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Image A

BACKGROUND

A 618 lb (281 kg), yearling, Ayrshire, heifer (young female), Tag 553 presents to your clinic with a 2 day history of abdominal pain (colic), scant smelly feces, partial anorexia and no urinations noted. The cow is the owner’s prize heifer and he will stop at nothing to save her life! The referring veterinarian gave mineral oil the previous day, but no improvement was noted, so she was referred in for further work-up. On presentation the heifer is mildly colicky, with a normal rectal temperature (101.7°F), tachycardia (80 bpm) and tachypnea (44 breaths/min). Mucus membrane color is pink and capillary refill time is 2-3 seconds (normal is < 2 sec). Right sided abdominal distention is noted on physical examination and there are no rumen contractions noted on auscultation. There is no "ping" on percussion of the abdomen. CBC showed a stress leukogram. Plasma biochemical panel showed hyperglycemia (141 mg/dl), hyponatremia (129 mmol/L), hypokalemia (2.4 mmol/L), and hypochloremia (85 mmol/L). Venous blood gases showed a severe metabolic alkalosis (pH 7.685, pCO2=57.3 mmHg, HCO3=68.5 mmol/L). Percutaneous ultrasonographic examination of the right cranial ventral abdomen (A) shows the above image (Image A).

Authors:

• Dr. Benjamin Buchanan

• Dr. Jerry Roberson

• Dr. Monique Hanrath

• Dr. Frank Andrews

1. What’s your diagnosis?

2. What other diagnostic tests would be helpful in determining the diagnosis?

3. What treatment(s) would be appropriate?

 

DIAGNOSIS

The Ultrasonographic image (A) of the right cranial ventral abdomen showed a target lesion consistent with a small intestinal intusseption. Rectal examination was not rewarding because of the position of lesion in the cranial abdomen. Because of the continued abdominal pain, scant feces, and ultrasound findings, an exploratory laparotomy was performed from an incision made in the right paralumbar fossa (considered an extension of the physical examination in cattle). The heifer was placed in left lateral recumbency. The proximal jejunum was exteriorized through the flank incision and a 3 foot long segment of proximal jejunum with edema was identified and resected. The abdomen was lavaged with a copious volume of sterile saline. Post-op, the heifer was treated with intravenous fluids (Normosol-R) with dextrose, KCl calcium, magnesium, flunixin meglamine (Banamine), and Excenel (Ceftiofur Sodium). The heifer was discharged with antibiotics and fly spray to prevent fly strike. The severe hypochloremic metabolic alkalosis slowly resolved and was normal 6 days post-op. The metabolic alkalosis was consistent with an abomasal outflow obstruction secondary to the proximal jejunal intusseption.

Image A:
Note the classic target lesion (yellow arrow) in the cranial abdomen
consistent with an intusseption of the small intestine (proximal jejunum).