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ILMU BEDAH KHUSUS VETERINER

TEKNIK OPERASI GASTROTOMY DAN RUMENOTOMY

OLEH :

KELOMPOK 4 D

I Made Gede Wijaya Kusuma 1809511107

Ida Bagus Ketut Indra Permana 1809511108

I Komang Aswin Nurcahya 1809511109

Made Ade Pranatawan 1809511110

Sheren 1809511113

FAKULTAS KEDOKTERAN HEWAN

UNIVERSITAS UDAYANA

DENPASAR

2021

i
KATA PENGANTAR

Puji syukur kehadirat Tuhan Yang Maha kuasa karena telah memberikan kesempatan pada
penulis untuk menyelesaikan paper ini. Atas rahmat dan hidayah-Nya lah penulis dapat
menyelesaikan paper yang berjudul “TEKNIK OPERASI GASTROTOMY DAN
RUMENOTOMY” tepat waktu. Paper disusun guna memenuhi tugas mata kuliah Ilmu Bedah
Khusus Veteriner. Selain itu, penulis juga berharap agar paper ini dapat menambah wawasan bagi
pembaca.

Penulis mengucapkan terima kasih sebesar-besarnya kepada dosen pengampu mata kuliah
Ilmu Bedah Khusus Veteriner. Tugas yang telah diberikan ini dapat menambah pengetahuan dan
wawasan terkait bidang yang ditekuni penulis. Penulis juga mengucapkan terima kasih pada
semua pihak yang telah membantu proses penyusunan paper ini.

Penulis menyadari paper ini masih jauh dari kata sempurna. Oleh karena itu, kritik dan
saran yang membangun akan penulis terima demi kesempurnaan paper ini.

Denpasar, 01 Oktober 2021

Hormat Kami

Penulis

ii
DAFTAR ISI

KATA PENGANTAR ................................................................................................................... ii

DAFTAR ISI ................................................................................................................................. iii

DAFTAR GAMBAR .................................................................................................................... iv

BAB I ..............................................................................................................................................1

PENDAHULUAN ..........................................................................................................................1
1.1 Latar Belakang .................................................................................................................1
1.2 Rumusan Masalah ............................................................................................................1
1.3 Tujuan Penulisan ..............................................................................................................2
1.4 Manfaat Penulisan ............................................................................................................2

BAB II .............................................................................................................................................3

PEMBAHASAN .............................................................................................................................3
2.1 Terminologi Gastrotomy dan Rumenotomy ....................................................................3
2.2 Indikasi Gastrotomy dan Rumenotomy............................................................................3
2.3 Pre Operasi dan Anestesi Gastrotomy dan Rumenotomy ................................................3
2.4 Teknik Operasi Gastrotomy dan Rumenotomy ................................................................6
2.5 Pasca Operasi Gastrotomy dan Rumenotomy ................................................................10

BAB III .......................................................................................................................................122

PENUTUP...................................................................................................................................122
3.1 Kesimpulan...................................................................................................................122
3.2 Saran ...............................................................................................................................12

DAFTAR PUSTAKA ...................................................................................................................13

iii
DAFTAR GAMBAR

Gambar 1. Gerakan melingkar pada tahap wipe suds. ..................................................................5

Gambar 2. Restrain fisikal dan preparasi aseptic pada sapi. .........................................................5

Gambar 3. Penjepitan gastro dengan hemostat. ............................................................................6

Gambar 4. Insisi di daerah penjepitan gastro. ...............................................................................6

Gambar 5. Pengangkatan lipoma...................................................................................................7

Gambar 6. Penjahitan bagian mukosa lambung dengan tipe jahitan menerus sederhana (kiri). ...7

Gambar 7. Penjahitan bagian submukosa, muskularis, dan serosa dengan tipe jahitan cushing
(kanan). ...........................................................................................................................................7

Gambar 8. Restrain menggunakan tali ..........................................................................................8

Gambar 9. Insisi pada flank bagian kiri ........................................................................................9

Gambar 10. Benda asing yang terdapat pada rumen .....................................................................9

