, using No. 2 cedure by means of a calculation program (SPSS/PC
nylon suture (Figure 3). The rumen was then opened and V 2.0, SPSS Inc. Chicago, Illinois, USA). A significance
the edges were grasped with artery forceps. Exploration level (P < 0.05) was assumed.
of the ruminal cavity was carried out using a rumen
shroud. Ruminal and abdominal closure were as Results
described for RSSF. Rumenotomy by the RSSF procedure took significantly
(P < 0.003) longer than by the other 3 techniques. It
Rumen skin clamp flxation (RSCF) ranged from 21 to 25 min (mean 22.5, s = 2.3 min), due
Six to 8 Backhaus towel clamps were used for this to the time spent suturing the rumen to the skin and sub-
technique. Following laparotomy, the rumen was gently sequently removing these sutures for ruminal closure. The
pulled out of the incision and firmly anchored to the skin mean surgical times (skin incision to skin closure) for
dorsally and ventrally by towel clamps. The rumen was the RSSF, WRR, SSR, and RSCF techniques were
opened and its edges were fixed cranially and caudally 76.00, s = 2.9, 55.7, s = 5.4, 51.2, s = 5.3, and 55.5,
to the skin incision using towel clamps. Additional s = 5.6 min, respectively. The mean body temperature
clamps were used to secure the rumen edges to the skin of each group was compared with its presurgical mean
between previously placed clamps (Figure 4). The value (Table 1). Significant differences were observed
clamp handles were pointed away from the incision only in the group treated by the SSR technique (P <
and the rumen edges overlapped the skin edges by 2 to 0.05), where the postoperative body temperature levels
3 cm. Removal of ingesta and exploration of the rumen during the first 4 d were significantly higher than the pre-
was done as before. The rumen was rinsed with sterile operative levels. The total WBC counts were reduced
saline. For closure, the clamps on the cranial and caudal during the 1 st postoperative day and increased again on
side were removed first and the dorsal and ventral the 2nd postoperative day in all groups (P > 0.05).
clamps were left on. The 1 st layer was closed as in the Only after the SSR procedure did the total WBC count
other procedures, while closure of the 2nd layer was car- increase significantly (P < 0.05) on the 4th postoperative
ried out after removal of the dorsal and ventral clamps, day. The neutrophil/lymphocyte (N/L) ratio also
allowing for inversion of traumatized areas of the increased significantly (P < 0.05) in this group on the
rumen. 4th postoperative day. The animals appeared anorectic,
All the operations were performed by the same surgical emaciated, with a rough hair coat, and had poor carcasses
team. No antibiotics were used either preoperatively at slaughter.
or postoperatively. Physical examinations were carried At slaughter, all the ruminal and abdominal inci-
out daily, including evaluation of heart rate, respiratory sions had healed grossly with no complications. There
rate, rectal body temperature, and general status. Blood were negligible local adhesions at the rumenotomy site
samples were collected from the jugular vein daily, for in 1 animal in the RSSF group, a few small local fibrous
4 consecutive days after surgery, for determination of bands in 1 animal in the RSCF group, and local fibrous
Can Vet J Volume 36, November 1995 695
 Table 1. Mean body temperatures, total leukocyte counts, and
neutrophil to lymphocyte ratios (N/L) in 4 groups of 5 cattle
treated by rumenotomy
Mean Mean
body temp. total WBC Mean
Surgical group (OC) (X 109/L) N/L ratio
preoperative 38.3, s = 0.44 8.8, s = 1.8 0.44, s = 0.05
RSSF postoperative
day 1 38.7, s = 0.42 7.7, s = 1.5 0.42, s = 0.06
day 2 38.8, s = 0.39 7.4, s = 1.7 0.40, s = 0.08
day 3 39.0, s = 0.62 9.4, s = 1.6 0.50, s = 0.08
day 4 39.0, s = 0.56 9.8, s = 9.4 0.52, s = 0.07
preoperative 38.2, s = 0.59 10.0, s = 8.0 0.50, s = 0.10
WRR postoperative
day 1 39.3,s=0.64 8.5,s=7.4 0.49,s=0.10
day 2 39.4, s = 0.62 8.0, s = 1.0 0.45, s = 0.10
day3 39.4,s=0.60 1l.5,s= 1.1 0.64,s=0.12
day4 39.4,s=0.55 12.5,s= 1.8 0.68,s=0.10
preoperative 37.8, s = 0.24 9.0, s = 1.6 0.56, s = 0.13
SSR postoperative
day 1 39.2,s=0.46a 6.5,s= 1.2 0.51,s=0.10
day2 39.2,s=0.70a 5.9,s= 1.5 0.45,s= 0.10
day 3 39.2, s = 0.42a 11.6, s = 1.9 0.73, s = 0.08
day 4 39.3, s = 0.56a 12.6, s = 1 .5a 0.79, S = O.09a
preoperative 38.3, s = 0.48 9.4, s = 1.7 0.46, s = 0.09
RSCF postoperative
day 1 39.0, s = 0.65 8.1, s = 2.0 0.42, s = 0.06
day 2 39.0, s = 0.63 7.8, s = 1.2 0.39, s = 0.07
day3 39.2,s=0.70 10.3,s= 1.6 0.56,s=0.13
day4 39.2,s=0.56 10.7,s= 1.3 0.58,s=0.13
WBC - white blood cell
RSSF - rumen skin suturing fixation
WRR - Weingarth ring rumenotomy
SSR - stay suture rumenotomy
RSCF - rumen skin clamp fixation
adata are significantly different (P < 0.05)

