Left displacement of the abomasum

(LDA)
LDA, what is it?

 Condition affecting high producing dairy cows

 A displacement of the abomasum from the right
abdominal floor to the left dorsolateral abdomen
between the rumen and right abdominal wall
 A majority of cases (80%) occur within the first month
of lactation
Predisposing factors

 High grain feeding in the late dry period and early

post partum period
 Pregnancy and parturition
 Hypocalcemia
 Post partum conditions such as fatty liver, acute
mastitis, metritis
 Normal location of the abomasum

Right side of a cow

Left side of a cow

Pathophysiology

 Relate to predisposing factors

 Pathophysiology

 With progression of pregnancy, the enlarging uterus descends into

the abdomen
 Craniodorsal displacement of rumen, leaving a gap through which
the pyloric end of the abomasum slips to the left abdominal floor
 After parturition, uterine ascent and ruminal descent occur,
leaving the abomasum trapped on the left
Pathophysiology ctd

 In cows with hypocalcemia, there is reduced abomasal

contractility, leading to delayed emptying and
subsequent distension with ingesta and fluid-
displacement
 High grain diet leads to excessive production of VFAs->
on reaching the abomasum->inhibit motility->atony,
distention with ingesta and gas->displacement
Clinical signs

 In most cases vitals are normal

 The first sign is a sudden drop in milk production and
anorexia
 There may be soft stool or diarrhoea
 13th rib elevated
 Dehydration
Differential diagnosis

 RDA
 Ruminal tympany
 Ketosis
 Vagal indigestion
 TRP
 Hypocalcaemia
 Diagnosis

 History and clinical signs

 Simultaneous auscultation and percussion over the 9th-13th
ribs and on the left paralumbar fossa yields a high pitched
metallic pinging sound
 Fluid aspirate from the area->pH<5 and absence of
protozoa suggestive of abomasal fluid
 Treatment

Aims
 Return abomasum to its normal anatomical position
 Create a permanent attachment
 Correct electrolyte, acid-base and hydration deficits
 Treat other concurrent/ predisposing disease
 Non surgical management

Rolling the cow

• Tie up the cow and place in left lateral recumbency
• Roll rapidly over to right lateral recumbency, then slowly
return to left recumbency and allow the cow to stand up
• Only moderate success, high rate of recurrence
Surgical management

 Presurgical considerations, starve for 24hrs

 Surgical techniques
- Left Flank Abomasopexy
-Right Flank Omentopexy
-Ventral Paramedian Abomasopexy
 Left flank abomasopexy

 Restrain cow in crush

 The left paralumbar fossa area is shaved and then scrubbed
using dilute betadine solution
 Perform a line block using 2% lignocaine hydrochloride
 An incision of about 20cm is made on the paralumbar fossa
 Displaced abomasum is easily identified between the body wall
and the rumen
Abomasopexy ctd

 The abomasum can then be pulled to the surgical window and

deflated
 Nylon suture material (1/0) is then threaded into the
subserosa of the greater curvature of the abomasum leaving
two free long ends abt 1m long
 Abomasopexy ctd

 Return abomasum to right ventral abdomen

 The cranial free end of the nylon is threaded through the
eye of the gerlac needle and passed into the abdominal
cavity and brought to the ventral surface of the abdominal
wall
 The needle is stabbed through the abdominal wall a hand’s
breadth caudal to the xyphoid process.
Abomasopexy ctd

 The remaining caudal free end is placed 5cm caudal to the

first one.
 Repositioning of the abomasum can be done manually and
by traction of the suture
 Sutures are then tied together to fix the abomasum in its
proper position.
 Intraoperative antibiosis must be done to prevent
peritonitis
 Abomasopexy ctd

 The peritoneum, transverse abdominis, internal abdominal

oblique and external abdominal oblique muscles are closed
using simple interrupted pattern with absorbable suture
material
 The skin is then closed using non absorbable nylon(0/0)
and a small opening left at the ventral end of the wound for
drainage
Post operative care

 Spray suture line with Exit

 Provide adequate fresh feed and water
Post op complications

 Recurrence
 Suture line abscessation
 Myasis
 Infection
 Peritonotis
PREVENTION

 Ensuring a rapid increase in rumen volume

following calving
 Avoid rapid dietary changes
 Avoid negative energy balance prepartum
 Maximize dry matter intake in late pregnancy
 Prevention of asstd post partum conditions
 References

 Cunningham J.G(2002) Textbook of Veterinary Physiology: 3rd

editin,W.B Saunders Company, Philadelphia
 Latimer et al (2003) Veterinary Laboratory Medicine: Clinical
pathology: 4th edition, Iowa State Press
 Radostitis et al Veterinary Medicine (A textbook of the diseases of
cattle,sheep,goats,pigs and horses):10th Edition, Saunders,
Elisever.
 Smith B.P(2002) Large Animal Internal Medicine: 3rd
Edition,Mosby,St Louis