Case report of Traumatic Recticulo-peritonitis (TRP) or Hardware disease
in a cow operated encountered in Haa
Sangay Rinchen1, Basant Sharma2, Loden Jimba3, Norbu4, Sangay Dorji5,
Kuenga Tenzin6, Kelzang Dorji6, Rinchen Wangmo7
Introduction
Hardware disease is the alternate name given to traumatic reticuloperitonitis
wherein there is inflammation of reticulum due to trauma of various degrees
caused by the ingested foreign bodies especially the metallic objects. Since the
cause of traumatic reticuloperitonitis is at large incriminated to the metallic
objects, the case is thus commonly referred to as hardware disease. Depending
upon the degree/extend of the damage caused by the foreign body the
condition can be classified as traumatic reticulitis (where the foreign body
has just injured the reticular wall), traumatic reticuloperitonitis (the object
has pierced the reticular wall through and inflamed the peritoneum and even
further), traumatic reticulopericarditis (where the object has reached to the
pericardium causing inflammation). Thus the complication of the case depends
upon the direction and the characteristics of the foreign body ingested.
Such cases are at large encountered in the adult cattle though few in calves
and small ruminants. The case in our context may be high during the lean
seasons and in the animals dwelling the streets of markets wherein animals
resort to ingesting non conventional objects but in organized farms the cases
increases when the animals are feed green chopped fodders collected from the
fenced pastureland.
Current case
One such case was referred to the Regional Livestock Development centre,
Tsimasham by the livestock officials from the Haa Dzongkhag in a recently
calved cow.
Anamnesis
The case of traumatic reticuloperitonitis was referred wherein in then the
animal was already three months showing the signs of the TRP. The owner
bought the animal three months ago from an acquaintance residing in Haa
town. Though there was indication of swelling mass at the left ventro lateral
thoracic region, he didn’t pay heed considering it to be some fibrosed non
malign swelling. But soon through the indications of severe pain when
touched, the owner suspected it be some abscess and the case was referred to
the para veterinarian of the geog. It was for one long month the animal had
Veterinary officer, animal health specialist, Dzongkhag livestock officer, offtg. DVH in charge, Geog in chargeKatsho, Laboratory in charge, in charge- Sama geog, In charge- Eusu
been treated and dressed for the abscess and eventually when all the pus were
drained, the main causative factor, the handle of the spoon made its way out
piercing the muscles and the skin (fig.2).
The cow had calved very recently and the pressure of the gravid horn on the
gut could have been one precipitating factor for the same. The livestock health
officials then tried pulling out the spoon from the handle by extending the
aperture making incisions on the skin and the muscle but reticular wall
couldn’t be accessed thus the attempt was futile before referring the case to
RLDC, Tsimasham. While trying to pull the spoon from outside there was also
chances of spilling of the reticular or ruminal contents in the peritoneum as
shown by the animals with respiratory distress and emaciation. So the only
option recommended was exploratory diagnosis through ruminotomy.
Observation
The animal was active with normal feeding habits but was emaciated. Unlike in
most of the TRP where there is static gut motility, the case animal had
Diarrhoea. The rectal temperature was 100F and the palpabrel mucous
membrane was pale pink. There was slight increase in the rumen and reticular
motility. The animal showed slight tachycardia was no abnormal pulmonary
sounds on auscultation.
Fig 1. Emaciated animal
Fig. 2 The handle of the spoon
Veterinary officer, animal health specialist, Dzongkhag livestock officer, offtg. DVH in charge, Geog in chargeKatsho, Laboratory in charge, in charge- Sama geog, In charge- Eusu
Fig. 3. Trying to pull out from the Fig. 5 restrained for rumenotomy
opening
Surgical intervention
Restraint and anesthesia
The animal was restrained by local method wherein with the help of people, it
was grounded on right lateral recumbency by fastening all the limbs. The neck
was raised enough to ensure the complications of asphyxia and aspiration due
to regurgitation. The animal was given 0.7 ml of xylazine as a sedative dose and
the surgery was planned to be carried out under regional anesthesia by
blocking the nerves innervating flank region T13, L1 and L2 using
Furquharson’s technique of para vertebral nerve blocking. At each site 20 ml of
2% lignocaine HCL was injected, 10 ml deep aiming to block the ventral branch
of spinal nerve and then the needle was withdrawn slightly outward and
remaining 10 ml was injected to block the dorsal branch of the spinal nerve.
Around 8 ml of 2% lignocaine was injected subcutis in the projected line of
surgical incision.
Surgical site preparation
The area starting dorsally from 2-3 inches below the wings of the lumbar
vertebrae till 15 cm vertically down, behind the last rib and about 4 fingers
distance from the pin bone was cleaned and the hair were clipped and shaved.
The site was then disinfected using tincture iodine. The area of injecting local
anesthetic was also prepared by cleaning at the site of injection.
Rumenotomy and removal of the spoon
Veterinary officer, animal health specialist, Dzongkhag livestock officer, offtg. DVH in charge, Geog in chargeKatsho, Laboratory in charge, in charge- Sama geog, In charge- Eusu
About 15 cm long incision was
made on the skin using the BP
blade. The subcutis fats were at
the stage of gelatinization which
was separated using the scissors.