adhesions in 2 animals in the WRR group. There were, peritoneal cavity. Reduction in the number of lympho-
however, extensive fibrous adhesions present in 3 ani- cytes, as indicated by the increased N/L ratios (Table 1),
mals in the SSR group, including a few small abscesses and increases in the total WBC counts, along with pres-
in 1 animal and a large peritoneal abscess in another. The of eosinophils, suggested that mild inflammation
ence
abscess (36 X 14 X 23 cm) was found between the occurred with the SSR group (5).
rumen and left abdominal body wall. Advantages and dis- Antibiotics were not used in animals in this study,
advantages of the 4 rumenotomy techniques are sum- because avoiding the use of antibiotics for an operation
merized in Table 2. has economic advantages, especially in food animals. In
the case of emergency slaughter, antibiotic residues in
edible tissues and the subsequent public health hazard are
Discussion avoided. Therefore, choosing the correct technique and
The results in Table 1 demonstrate that rumenotomy by doing it as aseptically as possible could have consider-
the RSSF technique was superior to rumenotomy by able economic value.
the WRR and SSR techniques, because there were no sig- Rumenotomy by RSSF, as performed in this study, was
nificant changes in body temperature or total WBC slightly different from that previously reported (2).
count, and there were only a negligible number of adhe- Special attention was focused on the dorsal and ventral
sions. The RSCF and RSSF techniques were equivalent, incision commissures, so that there was a good overlap
since although the postoperative findings in the RSCF of rumen on the skin where the leakage of ingesta into the
group were slightly higher than those in the RSSF peritoneum was most likely to occur (Figure 1). Although
group, the RSCF technique required a shorter surgical No. 2 silk was used for RSSF in this study, almost any
time. The changes in body temperature, total WBC nonabsorbable suture material could have been used.
count, and neutrophil to lymphocyte (N/L) ratios in Other techniques or devices for rumenotomies in
the WRR group, although not significant, were greater cattle have been described, such as, the rumenotomy
than in the RSSF or RSCF groups. With removal of board (4) and the Danish rumenotomy set (2), which are
rumen ingesta and reduction in the intraruminal pressure, more or less similar to Weingarth's ring. Rumenotomy
the hooks in WRR technique tended to become loose, by the Gotze method requires that the rumen be sutured
providing room for spillages and contamination of the to the peritoneal membrane by a continuous suture
696 Can Vet J Volume 36, November 1995
 Table 2. Comparison of 4 rumenotomy techniques
Technique Advantage
RSSF - Clean wound after rumen closure
- Fewer postoperative complications than
SSR and WRR technique
- Good for all purpose rumenotomy,
especially for rumen lavage
- No special instruments needed
- No assistant required
WRR - Fast technique
- Good for foreign body removal, impactions,
and grain overloads
SSR - No special instruments needed
- Good for fast removal of foreign body
RSCF - Clean wound after rumen closure
- Fast technique
- No special instruments needed except
