Intas Polivet (2017) Vol.

18 (II): 352-354 Short Communication

Surgical Management of Intestinal Obstruction due to

Intraluminal Tumor in a Cow
S.T. Maruthi1, M.L. Bharath Kumar2 and G.N. Chethan3
Doddaballapura Milk Dairy
Bengaluru Urban, Rural and Ramanagara District
Co-Operative Milk Producers Societies Union Ltd. (BAMUL)
Dairy Circle, Doddaballapura
Dist. Bengaluru Rural - 561203 (Karnataka)

Abstract
A pregnant crossbred cow was presented with history of complete anorexia and absence of defecation for past one week.
Animal was showing restlessness, frequent sit-ups and kicking at belly. Clinical examination revealed animal was dull,
dehydrated with decreased ruminal motility. Per rectal examination revealed gas filled distended empty intestinal loops and
presence of mucus in rectum. Tentatively the condition was diagnosed as intestinal obstruction and exploratory right flank
laparotomy was performed. Laparotomy revealed intestinal adhesions and intraluminal tumor mass. Intestinal adhesions
were removed manually and tumorous mass was resected along with unviable intestinal lumen. Anastomosis was carried
out using polyglycolic acid in a single layer cushing inverting pattern. Routine post-operative care was provided and animal
had an uneventful recovery.
Keywords: Cow; intestinal obstruction; tumor

Introduction Most intestinal tumors are malignant. Intestinal

Intestinal obstruction represents an abdominal
emergency that is potentially life-threatening to
affected animals. Cattle are the most commonly
affected ruminants and diagnosis in sheep and goats
is rare (except for intestinal volvulus in lambs) (Kahn
and Line, 2010). Two common types of intestinal
obstruction that interrupt flow of ingesta have been
recognized in large ruminants as mechanical and
functional (Kahn and Line, 2010). Mechanical
intestinal obstruction occurs due to wide variety of
causes and is characterized as being luminal or
extraluminal. Luminal obstructions include
hemorrhagic jejunitis (jejunal occlusion with blood
clots), phytobezoars, cecocolic volvulus, impacted
ingesta and atresia coli, recti and ani. Extraluminal
mechanical obstructions include intussusception,
strangulation and volvulus of gastrointestinal tract
as well as intestinal compression with expanding
abdominal mass such as lymphosarcoma or fat
necrosis (Hussain et al., 2015). Functional intestinal
obstruction is mainly because of cessation of
peristalsis movement of intestinal tract or called
paralytic ileus.
1. Veterinary Officer and Corresponding author.
E-mail: maruthistvet@gmail.com
2. Veterinary Officer, Veterinary Dispensary, Kembalu
3. Veterinary Officer, Veterinary Hospital, Baragi
tumors may cause intramural or intraluminal
mechanical obstruction. They commonly invade the
muscular layer of intestinal wall where they
compromise the lumen diameter and reduce
distensibility. The proximal bowel distends with fluid
and gas and its function is compromised as with
foreign body obstruction. The disease usually is
advanced at the time of diagnosis and most
malignant tumors have metastasized. Malignant
tumors spread by local invasion (e.g., serosa,
mesentery, omentum, local lymph nodes) and distant
metastasis (i.e., lungs, liver, and spleen). The most
common small intestinal malignancies are
adenocarcinomas and lymphosarcomas. Other
small intestinal neoplasms are leiomyomas, leiomyo-
sarcomas, fibrosarcomas, mast cell tumors,
hemangiosarcomas, anaplastic sarcomas,
carcinoids, plasmacytomas, neurolemmomas,
adenomas and adenomatous polyps (Fossum et al.,
2014).
Materials and Methods
A two year old four month pregnant crossbred
Holstein Friesian cow was presented with the history
of complete anorexia and absence of defecation for
past seven days. Detailed history revealed that
animal was showing restlessness, frequent sit-ups
and kicking at belly signs, since the onset of the
condition. Clinical examination revealed animal was