Gambar 11. Post operasi rumenotomy ........................................................................................10

iv
BAB I
PENDAHULUAN
1.1 Latar Belakang

Anjing dan kucing merupakan hewan kesayangan yang banyak digemari oleh
masyarakat. Banyak diantara hewan kesayangan tersebut mengalami gangguan penyakit
sehingga harus menjalani pembedahan. Salah satunya pembedahan di saluran pencernaan
seperti pada gastrium. Gastrium merupakan bagian dari alat pencernaan pada hewan non
ruminansia. Pada kucing dan anjing terletak pada sisi kiri linea alba cranial abdominal,
dibelakang diafragma dan hepar. Letaknya bervariasi tergantung dari jumlah isi gastrium.
Kasus gastrointestinal pada hewan kesayangan (kucing dan anjing) yang mengharuskan
dilakukannya gastrotomy adalah kasus foreign body removal (pengangkatan benda asing)
yang sering ditemukan pada hewan di bawah umur 2 tahun.
Sementara pada ruminansia, kejadian tertelannya benda asing sangat umum terjadi
terutama di negara berkembang, di mana standar pemeliharaan hewan kurang bagus, dan
status gizi rendah memaksa mereka untuk mengais makanan di TPA yang beresiko bagi
system pencernaan mereka. Ruminansia sering menelan benda tidak beraturan dengan
potensi risiko kerusakan rumeno-reticular. Benda asing non-logam, benda asing plastik,
tali, dan potongan pakaian bekas biasanya tertelan oleh ternak dan terakumulasi dalam
retikulorumen sehingga menimbulkan berbagai penyakit pada rumen mereka.
Tindakan yang dapat di lakukan untuk kasus seperti diatas pada gastrium dan
rumen adalah gastrotomy dan rumenotomy. Gastrotomy dilakukan ada hewan non
ruminansia, sedangkan hewan ruminansia misalnya pada sapi dilakukan Rumenotomy
yaitu prosedur rutin untuk banyak penyakit pada sapi. Dalam paper ini akan dibahas lebih
lanjut mengenai terminologi, indikasi, persiapan praoperasi serta anastesi, teknik operasi,
dan perawatan pascaoperasi dari gastrotomy dan rumenotomy.

1.2 Rumusan Masalah

1. Bagaimana terminologi dari operasi gastrotomy dan rumenotomy ?


2. Bagaimana indikasai dari operasi gastrotomy dan rumenotomy ?
3. Bagaimana persiapan praoperasi dan anestesi yang digunakan pada operasi
gastrotomy dan rumenotomy ?
4. Bagaimana teknik operasi gastrotomy dan rumenotomy ?
5. Bagaimana perawatan pascaoperasi gastrotomy dan rumenotomy ?

1
1.3 Tujuan Penulisan

1. Bagaimana terminologi dari operasi gastrotomy dan rumenotomy ?


2. Bagaimana indikasi dari operasi gastrotomy dan rumenotomy ?
3. Bagaimana persiapan praoperasi dan anestesi yang digunakan pada operasi
gastrotomy dan rumenotomy ?
4. Bagaimana teknik operasi gastrotomy dan rumenotomy ?
5. Bagaimana perawatan pascaoperasi gastrotomy dan rumenotomy ?

1.4 Manfaat Penulisan

Setelah membaca paper ini diharapkan bisa menambah pengetahuan mahasiswa


mengenai terminologi, indikasi, persiapan praoperasi serta anastesi, teknik operasi, dan
perawatan pascaoperasi dari gastrotomy dan rumenotomy.

2
BAB II
PEMBAHASAN

2.1 Terminologi Gastrotomy dan Rumenotomy


Gastrotomy adalah tindakan pembedahan dengan melakukan insisi pada dinding
lambung sehingga lumen akan terlihat. Sedangkan rumenotomy adalah tindakan pembedahan
pada hewan ruminansia dengan membedah dinding abdomen sehingga rumen akan terlihat.

2.2 Indikasi Gastrotomy dan Rumenotomy


Gastrotomy adalah operasi membuka gastrium atau dinding lambung yang dilakukan
untuk mengambil benda asing, inspeksi mukosa gastrium terhadap kemungkinan ulcer,
neoplasma atau hipertropi dan untuk mengambil spesimen biopsi, untuk mengurangi tekanan
akibat gastrium terlalu berdilatasi, distensi lambung serta penyempitan pylorus. Sedangkan
indikasi untuk operasi pada rumen meliputi trauma reticuloperitonitis, adanya benda asing di
rumen, frothy bloat, vagal indigesti, kelebihan gandum (grain overload), toxin ingestion dan
chronic reoccuring bloat. Rumenotomi juga telah digunakan untuk mengurangi pengisian
rumen untuk membantu operasi perut seperti operasi caesar.