rumen shroud
- No assistant required
- Fewer postoperative complications than with
SSR and WRR techniques
- Good for all purpose rumenotomy
RSSF - rumen skin suturing fixation
WRR - Weingarth ring rumenotomy
SSR - stay suture rumenotomy
RSCF - rumen skin clamp fixation
pattern before entering the rumen (7); it has the dis-
advantage that the peritoneum has less holding power
than the skin and contamination of the abdominal mus-
cle layers is almost inevitable.
A single layer of continuous inverting closure is ade-
quate for the rumen (2,4), except when it is largely
distended (2) or if there is any question of the viability
of the rumen wall. In this study, the rumen was closed by
2 inverting suture patterns. The 1st layer closure limited
the source of contamination and allowed cleaning of the
rumen and wound, while the 2nd layer was supportive
and allowed for inversion of all traumatized areas close
to the incision that were not previously visible. Haven
et al (6) also preferred double layer ruminal closures.
Rumenotomy by RSSF is the best procedure, but it
requires the longest time. Rumenotomy by the WRR pro-
cedure is usable, but requires attention during the opera-
tion to prevent loosening of the hooks and spillage of
ingesta into the peritoneal cavity. Rumenotomy by
RSCF has similar advantages to the RSSF procedure, but
it requires a shorter operative time, so it can be con-
sidered as a safe alternative technique for rumenotomy.
Can Vet J Volume 36, November 1995
Disadvantage
- Time consuming
- Failure to invert suture holes made in the
rumen will sometimes cause leakage and
peritonitis
- Easily displaced
- Not a clean wound after rumen closure
- Need special instrument
- Requires assistant
- Not good for frothy bloats or rumen lavage
- Contamination of surgical wound and
peritoneum
- Possible peritonitis and abcessation
- Requires assistant
- If rumen shroud is not used, clamps may
interfere with operator's hand
Acknowledgment
The authors thank Mattias Haab of the Veterinary
Surgery Clinic of the University of Zurich for preparing
the illustrations. cvj
References
1. Amstuts HE. Bovine Medicine and Surgery. 2nd ed. Vol 2. California:
American Veterinary Publications Inc, 1980: 1202-1210.
2. Turner AS, Mcllwraith CW. Technique in Large Animal Surgery.
2nd ed. Philadelphia: Lea & Febiger, 1989: 268-273.
3. Hessamizadeh C. Radiological and surgical study of foreign body
ingestion in cattle (DVM Thesis). Shiraz, Iran: Shiraz University,
1987.
4. Hofmeyr CFB. The digestive system. In: Oehme FW, ed. Textbook
of Large Animal Surgery. 2nd ed. Baltimore: Williams & Wilkins,
1988: 448.
5. Schalm OW, Jain NC, Carrol EJ. Veterinary Hematology. 3rd ed.
Philadelphia: Lea & Febiger, 1975: 14 1-143, 522.
6. Haven ML, Wichtel JJ, Bristol DG, Fetrow JF, Spears JW. Effects
of antibiotic prophylaxis on postoperative complications after
rumenotomy in cattle. J Am Vet Med Assoc 1992; 200: 1332-1335.
7. Rosenberger G. Krankheiten des Rindes, Berlin: Paul Parey, 1970:
226-227.
8. Jubb KVF, Kennedy PC, Palmer N. Pathology of Domestic Animals.
3rd ed. Vol 2. New York: Academic Pr, 1985.
697
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Gastrotomy for Retrieval of Thoracic Oesophageal Foriegn Body Using Long