The three abdominal muscles viz.
external oblique muscle, internal
oblique
muscle
and
the
transverse
abdominalis
were
blunt dissected to avoid severing
any minute blood vessels and
subsequent bleeding. With the
nick on the peritoneum the
Figure 6 The local infiltration of Lignocaine HCL
abdominal cavity was accessed
and the part of dorsal rumen was exteriorized through the opening. About
10cm long incision was made on the rumen and the ends were fixed to the
rumen using a stay suture. Around 1/3rd of the rumen content was removed
along with which the team also removed a nylon rope measuring almost more
than one meter.
The location of the ridge separating the rumen and reticulum was done thus
getting accessed to the reticulum. The bowl of the spoon was found to be left in
the reticulum with small, around 10mm opening caused at the wall of the
reticulum. The spoon was slowly removed but though risky, nothing could be
done with that opening made by the penetrating handle of the spoon. However
the chance of healing was high since the opening was minute.
Closing of the surgical wound and post operative management
The rumen packing drapes was retrieved and the cut edges of the rumen was
washed using normal saline and debraded. The wound was opposed using
vicryl 2 in Lambert suture pattern after which the peritoneum was closed in
simple continuous fashion using cat gut size 2. The three layers of muscles
were opposed using vicryl 2 in the simple continuous pattern and finally the
skin was sutured using braided silk 3-0.
The heart rate and the respiratory rate of the animal were under constant
observation. The animal was under DNS infusion. The animal was given 10 ml
of Phenyl Butazone intramuscularly, OTC LA 20 ml intramuscularly, 8ml of
Chlorphenaramine maleate intramuscularly and 8 ml of B-complex injection
intramuscularly.
Veterinary officer, animal health specialist, Dzongkhag livestock officer, offtg. DVH in charge, Geog in chargeKatsho, Laboratory in charge, in charge- Sama geog, In charge- Eusu
Fig. 7 opening the abdomen
Fig. 8 Rumenotomy
Fig. 9 Closing of muscle
Fig. 10. The spoon retrieved from
reticulum
Differential diagnosis
The condition needs to be differentially diagnosed from diseases/ pathological
condition that may confuse the clinician in reaching to the final diagnosis.
Differential diagnoses should include conditions that can produce variable or
nonspecific GI signs, eg, indigestion, lymphosarcoma, or intestinal obstruction.
Abomasal displacement or volvulus should be ruled out by simultaneous
auscultation and percussion. Pleuritis or pericarditis of nontraumatic origin
produces signs similar to those associated with foreign body perforation.
Though traumatic reticulitis and traumatic reticuloperitonitis may be similar to
the condition and the approach of intervention is same, to be specific we may
need to differentially diagnose these conditions as well
Diagnosis
The diagnosis of TRP(Tarumatic Reticuloperitonitis) can be done through
history provided by owner supported by the signs of abdominal and thoracic
pain. In this case, the indications were clear with piercing handle of the spoon
Veterinary officer, animal health specialist, Dzongkhag livestock officer, offtg. DVH in charge, Geog in chargeKatsho, Laboratory in charge, in charge- Sama geog, In charge- Eusu
from the anatomical location of the reticulum and the movement of the handle
synchronized with the reticular motility. The differential leukocyte count
performed has indicated neutrophilia with shift to left.
Recommendations
The owner was asked not to free graze the animals thus reducing the risk of
such incidences. The owner was asked to keep the animal on restricted diet
with much of semisolid feed. The geog incharge of Katsho was advised to
continue the antibiotics course and monitor the post surgical health of the
animal.
Though the rumenotomy isn’t a major surgery, it would be even made easier by
the use of rumenotomy set, hence every veterinary hospitals or centres should
have such facilities.
The veterinarians across the country should find out a best general anesthetic
protocol for the large animals as this is one area where the field vets are found
to be fumbling. Hence, there is dire need in agreeing upon a safe GA protocol in
the large ruminants during one of the clinical conference backed by experiment
on the dummy animals.
TRP in many cases can be diagnosed by the clinical signs exhibited by the
animals but the extent of damage done and the planning of the type of
intervention to be made can be made only after the detail radiographic study.
Hence, with the government’s plan to boom the population of improved cattle in
the country, the equipping of the veterinary hospitals with improved diagnostic
and therapeutic instruments is much felt need.
Acknowledgement
The management of RLDC Tsimasham would like to thank Mr. Loden Jimba
DLO of Haa and his staffs for prompt action and referral of the case which
could save the life of the animal. The success of the operation was also due to
the dedicated and prompt operation led by Dr. Sangay Rinchen Veterinary
officer of RLDC Tsimasham and also due to the cooperation rendered by the
owner of the animal. We look forward for similar actions.
Veterinary officer, animal health specialist, Dzongkhag livestock officer, offtg. DVH in charge, Geog in chargeKatsho, Laboratory in charge, in charge- Sama geog, In charge- Eusu