2.3 Pre Operasi dan Anestesi Gastrotomy dan Rumenotomy


a. Persiapan Ruang Operasi
Ruang operasi dan meja operasi didesinfeksi menggunnakan KMnO4 5% cair
dicampur dengan formalin 10% dengan perbandingan 1:2 dibiarkan selama 15 menit.
b. Persiapan Peralatan dan Bahan Operasi
Dalam pak instrumen operasi biasanya terdapat kain kasa, scalpel, gunting, thumb
forcep. Needle holder, carmalt, hemostatic forcep, mosquito forcep, towel clamp, dan
forceps pons. Peralatan lain yang dibutuhkan adalah meja operasi spuit, thermometer, meja
operasi dan stetoskop.
Bahan yang perlu disiapkan adalah alcohol 70% atau 99%, Povidone Iodine,
Chlorhexidine, benang jahit absorbable dan non absorbable, dan infus.
c. Persiapan Obat
a) Gastrotomy
Jika hewan mengalami mual dapat diberikan diazepam (0.2 mg/kg IV) atau
midazolam (0.2 mg/kg IV, IM). Obat-obatan yang digunakan untuk menginduksi

3
hewan adalah Propofol (2-4 mg/kg IV), alfaxalone (2-3 mg/kg IV), atau jika hewan
tidak diberikan premedikasi dapat menggunakan ketamine (5 mg/kg IV ditambah
diazepam atau midazolam).
b) Rumenotomy
5 ml lidocaine disetiap rongga paravertebral (lidocaine hydrochloride 2%)
dengan syringe berjarum 18 Gauge 10 cm untuk mengdesensitasi area flank,
muskulus abdominal, dan menghilangkan rasa sakit selama prosedur. Jarum
dimasukan setengah diantara prosesus transvers intervertebral dan dimiringkan
sedikit agar lidocaine dapat masuk kedalam rongga subarachnoid. 2 infiltrasi linear
menggunakan anestesi lidocaine sebanyak 60 ml pada lokasi insisi dan tunggu 10
menit.
d. Persiapan Operator
Operator harus berkompeten dalam melakukan operasi agar prosedur berjalan lancar
dan baik. Sebelum melakukan operasi, aksesoris harus dilepaskan semua, dan opperatpr
harus steril. Lakukan pembersihan diri dengan mencuci tangan dengan sabun antiseptic
dan larutan alcohol secara terhadap. Gunakan APD (alat perlindungan diri) lengkap seperti
glove, masker dan penutup kepala.
e. Persiapan Pasien
a) Gastrotomy
Dehidrasi, ketidakseimbangan asam-basa, dan gangguan elektrolit harus
diperbaiki terlebih dahulu. Lalu hewan dipuasakan selama 4-48 jam sebelum
operasi (umumnya 12 jam, pada hewan muda 4-6 jam agar mencegah
hipoglicemia). Pencukuran bagian abdomen hewan akan mempermudah persiapan
operasi.
Persiapan lokasi inisial insisi dilakukan dalam 4 tahap, yaitu:
1. Soap Scrub: secara mekanik membersihkan minyak dan kotoran dan
mengurangi flora bakteri pada kulit dengan sabun yang bahan utamanya
chlorehixidine atau povidone-iodophor.
2. Wipe Suds: pergerakan melingkar dari dalam hingga luar denngan swab iodin
atau alcohol.
3. Alcohol: membersihkan area dengan kain kasa dibasahi isopropyl alcohol.
4. Disinfectant: membersihkan area dengan disinfektas untuk membunuh bakteri
lebih lanjut.

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Gambar 1. Gerakan melingkar pada tahap wipe suds.
b) Rumenotomy
Pada rumenotomy, hewan diberi antibiotic selama 3 hari dan terapi cairan
(5% dextrose dan 0.9% NaCl IV) untuk mengkoreksi status dehidrasi. Setelah itu,
hewan direstrain dengan kombinasi restrain fisikal (dengan tali) dan retrain kimia
(detomodone hydrochloride 20 µg/kg IV). Permukaan kulit pada paralumbar kiri
dicukur dan dibersihkan secara aseptic dengan air, sabun dan solusi antiseptic
(Cetrimide 3% dan Chlorhisxidine gluconate 0.5%). Lalu, area digosok dengan
solusi povidone iodine 1% untuk mengurangi tingkat microbial dan diamkan
hingga kering.