Forceps Technique in Three Dogs

Article · July 2011

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Journal of
Advanced Veterinary Research
Volume 1 (2011) 74-75 Case Report
Gastrotomy for Retrieval of Thoracic Oesophageal Foriegn Body Using Long
Forceps Technique in Three Dogs
Suresh Kumar R.V., Sankar P.*, Kokila S., Reetu, Sailaja B., Ravikumar P., Dhana Lakshmi N.,
Veena P.
Department of Veterinary Surgery and Radiology, College of Veterinary Science, Tirupati-517 502, Sri Venkateswara Vet-
erinary University, Andhrapradesh, India

(Recieved 20 May 2011/ Accepted 10 July 2011)

Abstract

Three dogs age between 3- 6 years old was presented to the Department of Veterinary Surgery and Radiology with the
history of anorexia, attempt for vomiting, regurgitation, dysphagia, gagging, mild salivation after taking a piece of bone.
Clinical examination revealed heart rate and respiratory were within physiological limits. Lateral plain radiograph of thorax
revealed radio opaque foreign body was lodged between heart and diaphragm. Surgical invention was planned to retrieve
thoracic oesophageal foreign body through gastrotomy incision. This clinical paper reports the successful surgical management
of thoracic oesophageal foreign body through gastrotomy incision using long forceps without complication.
Keywords: Oesophageal foreign body; Gastrotomy; Long forceps

Introduction opaque foreign body was lodged between heart and

diaphragm (Kaiser et al., 2003). Surgical invention
The ingestion of a foreign body is common prob- was planned to retrieve thoracic esophageal foreign
lem in dogs. Rarely foreign body may become body through gastrotomy incision using long for-
blocked in the oesophagus, particularly near the ceps (Fig. 2).
caudal oesophageal sphincter or between the heart
and diaphragm which is the most inaccessible part
of the oesophagus and it is easy to retrieve thoracic
oesophageal obstruction through gastrotomy inci-
sion using long forceps (HunYoung et al., 2009).

Case history and observations

Three dogs age between 3- 6 years was presented

to the Department of Veterinary Surgery and Radi-
ology, College of Veterinary Science, Sri
Venkateswara Veterinary University, Tirupati
Andhrapradesh, India with the history of anorexia,
attempt for vomiting, dysphagia, gagging, mild
Fig. 1. Lateral plain radiograph show thoracic oe-
salivation for 2 days after taking a piece of bone.
sophageal obstruction.
Clinical examination revealed heart rate and respi-
ratory were within physiological limits. Lateral
plain radiograph of thorax (Fig. 1) revealed radio Treatment and Results

Under aseptic precaution site was prepared for gas-

*Corresponding author: Sankar P.
Address: Department of Veterinary Surgery and Radiology, College
of Veterinary Science, Tirupati-517 502, Sri Venkateswara Veteri-
nary University, Andhrapradesh, India
E-mail address: sansurvet@gmail.com
trotomy. Atropine sulphate at 0.044 mg/kg body
weight subcutaneously and xylazine hydrochloride
at 0.5 mg/kg body weight intramuscularly were

