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Duodenal obstruction caused by duodenal sigmoid flexure volvulus in dairy cattle: 29 cases (2006–2010)

Susan R. VogelFarm Animal Hospital, Faculté de Médecine Vétérinaire, Université de Montréal, CP 5000, St-Hyacinthe, QC, Canada.

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Sylvain NicholsFarm Animal Hospital, Faculté de Médecine Vétérinaire, Université de Montréal, CP 5000, St-Hyacinthe, QC, Canada.

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Sébastien BuczinskiBovine Ambulatory Service, Faculté de Médecine Vétérinaire, Université de Montréal, CP 5000, St-Hyacinthe, QC, Canada.

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André DesrochersFarm Animal Hospital, Faculté de Médecine Vétérinaire, Université de Montréal, CP 5000, St-Hyacinthe, QC, Canada.

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Marie BabkineFarm Animal Hospital, Faculté de Médecine Vétérinaire, Université de Montréal, CP 5000, St-Hyacinthe, QC, Canada.

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Manon VeilletteBovine Ambulatory Service, Faculté de Médecine Vétérinaire, Université de Montréal, CP 5000, St-Hyacinthe, QC, Canada.

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David FrancozFarm Animal Hospital, Faculté de Médecine Vétérinaire, Université de Montréal, CP 5000, St-Hyacinthe, QC, Canada.

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Elizabeth DoréFarm Animal Hospital, Faculté de Médecine Vétérinaire, Université de Montréal, CP 5000, St-Hyacinthe, QC, Canada.

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Gilles FecteauFarm Animal Hospital, Faculté de Médecine Vétérinaire, Université de Montréal, CP 5000, St-Hyacinthe, QC, Canada.

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Anne-Marie BélangerBovine Ambulatory Service, Faculté de Médecine Vétérinaire, Université de Montréal, CP 5000, St-Hyacinthe, QC, Canada.

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Mauricio BadilloBovine Ambulatory Service, Faculté de Médecine Vétérinaire, Université de Montréal, CP 5000, St-Hyacinthe, QC, Canada.

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Abstract

Objective—To characterize duodenal sigmoid flexure volvulus (DSFV) and determine the prognosis for affected cattle undergoing surgery.

Design—Retrospective case series.

Animals—29 dairy cattle.

Procedures—The medical records were analyzed for history, signalment, clinical signs, medical management, surgical findings, and outcome.

Results—29 cattle were determined to have DSFV between December 2006 and August 2010. Twenty cattle had had an omentopexy or pyloropexy performed 1 day to 2 years before initial evaluation. Cattle were afebrile, tachycardic, and moderately dehydrated, with a small zone of percussion with a ping at the 10th to 12th right intercostal spaces and associated succussion. Biochemical changes were a severe hypokalemic (mean ± SD, 2.9 ± 0.5 mmol/L; median, 3.1 mmol/L; range, 2.08 to 3.92 mmol/L), hypochloremic (mean, 69.7 ± 11.1 mmol/L; median, 71.7 mmol/L; range, 49.1 to 94.1 mmol/L) metabolic alkalosis (mean total CO2, 44.5 ± 7.4 mmol/L; median, 45.3 mmol/L; range, 31.5 to 59.6 mmol/L) and hyperbilirubinemia (mean, 32.4 ± 29.0 μmol/L; median, 20.5 μmol/L; range, 7.8 to 107 μmol/L). Surgical findings for DSFV included an empty descending duodenum adjacent to a dorsally displaced and dilated cranial segment of the duodenum, distended abomasum and gallbladder, and a tight volvulus at the base of the duodenal sigmoid flexure. Manual reduction was considered successful if the descending duodenum filled after cranial duodenal massage. Twenty-two patients were successfully treated; the remaining 7 died or were euthanized within 4 days after surgery.

Conclusions and Clinical Relevance—A condition clinically resembling abomasal volvulus but affecting the duodenal sigmoid flexure has been recognized in dairy cattle. When a focal, dorsal right-sided ping and succussion are present combined with severe hypokalemic, hypochloremic metabolic alkalosis and high bilirubin concentration, DSFV should be suspected, especially when there is a history of prior abomasal fixation. After surgical correction, the prognosis is fair to good.

Abstract

Objective—To characterize duodenal sigmoid flexure volvulus (DSFV) and determine the prognosis for affected cattle undergoing surgery.

Design—Retrospective case series.

Animals—29 dairy cattle.

Procedures—The medical records were analyzed for history, signalment, clinical signs, medical management, surgical findings, and outcome.

Results—29 cattle were determined to have DSFV between December 2006 and August 2010. Twenty cattle had had an omentopexy or pyloropexy performed 1 day to 2 years before initial evaluation. Cattle were afebrile, tachycardic, and moderately dehydrated, with a small zone of percussion with a ping at the 10th to 12th right intercostal spaces and associated succussion. Biochemical changes were a severe hypokalemic (mean ± SD, 2.9 ± 0.5 mmol/L; median, 3.1 mmol/L; range, 2.08 to 3.92 mmol/L), hypochloremic (mean, 69.7 ± 11.1 mmol/L; median, 71.7 mmol/L; range, 49.1 to 94.1 mmol/L) metabolic alkalosis (mean total CO2, 44.5 ± 7.4 mmol/L; median, 45.3 mmol/L; range, 31.5 to 59.6 mmol/L) and hyperbilirubinemia (mean, 32.4 ± 29.0 μmol/L; median, 20.5 μmol/L; range, 7.8 to 107 μmol/L). Surgical findings for DSFV included an empty descending duodenum adjacent to a dorsally displaced and dilated cranial segment of the duodenum, distended abomasum and gallbladder, and a tight volvulus at the base of the duodenal sigmoid flexure. Manual reduction was considered successful if the descending duodenum filled after cranial duodenal massage. Twenty-two patients were successfully treated; the remaining 7 died or were euthanized within 4 days after surgery.

Conclusions and Clinical Relevance—A condition clinically resembling abomasal volvulus but affecting the duodenal sigmoid flexure has been recognized in dairy cattle. When a focal, dorsal right-sided ping and succussion are present combined with severe hypokalemic, hypochloremic metabolic alkalosis and high bilirubin concentration, DSFV should be suspected, especially when there is a history of prior abomasal fixation. After surgical correction, the prognosis is fair to good.

Contributor Notes

Dr. Vogel's present address is MED Institute Inc, 1 Geddes Way, West Lafayette, IN.

Presented in abstract form at the 43rd Annual Conference of the American Association of Bovine Practitioners, Albuquerque, August 2010; and the American College of Veterinary Surgeons Symposium, Seattle, October 2010. Presented as a poster at the 26th World Buiatrics Congress, Santiago, Chile, November 2010.

Address correspondence to Dr. Vogel (svogel@medinst.com).