Gambar 2. Restrain fisikal dan preparasi aseptic pada sapi.

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2.4 Teknik Operasi Gastrotomy dan Rumenotomy
2.4.1 Teknik Operasi Gastrotomy
Setelah hewan diberikan anestesi umum dan ditempatkan pada posisi dorsal recumbency.
Lakukan hal pencukuran rambut pada site operasi yaitu bagian ventral abdomen
dilanjutkan pemberian iodeine. (Sudisma. 2006)
1) Setelah itu melakukan incisi kulit pada ventral midline abdominal dari thipoid
sampai pubis. Incisi dilanjutkan pada linea alba dan peritonium sehingga rongga
abdominal terbuka.
2) Dinding abdominal dikuakkan dengan retraktor sehingga gastrointestinal terlihat.
Lambung dikeluarkan dengan membuat jahitan stay suture yang bertujuan untuk
memegang dinding lambung.

Gambar 3. Penjepitan gastro dengan hemostat


3) Selanjutnya insisi dilakukan pada daerah curvatura mayor didinding gastrium karena
sedikit terdapat pembuluh darah. Icisi dibuat agar tidak dekat dengan pilorus dan
incisi dilebarkan dengan gunting.

Gambar 4. Insisi di daerah penjepitan gastro (Tobias, 2010; Fossum, 2013)


4) Setelah dilakukan tindakan pada lambung (mengeluarkan benda asing, biopsi),
segera dilakukan penutupan pada serosa muskularis, dan submukosa sebagai lapis
pertama dengan pola jahitan cushing atau simple interrupted selanjutnya dijahit
dengan pola lembert atau cushing.

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Gambar 5. Pengangkatan lipoma
(sumber:https://www.academia.edu/37901573/teknik_operasi_gastrotomy.pdf
diakses pada tanggal 3 Oktober 2021)

Gambar 6. Penjahitan bagian mukosa lambung dengan tipe jahitan menerus


sederhana (kiri) (sumber: (Tobias, 2010; Fossum, 2013)

Gambar 7. Penjahitan bagian submukosa, muskularis, dan serosa dengan tipe


jahitan cushing (kanan). (sumber: (Tobias, 2010; Fossum, 2013)
5) Lambung dimasukkan ke dalam rongga perut dan dilakukan penutupan dinding perut.
Pada bagian peritonium, linea alba, dan subkutan dijahit dengan benang absorbable
serta kulit dijahit dengan benang nonabsorbable.
6) Perawatan pasca operasi, hewan jangan diberi makan dan minum. Diberikan infus
secara intravena, antibiotika secara intravena dan oral. Setelah 24 jam dapat
diberikan makanan ringan (pakan bayi)

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2.4.2 Teknik Operasi Rumenotomy
Sebelum dilakukan operasi, hewan dipuasakan makan selama 12 jam dan puasa minum
selama 6 jam. Tujuan dari puasa ini adalah untuk pengosongan lambung supaya tidak
mendesak diafragma selama operasi sehingga tidak terjadi muntah.
1) Hewan yang telah dipersiapkan kemudian diletakkan diatas meja operasi dan
direstrain. Operasi dilakukan pada flank kiri. Sebelum operasi dilakukan, bagian
yang akan dioperasi dicukur (daerah flank), setelah itu diolesi iodine ( PVP 10%).
(Benchohra Mokhtar. 2017).