ISSN: 2090-6277/2090-6269, www.advancedvetresearch.com

 Suresh Kumar et al. / Journal of Advanced Veterinary Research 1 (2011) 74-75
given as premedication. Ketamine hydrochloride
was given at 8.0 mg/kg body weight intramuscu-
larly and anaesthesia was maintained with the com-
bination of Ketamine hydrochloride-
Diazepam10:1 ratio. To dislodge the foreign body
in to the stomach stomach tube were used unsuc-
cessful. Gastrotomy was performed through ventral
midline incision from the xiphoid to the pubis. Ab-
dominal wall is then retracted using Balfoure re-
tractor. Stomach was isolated from the abdominal
content with moistened laparotomy sponges to re-
duce the contamination and incision was made at
ventral aspect of the stomach between the greater
and lesser curvatures, through the incision long
foreceps (HunYoung et al., 2009) was introduced
gently to dislodge the bone piece (Meffert, 2010)
from the oesophagus and removed through stom-
ach (Haragopal and Suresh Kumar, 1996). Gastro-
tomy wound incision was closed by simple
continuous followed by cushing suture pattern
(Fig.3) using 2/0 chromic catgut.
Fig. 2. Retrieved foreign body (Bone) through
stomach
Fig. 3. Showing gastrotomy closure- Cushing su-
ture pattern
75
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Post operatively animal was maintained with in-
travenous dextrose normal saline and ringers lac-
tate for first 5 days twice daily followed by once
daily along with liquid diet, ceftriaxone at 10
mg/kg body weight and dexamethazone 0.5 ml/kg
body weight and ranitidine hydrochloride 0.5 ml
were given intravenously for 5 days with alternate
day dressing with povidone iodine ointment. All
the animals were recovered uneventfully on 9th
post operative day.
References
Haragopal, V., Suresh Kumar, R.V., 1996. Surgical removal of a fish
bone from the canine esophagus through gastrotomy. Canadian
Veterinary Journal 37, 156.
HunYoung,Y., MyungGon, K., SoonWuk, J., 2009. Gastrotomy ap-
proach retrieval of esophageal foreign body using long forceps
technique in five dogs. Journal of Veterinary Clinics 26, 628-
631.
Kaiser,S., Forterre, F., Kohn, B., Brunnberg, L., 2003. Oesophageal
foreign bodies in dogs: a retrospective study of 50 cases (1999-
2003). Kleintierpraxis 48, 397-400.
Meffert, F.J., 2010. Canine oesophageal foreign bodies: a retrospec-
tive study of 49 cases (2001-2009). Australian Veterinary Prac-
titioner 40, 90-94.
 Vet Clin Food Anim 24 (2008) 341–347

Rumenotomy
Andrew J. Niehaus, DVM, MS
Department of Veterinary Clinical Sciences, College of Veterinary Medicine,
The Ohio State University, 601 Vernon L. Tharp Street, Columbus, OH 43210-1089, USA

The rumen in the adult cow comprises approximately 80% of the abdom-
inal cavity [1] with a capacity around 80 L (roughly 16% of body weight) [2].
Some sources report capacities varying from 102 to 148 L for mature cattle
[3]. The rumen lies primarily on the left side of the abdomen and its length
extends from the seventh or eighth rib to the pelvis [1]. The ventral sac of the
rumen extends to the right side of the abdomen. The rumen is typically
described as a ‘‘fermentation vat.’’ Through the process of fermentation,
microbes within the rumen convert complex carbohydrates that are useless
to the host animal into volatile fatty acids, microbial protein, and B vita-
mins, which are useful products. By-products of fermentation include meth-
ane, carbon dioxide, ammonia, and nitrate, which need to be cleared [2]. The
neonate has a very small rumen and relatively large abomasum. The relative
size of the rumen increases with the age of the animal. Ingestion of forage
and fermentation products is stimulus for rumen enlargement. The ratio
of rumen volume to abomasal volume is 0.5:1 at 4 weeks of age and even-
tually reaches 10:1 in adult cattle [1].

Indications for rumenotomy

The apposition of the rumen against the left body wall makes it an easy
portal though which to access other proximal gastrointestinal (GI) struc-
tures including the reticulum, the reticulo-omasal orifice, and the rumen
itself. Indications for rumenotomy include traumatic reticulitis, reticuloper-
itonitis, or reticulopericarditis (hardware disease). It can also be used to re-
move rumenal or reticular foreign bodies not associated with inflammatory
conditions (most commonly for removal of instruments that have been inad-
vertently swallowed during administration of enteral medications such as
balling guns, Frick speculums, or broken or chewed off esophageal tubes).

E-mail address: andrew.niehaus@cvm.osu.edu

0749-0720/08/$ - see front matter Ó 2008 Elsevier Inc. All rights reserved.
doi:10.1016/j.cvfa.2008.02.011 vetfood.theclinics.com
342 NIEHAUS

Using the rumen as access, the reticulum can be explored and foreign bodies
penetrating the wall of the reticulum or causing reticular irritation can be
removed. Perireticular abscesses that develop secondary to penetrating
reticular foreign bodies can be surgically drained into the reticulum via
a rumenotomy. In the author’s practice, the indication for performing
approximately half of the rumenotomy surgeries is for retrieval of a foreign
body in cases of hardware disease. Other indications for performing a rume-
notomy include removal of rumen contents in cases of acute toxin ingestion,
grain overload, or frothy bloat.
Rumenotomy has also been used to decrease rumen fill to aid in other
abdominal surgeries such as cesarean section. Rumen impaction leading
to decreased rumen outflow can also be relieved by decreasing rumen fill
and rumen lavage through rumenotomy. Impaction caused by ingestion of
hair can be seen in calves and camelids (Fig. 1).