352
 Maruthi et al.
Fig. 1: Animal prepared for right flank laparotomy
Fig. 3: Intraluminal intestinal tumor
dull, reduced body weight, dehydrated and
decreased ruminal motility. Per-rectal examination
revealed gas filled distended empty intestinal loops
and mucus in rectum. Tentatively, the condition was
diagnosed as intestinal obstruction and surgical
repair was resorted to. Animal was stabilized with
fluid therapy before anaesthesia and surgery.
Ceftriaxone (Intacefa) antibiotic was given at the rate
of 15 mg/kg b. wt. intravenously as a prophylactic
antibiotic, half an hour before surgery. Pre-emptive
analgesia was provided with Meloxicam (Melonexa)
@ 0.5 mg/kg b. wt. intraveneously. Distal para-
vertebral nerve block was performed to provide local
anaesthesia for right flank using 2% Lignocaine
hydrochloride (Loxb) local anesthetic solution and
also local infiltration of Lignocaine was done along
the site of incision.
The right flank was shaved and prepared aseptically
a - Brand of Intas Animal Health, Ahmedabad
b - Brand of Neon Laboratories Ltd., Mumbai
c - Brand of Sutures India Pvt. Ltd., Bengaluru
353
Fig. 2: Adhesions between intestinal loops
Fig. 4: Single layer inverted cushing
pattern suture technique
(Fig. 1). A 10-15 cm long linear incision was made
on right middle flank area. Skin, fascia, underlying
muscles and peritoneum were incised to expose the
abdomen. Hand was passed inside the abdomen to
check for abnormality and identified adhesions
between intestines and intestine to abdominal cavity
(Fig. 2). Slowly the adhesions were removed
manually without causing damage to intestinal wall
and then intestines were taken out of abdomen for
thorough examination. Hard mass was felt on
palpation of small intestine and enterotomy showed
presence of intraluminal tumor (Fig. 3). The tumor
mass was resected along with unviable intestinal
lumen and anastomosis was carried out using no.
2-0 polyglycolic acid (Truglydec) in a single layer of
continuous cushing inverted pattern (Fig. 4). The
peritoneum and muscle layers were sutured together
in a single continuous pattern using no. 2 Polyglycolic
acid and subcuticular suturing was done with No. 2-
0 polyglycolic acid. The skin was sutured with no. 2
nylon in a simple interrupted pattern. Routine post-
operative care was provided for five days with
 Intraluminal tumor in cow
Ceftriaxone @ 15 mg/kg b. wt. intravenously twice
daily and Meloxicam @ 0.3 mg/kg b. wt.
subcutaneously once daily. Post-operatively, fluid
therapy was given for three days and then advised
to start semi-solid diet for one week followed by
regular diet. The skin sutures were removed on tenth
post-operative day.
Results and Discussion
Intestinal obstructions due to neoplasms are less
likely to be reported as compared to other
mechanical obstructions. Tentative diagnosis of the
condition was made based on history and clinical
symptoms. Most common features of intestinal
obstructions are loss of appetite, weight loss, clinical
signs of pain like kicking at belly, frequent sits and
ups and restlessness, reduced faecal output with or
without mucus finally leads to complete cessation
and distended gas filled empty intestinal loops.
Ultrasonography is an essential tool for diagnosis of
several abdominal disorders (Braun, 2003).
However, diagnostic radiology specifically contrast
radiography helps in diagnosis of intestinal problems.
The goal of treatment was to remove the intestinal
obstruction and promptly restore enteric nutrition. In
small intestinal obstruction, the secretion of fluid into
intestinal lumen increases and absorption of
intraluminal fluid and electrolytes decreases. This
leads to reduction in intravascular fluid volume,
which results in dehydration. If dehydration is left
untreated, it can result in hypovolemic shock. Animals
with mechanical obstruction are at risk for
hypokalemia, hyponatremia, hypochloremia,
metabolic acidosis and metabolic alkalosis (Mishra
et al., 1974). Treatment should consists of
intravenous infusion of balanced electrolyte
solutions and correction of severe acid base and
electrolyte abnormalities (Ellison, 1990). Intestinal
viability is commonly assessed by clinical parameter
such as peristalsis, vascular pulsations and intestinal
color (pink vs blue, black, or gray). If viability is
questionable, only healthy bowel should be included
in anastomosis. In the present case, there was no
pulsation near the tumor mass and colour was black,
hence it was decided for intestinal resection and
anastomosis. Submucosal apposition is most
important while considering intestinal anastomosis
since it is recognized as strongest part of intestinal
wall. Submucosal apposition is poorer with two layer
354
closure than with single layer closure. Two layer
closures also result in avascular necrosis of inverted
cuff of tissue, which prolongs lag phase of wound
healing and increased intraluminal protrusion of
inverted tissues, making animal more susceptible to
obstruction (Jansen et al., 1981). Inverting sutures
initially results in greater narrowing of intestinal
lumen and everting pattern are more likely to cause
adhesion, approximating suture patterns
theoretically avoid these potential complications.
Omentalization of anastomosis part helps in faster
healing and reducing post-operative complications.
Omentum has extensive vascular and lymphatic
supply and exhibits angiogenic, immunogenic and
adhesive properties that assist in restoring blood
supply, controlling infection and stabling lymphatic
drainage (Hosgood, 1990).
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