Gambar 8. Restrain menggunakan tali (sumber: Haben Fesseha 2020)


2) Persiapan alat – alat operasi juga dilakukan. Perbedaan alat yang dipakai adalah
pemakaian shroud atau plastik untuk rumen. Setelah itu baru hewan diberi cairan
anastesi. Anastesi yang dapat diberikan dengan cara line block, inverted block, atau
paravertebral block.
3) Pada kasus rumenotomy biasanya anastesika diberikan secara regional dengan
menggunakan teknik paravertebral block dan L – block. Anastesi ini dimaksudkan
untuk mematikan rasa di daerah flank.
4) Anastetika yang digunakan adalah Lidocain HCl. Pemberian Lidocaine HCL
dilakukan menggunakan metode farqurhason dengan processus transversus sebagai
penanda.
5) Tiap tempat diberikan injeksi Lidocaine HCl sebanyak 20 ml. Setelah sekitar 5 – 10
menit kemudian, dilakukan tes untuk mengetahui apakah daerah operasi sudah
teranastesi sempuna atau belum, dengan menggunakan Allis forceps dilakukan
jepitan – jepitan daerah yang dianastesi tersebut.

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6) Setelah hewan teranastesi, dilakukan incisi sepanjang 12 cm pada kulit dimulai dari
kira – kira 10 cm di bawah prosesus transversus dari vertebrae lumbaris pertengahan
flank.

Gambar 9. Insisi pada flank bagian kiri (sumber: Haben Fesseha 2020)
7) Struktur lain dari dinding abdomen yang harus dihindari saat insisi adalah nervus dan
pembuluh darah. Jika ada pembuluh darah harus di ligasi terlebih dahulu. Rumen
ditarik ke luar dengan bantuan allies forcep atau dua buah jahitan yang kuat.
8) Incisi rumen dibuat diantara kedua jahitan setelah cavum abdomen ditutup. Setelah
rumen dibuka dimasukkan rumen shroud untuk mencegah kontaminasi kemudian isi
rumen dikeluarkan sehingga rumen dapat dieksplorasi untuk mencari benda asing.

Gambar 10. Benda asing yang terdapat pada rumen (sumber: Haben Fesseha 2020)
9) Tepi rumen yang diincisi dibersihkan dan dijahit dengan tipe jahitan Simple
continnue dilanjutkan dengan tipe jahitan continous lambert dengan menggunakan
benang catgut chromic
10) Peritoneum dan muskulus dijahit secara terpisah dengan tipe jahitan Simple
Inerrupted menggunakan benang catgut chromic. Sub kutan dijahit dengan pola
jahitan sederhana menerus menggunakan benang catgut plain. Kulit dijahit dengan
tipe jahitan Simple Inerrupted menggunakan benang katun.

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Gambar 11. Post operasi rumenotomy

2.5 Pasca Operasi Gastrotomy dan Rumenotomy


2.5.1 Pasca Operasi Gastrotomy
Selama hewan masih teranastesi, dilakukan infus RD 5 % untuk mengganti cairan
yang hilang dan untuk koreksi keseimbangan elektrolit secara intravena. Luka bekas
operasi diolesi salep bioplasenton. Segera setelah penutupan dinding abdomen dilakukan
penyuntikan Ampicillin 10 % dengan dosis 10-20 mg/kg BB secara intramuskuler untuk
menghindari adanya infeksi sekunder. Setelah hewan dioperasi ditempatkan pada tempat
yang kering dan bersih, luka operasi dijaga kebersihannya dan pemeriksaan dilakukan
selama 4 – 6 hari berturut – turut. Penggantian penutup luka atau perban dilakukan 3 hari
sekali. Sebelumnya luka dibersihkan menggunakan NaCl steril dan diolesi dengan salep
Bonti, kemudian ditutup menggunakan kassa steril dan Hypafix®. Jahitan dapat dibuka
setelah luka operasi benar-benar kering dan sembuh serta telah tertutup, kemudian diolesi
kembali iodiun tinkture 3%.
Pengamatan post operasi dilakukan setiap hari meliputi pemeriksaan Suhu, Heart
Rate, Respiration Rate, Mucosa, Capillary Rafille Time, Turgor, Appetite, Urinasi,
Defekasi dan Vomit. Untuk mencegah keadaan hipotermi dapat dilakukan dengan
menggunakan lampu penghangat, selimut atau infus yang dihangatkan. Perawatan post
operasi meliputi pemberian cairan RL secara intravena selama 14-24 jam. Hewan
dipuasakan terlebih dahulu selama 14-24 jam untuk mengistirahatkan lambung. Jika
hewan tiddak muntah atau mual, hewan dapat diberikan pakan wet food selama 7 hari
untuk mengurangi kerja gastrium.