Surgical techniques
Multiple techniques have been described for performing laprorumenot-
omy in cattle. All techniques involve making an approach in the left paral-
umbar fossa to gain access to the rumen, exteriorization of the rumen,
securing the rumen to the body wall or skin, and limiting contamination
is a picture of a completed rumenotomy incision [4–6]. The techniques dif-
fer by the method in which the rumen is secured to the body wall or skin.
A standard laparotomy incision is made in the left paralumbar fossa
through the skin and external, internal, and transverse abdominal muscles
followed by the peritoneum. It has been suggested to always perform an

Fig. 1. Trichobezoar removed from the first stomach compartment (C1) of an alpaca cria.
 RUMENOTOMY 343

abdominal exploratory before performing the rumenotomy [4,7]. Although

a thorough abdominal exploratory is limited from the left flank because of
the overwhelming size of the rumen, the cranioventral abdomen can be
palpated for the presence of reticular adhesions, a common sequela to re-
ticuloperitonitis. Peritonitis can also be diagnosed from the left paralum-
bar fossa approach. Both of these findings are indications for continuing
with the rumenotomy to search for penetrating foreign bodies [7]. It is rec-
ommended to palpate the area of suspected peritonitis last to avoid
spreading contamination throughout the abdomen. The dorsal sac of the
rumen is then exteriorized and secured before creation of the rumenotomy
incision.
One technique described securing the rumen to the peritoneum [5]. The
disadvantage with this technique is that the peritoneum can be weak and al-
low for retraction of the rumen into the abdomen. Contamination of the
muscle layers will also result since the body wall muscle layers are exposed.
The stay suture technique uses four stay sutures to anchor the rumen to
the skin at the dorsal, ventral, cranial, and caudal parts of the incision [6].
The stay suture technique has areas where rumen contents can pass between
the rumen and the body wall and allow contamination of the peritoneal
cavity. Similarly, the skin clamp technique uses towel clamps to secure the
rumen to the skin in an overlapping fashion in several discrete locations
around the incision.
Several devices have been developed to anchor the rumen following exte-
riorization and expedite the rumenotomy procedure. In 1954, a report on
a rumenotomy ring was published. This consisted of an aluminum ring
with a rubber ring attached to its inner circumference [8]. It was designed
so that the rumen could be hooked to this rubber ring. The idea was that
it would keep the rumen exteriorized and prevent abdominal contamination.
The hook placement is faster than suturing the rumen to the skin and thus
decreases time of the rumenotomy. Weingarth’s ring was based on this pre-
vious ring with some modifications for securing the hooks and lacked the
inner rubber ring. The Gabel rumen retractor (rumen board) is another
similar instrument used to keep the rumen exteriorized (Fig. 2). This device
has a hole in the center that the rumen is pulled through. A series of bolts
around the circumference of the hole allows hooks to attach the rumen to
the board. The board helps to decrease abdominal contamination and expe-
dites the procedure but limits the accessibility of the rumen.
The technique used most commonly in the author’s practice is skin suture
fixation. With this technique, the rumen is sutured to the skin using a contin-
uous inverting suture pattern such as a Connell or a Cushing [6]. If done
properly, this suture everts the rumen and inverts the skin edge to form
a continuous seal (Fig. 3).
Dehghani and Ghadrdani [6] compared skin suture fixation, stay suture
fixation, Weingarth’s ring, and the skin clamp technique in 20 cattle. They
found that stay suture fixation was inferior to the other techniques with
344 NIEHAUS

Fig. 2. Gabel rumen retractor with hooks for securing the rumen to the board.