10
Selama pemulihan pasca operasi, kepala hewan sebaiknya dijaga agar tetap lebih
tinggi dari badan untuk mengurangi refluks lambung. Pemberian obat-obatan post
operasi meliputi antibiotik amoxycilin dan ketoprofen secara oral. Evaluasi hematokrit
perlu dilakukan jika terjadi hematomesis, pucat, anemia atau melena yang signifikan.
Muntah atau mual muntah pasca operasi dapat terjadi akibat ileus, kelainan elektrolit
(terutama hipomagnesemia), nyeri, maupun iritasi lambung. Terapi yang dapat diberikan
termasuk pmberian cairan intravena, gastroprotektan (sucralfate), penghambat asam
lambung (misalnya, omeprazol atau famotidin), obat peningkat motilitas untuk ileus
(misalnya, metoclopramide), atau antiemetik (misalnya, klorpromazin, ondansetron,
dolasetron, atau maropitan). Pemberian analgesik dan antibiotik juga juga diperlukan
untuk mengurangi rasa nyeri pasca operasi serta mencegah infeksi bakteri.
2.5.2 Pasca Operasi Rumenotomy
Lakukan monitoring terhadap denyut jantung, pernafasan dan temperatur tubuh
serta memberikan nutrisi yang baik untuk memudahkan penyembuhan luka. Pada pasca
operasi, pencucian antiseptik pada daerah sayatan dilakukan pada hari kedua dan ketiga
pasca operasi hingga empat belas hari sampai benar-benar sembuh. Jahitan dilepas
setelah 14 hari.
Terapi pasca operasi lain yang diberikan adalah injeksi ampicilin 1,6 ml. Injeksi
diberikan secara intramuskuler 2 kali sehari. Pengobatan antibiotik ditujukan untuk
mencegah terjadinya infeksi baik yang diakibatkan oleh kurang terjaganya sterilitas
operasi maupun akibat masuknya agen penyakit atau bakteri melalui celah luka pada saat
proses penyembuhan. Ampicillin merupakan salah satu obat semi sintetik Penicillin yang
paling penting, mempunyai aktifitas bakterisid, merupakan antibiotik berspektrum luas,
dan aktif melawan sejumlah besar organisme gram positif dan negatif. Ampicillin bekerja
dengan cara menghambat sintesa dinding sel bakteri. Ampicillin didistribusikan ke
seluruh jaringan tubuh dan terpusat dalam hati dan ginjal. Dosis Ampicillin pada domba
10-20 mg/kg BB secara per oral, dan 5-10 mg/kg BB secara parenteral. Selain itu, dapat
diberi terapi cairan (larutan Dextrose 5%, 1000ml stat, IV) antibiotik (Ceftriaxone,
5gm/kg, IV), dan Meloxicam (0,5mg/kg, IM) selama lima hari berturut-turut. Semprotan
luka tetrasiklin juga diterapkan di sekitar luka.

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BAB III
PENUTUP

3.1 Kesimpulan
Gastrotomy adalah tindakan pembedahan dengan melakukan insisi pada dinding
lambung sehingga lumen akan terlihat. Sedangkan rumenotomy adalah tindakan
pembedahan pada hewan ruminansia dengan membedah dinding abdomen sehingga
rumen akan terlihat. Gastrotomy dan rumenotomy paling sering dilakukan untuk
mengambil benda asing di lambung. Selain itu tindakan ini juga diindikasikan untuk
inspeksi mukosa gastrium terhadap kemungkinan ulcer, neoplasma atau hipertropi dan
untuk mengambil spesimen biopsy. Tindakan preoperasi yang dilakukan adalah persiapan
ruang dan alat operasi, persiapan obat, operator dan pasien. Gastrotomy dilakukan pada
posisi dorsal recumbency dengan site operasi yaitu bagian ventral abdomen, sedangkan
rumenotomy dilakukan pada flank kiri. Perawatan pasca operasi yang dilakukan yaitu
pemberian infus secara intravena, serta antibiotika secara intravena dan oral.

3.2 Saran
Saran kepada mahasiswa FKH: karena literature yang sangat sedikit, diharapkan
mencari tahu lagi tentang teknik operasi ini agar dimasa depan dapat membantu. Saran
kepada masyarakat: agar tidak menyepelekan keadaan seperti hewan yang memakan
benda asing dan langsung menghubungi dokter hewan untuk dilakukan penanganan yang
tepat.

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DAFTAR PUSTAKA

Brisson, B. 2011. http://www.vetsurgeryonline.com/skin-preparation. Diakses pada tsnggal 03


Oktober 2021.

Fesseha, H. (2020). Rumenotomy due to Metallic Foreign Bodies in Rumen of Adult Dairy Cow.
Biomedical Journal of Scientific & Technical Research, 27(3), 20824-20827.

Fossum, Theresa W. 2013. Small Animal Surgery. 4th Edition. Missouri: Elsevier Mosby Inc.

Niehaus, A. J. (2008). Rumenotomy. Veterinary Clinics of North America: Food Animal Practice,
24(2), 341-347.

RV, S. K., Sankar, P., Kokila, S., Ravikumar, P., & Veena, P. (2011). Gastrotomy for Retrieval
of Thoracic Oesophageal Foriegn Body Using Long Forceps Technique in Three Dogs.
Journal of Advanced Veterinary Research, 1(2), 74-75.

Sudisma, I.G.N. 2006. Ilmu Bedah Veteriner dan Teknik Operasi. Bali : Udayana

Tobias, Karen M. 2010. Manual of Small Animal Soft Tissue Surgery. 1st Edition. Iowa: Wiley
Blackwell Pub

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TEKNIK OPERASI
GASTROTOMY DAN
RUMENOTOMY
ILMU BEDAH KHUSUS VETERINER
KELOMPOK 4 – KELAS D
ANGGOTA KELOMPOK

I Made Gede Wijaya Kusuma 1809511107

Ida Bagus Ketut Indra Permana 1809511108

I Komang Aswin Nurcahya 1809511109

Made Ade Pranatawan 1809511110

Sheren 1809511113
TERMINOLOGI

 Gastrotomy adalah tindakan pembedahan dengan melakukan


insisi pada dinding lambung sehingga lumen akan terlihat.
 Sedangkan rumenotomy adalah tindakan pembedahan pada
hewan ruminansia dengan membedah dinding abdomen
sehingga rumen akan terlihat.
INDIKASI

 Gastrotomy :
 Rumenotomy :
- untuk mengambil benda asing,
- trauma reticuloperitonitis,
- inspeksi mukosa gastrium terhadap
kemungkinan ulcer, - adanya benda asing di rumen,

- neoplasma atau hipertropi - frothy bloat,

- untuk mengambil spesimen biopsy - vagal indigesti,


- untuk mengurangi tekanan akibat gastrium - kelebihan gandum (grain overload),
terlalu berdilatasi, - toxin ingestion dan
- distensi lambung - chronic reoccuring bloat.
- penyempitan pylorus.
PRA OPERASI

1. Persiapan Ruang Operasi


2. Persiapan Peralatan dan Bahan Operasi
3. Persiapan Obat
4. Persiapan Operator
5. Persiapan Pasien
PREMEDIKASI DAN ANESTESI

 Gastrotomy
Jika mual: diazepam (0.2 mg/kg IV) atau midazolam (0.2 mg/kg IV,
IM)
Anestesi: Propofol (2-4 mg/kg IV), alfaxalone (2-3 mg/kg IV), atau jika
hewan tidak diberikan premedikasi dapat

 Rumenotomy
5 ml lidocaine disetiap rongga paravertebral (lidocaine hydrochloride
2%). Jarum dimasukan setengah diantara prosesus transvers
intervertebral dan dimiringkan sedikit agar lidocaine dapat masuk
kedalam rongga subarachnoid.
TEKNIK OPERASI

 Gastrotomy
1. Setelah itu melakukan incisi kulit pada ventral
midline abdominal dari thipoid sampai
pubis. Incisi dilanjutkan pada linea alba dan
peritonium sehingga rongga abdominal
terbuka.
2. Dinding abdominal dikuakkan dengan
retraktor sehingga gastrointestinal terlihat.
Lambung dikeluarkan dengan membuat
jahitan stay suture yang bertujuan untuk
memegang dinding lambung.
TEKNIK OPERASI