increased incidence of infection. The rumen shroud is a device that has been
developed to help limit abdominal contamination with rumen contents. It is
a rubber device that has a large flat surface similar to a rumen board on one
side and an inner flange that secures it to the inside of the temporary rumen
fistula [9].
An underlying principle with all of these techniques is to achieve a good
seal between the rumen and the skin so that abdominal contamination is
minimized. Blood and fibrin accumulation around the incision can be
advantageous, as it can help to seal the incision and limit leakage of liquid
contents from the rumen into the abdomen. It, however, can also trap debris
and contamination from the rumen. Before release of the rumen back into

Fig. 3. Rumenotomy procedure. The rumen has been sutured to the skin in an inverting pattern
achieving a seal. (Courtesy of Bruce L. Hull, DVM, MS, Columbus, OH.)
 RUMENOTOMY 345

the abdomen, an effort should be made to remove excess blood and fibrin
that has clotted around the incision.
Before opening the rumen, some surgical instruments should be set aside
and kept sterile while the rumen is opened. These instruments will be used to
close the body wall and skin following lavage and rumen closure. The min-
imum set of instruments to be set aside includes new drapes, surgery gowns,
gloves, needle holders, suture, needles (if not using suture with swedged on
needles), scissors, and towel clamps.
After completion of the rumen exploratory, the rumen is closed. A dou-
ble-layer inverting pattern is typically recommended to achieve a good seal
on the rumenotomy incision. The author typically uses a double-layer Cush-
ing pattern. After the first layer of rumen closure (while the rumen is still
attached to the skin), the rumen surface is lavaged multiple times to remove
any rumen contents that may be adhered. Usually serosal irritation to the
surface of the rumen will cause roughening and fibrin exudation, which
will allow debris to stick. Any blood and fibrin clots should be removed.
Following a good cleaning of the rumen surface, the stay sutures that are
attaching the rumen to the skin are removed and the second layer of closure
is performed before allowing the rumen to retract into the abdomen. The
second layer of rumen closure should incorporate the suture holes made
by the prior stay sutures. The animals should then be redraped, the surgeon
regowned, and the instruments should be changed to a sterile set. From this
point forward, the procedure should be considered a clean surgery.

Perioperative management
At best, rumen surgery is considered a clean-contaminated surgery, since
a hollow, contaminated viscus is penetrated. Antibiotics are recommended
in any surgery that is considered less than clean [10]. Haven and colleagues
[10] showed that prophylactic use of penicillin significantly decreased the in-
cidence of abscess formation following rumenotomy. They also demon-
strated that an initial antibiotic dose at the time of surgery was all that
was necessary and continuing the therapy for several postoperative days
had no significant decrease on the incidence of abscess and infection rate.
Medical management should include treatment of concurrent diseases.
Animals should be treated for peritonitis or pericarditis in severe cases of
hardware disease. Animals diagnosed with grain overload should be treated
medically for the severe rumenitis that results from acute rumen acidosis.
Mycotic rumenitis and liver abscesses are possible sequela to grain overload
and should be prophylactically treated if grain overload is diagnosed.

Complications
Overall in the authors practice, the apparent complication rate associated
with rumen surgery is low (!5%). The prognosis and outcome largely
346 NIEHAUS

depends on the presenting complaint and preoperative condition of the

animal and not operative factors.
Peritonitis is a major complication associated with rumen surgery. Any
spillage of rumen contents in the abdomen will result in some degree of
peritonitis. The degree of peritonitis is dependent on the amount of contam-
ination, blood and tissue levels of antibiotics, and the health status of the
animal. Frequently in cases of hardware disease, peritonitis is already pres-
ent before the surgical procedure so determination of whether peritonitis is
a result of the surgery or the primary problem can be difficult to assess. An-
imals with peritonitis will show signs of a painful abdomen, and a mild fever
may be observed. In lactating dairy cattle, affected animals will show an
immediate and drastic drop in milk production.
In addition to contamination and infection of the abdomen, the body
wall tissues may also be contaminated. Animals undergoing rumen surgeries
will frequently develop incisional infections, seromas, and abscesses. These
incisions are prone to dehiscence. If an incisional seroma or abscess de-
velops, we recommend partly opening the incision at the ventral-most aspect
to facilitate drainage. Warm water hydrotherapy can also be a useful
adjunct to facilitate drainage and resolution of an infected incision.

First stomach compartment surgery in camelids

Camelids (llamas and alpacas) are pseudoruminants. They have two forest-
omach compartments that precede the true stomach, as opposed to three for-
estomach compartments in true ruminants. Their compartments are labeled
C1, C2, and C3, which stand for the first, second, and third compartments.
The third stomach compartment (C3) is the ‘‘true stomach’’ of the camelid,
while the C1 compartment is analogous to the rumen in these species.
The same principles can be applied to ‘‘rumen’’ surgery in camelid species
as in true ruminants. An anatomic difference between the rumen and the C1
compartment is the C1 compartment has sacculations. This can make crea-
tion of a seal between the stomach and the skin more challenging; however,
the thinner nature of the wall usually allows a seal to be created. The thinner
walled C1 is also more prone to tear from the skin so care must be taken to
not place too much force on C1 after it has been sutured to the skin. An-
other difference that could pose complications for the novice surgeon is
the lack of stratification of rumen contents in camelids. Where ruminants
have a rumen mat and gas dorsal to the rumen mat, camelids have
a more homogeneous makeup to their C1 compartment. In a ruminant, if
the rumen is approached from the dorsal third, only gas will be encountered,
decreasing the risk of spilling rumen contents. However, in camelids, C1
contents are more ‘‘frothy’’ in consistency even in the dorsal parts of the
C1 compartment, and spillage of contaminated C1 contents is more likely.
It is the author’s impression that camelids are more sensitive to abdom-
inal contamination and subsequent peritonitis than are true ruminants. In
 RUMENOTOMY 347

cattle, the hallmark clinical signs of peritonitis are a mild fever and a sharp
drop in milk production; a clinical sign of peritonitis in camelids is fre-
quently acute death.

Summary
If performed correctly, the rumenotomy procedure can be a safe and ef-
fective way to retrieve ingested foreign bodies and address other problems of
the ruminant forestomachs. In the author’s practice, rumen surgery has been
associated with few postoperative complications. Morbidity and mortality
in cases that have had a previous rumenotomy have mostly been associated
with complications related to the original presurgical condition or from
causes unrelated to the rumen surgery.

References
[1] Ducharme NG. Surgery of the bovine forestomach compartments. Vet Clin North Am Food
Anim Pract 1990;6(2):371–97.
[2] Church DC. The ruminant animal: digestive physiology and nutrition. Englewood Cliffs
(NJ): Prentice-Hall; 1988. ix, p. 564.
[3] Oehme FW. Textbook of large animal surgery. Baltimore: Williams & Wilkins; 1988. p. xii,
714. p. 399–449.
[4] Noordsy JL. Rumenotomy in cattle. In: Food animal surgery. Lenexa (KS): Veterinary
Medicine Pub. Co.; 1989. p. x, p. 286. p. 105–9.
[5] Hofmeyr CFB. The digestive system. In: Oehme FW, editor. Textbook of large animal
surgery. Baltimore: Williams & Wilkins; 1988. p. xii, p. 714, p. 364–449.
[6] Dehghani SN, Ghadrdani AM. Bovine rumenotomy: comparison of four surgical tech-
niques. Can Vet J 1995;36(11):693–7.
[7] Donawick W. Abdominal surgery. In: Amstutz HE, editor. Bovine medicine and surgery.
Santa Barbara (CA): American Veterinary Publications; 1980. p. 2 v. (1269 p.) 1207–20.
[8] Michael SJ, McKinley RE. Rumenotomy simplified. J Am Vet Med Assoc 1954;124(922):
26–7.
[9] Turner AS, McIlwraith CW, Hull BL. Techniques in large animal surgery. Philadelphia:
Lea & Febiger; 1989. xv, p. 381.
[10] Haven ML, Wichtel JJ, Bristol DG, et al. Effects of antibiotic prophylaxis on postoperative
complications after rumenotomy in cattle. J Am Vet Med Assoc 1992;200(9):1332–5.