 Gastrotomy
3. Selanjutnya insisi dilakukan pada daerah
curvatura mayor didinding gastrium karena
sedikit terdapat pembuluh darah. Icisi dibuat
agar tidak dekat dengan pilorus dan incisi
dilebarkan dengan gunting.
4. Setelah dilakukan tindakan pada lambung
(mengeluarkan benda asing, biopsi), segera
dilakukan penutupan pada serosa muskularis,
dan submukosa sebagai lapis pertama dengan
pola jahitan cushing atau simple interrupted
selanjutnya dijahit dengan pola lembert atau
cushing.
TEKNIK OPERASI

 Gastrotomy
5. Lambung dimasukkan ke dalam rongga
perut dan dilakukan penutupan dinding
perut. Pada bagian peritonium, linea alba,
dan subkutan dijahit dengan benang
absorbable serta kulit dijahit dengan benang
nonabsorbable.
6. Perawatan pasca operasi, hewan jangan
diberi makan dan minum. Diberikan infus
secara intravena, antibiotika secara
intravena dan oral. Setelah 24 jam dapat
diberikan makanan ringan (pakan bayi)
TEKNIK OPERASI

 Rumenotomy
1. Hewan yang telah dipersiapkan kemudian
diletakkan diatas meja operasi dan direstrain.
Operasi dilakukan pada flank kiri. Sebelum
operasi dilakukan, bagian yang akan dioperasi
dicukur (daerah flank), setelah itu diolesi iodine
( PVP 10%).
2. Persiapan alat – alat operasi juga dilakukan.
Perbedaan alat yang dipakai adalah
pemakaian shroud atau plastik untuk rumen.
Setelah itu baru hewan diberi cairan anastesi.
Anastesi yang dapat diberikan dengan cara
line block, inverted block, atau paravertebral
block.
TEKNIK OPERASI

 Rumenotomy
3. Pada kasus rumenotomy biasanya
anastesika diberikan secara regional
dengan menggunakan teknik paravertebral
block dan L –block. Anastesi ini dimaksudkan
untuk mematikan rasa di daerah flank.
4. Anastetika yang digunakan adalah Lidocain
HCl. Pemberian Lidocaine HCL dilakukan
menggunakan metode farqurhason dengan
processus transversus sebagai penanda.
TEKNIK OPERASI

 Rumenotomy
5. Tiap tempat diberikan injeksi Lidocaine HCl
sebanyak 20 ml. Setelah sekitar 5 – 10 menit
kemudian, dilakukan tes untuk mengetahui
apakah daerah operasi sudah teranastesi
sempuna atau belum, dengan
menggunakan Allis forceps dilakukan jepitan
– jepitan daerah yang dianastesi tersebut.
6. Setelah hewan teranastesi, dilakukan incisi
sepanjang 12 cm pada kulit dimulai dari kira
– kira 10 cm di bawah prosesus transversus
dari vertebrae lumbaris pertengahan flank.
TEKNIK OPERASI

 Rumenotomy
7. Struktur lain dari dinding abdomen yang harus
dihindari saat insisi adalah nervus dan
pembuluh darah. Jika ada pembuluh darah
harus di ligasi terlebih dahulu. Rumen ditarik ke
luar dengan bantuan allies forcep atau dua
buah jahitan yang kuat.
8. Incisi rumen dibuat diantara kedua jahitan
setelah cavum abdomen ditutup. Setelah
rumen dibuka dimasukkan rumen shroud untuk
mencegah kontaminasi kemudian isi rumen
dikeluarkan sehingga rumen dapat dieksplorasi
untuk mencari benda asing.
TEKNIK OPERASI

 Rumenotomy
9. Tepi rumen yang diincisi dibersihkan dan dijahit
dengan tipe jahitan Simple continnue
dilanjutkan dengan tipe jahitan continous
lambert dengan menggunakan benang
catgut chromic
10. Peritoneum dan muskulus dijahit secara
terpisah dengan tipe jahitan Simple Inerrupted
menggunakan benang catgut chromic. Sub
kutan dijahit dengan pola jahitan sederhana
menerus menggunakan benang catgut plain.
Kulit dijahit dengan tipe jahitan Simple
Inerrupted menggunakan benang katun.
PASCA OPERASI

Pasca Operasi Gastrotomy


 Segera setelah penutupan dinding abdomen dilakukan penyuntikan
Ampicillin 10 % dengan dosis 10-20 mg/kg BB secara intramuskuler untuk
menghindari adanya infeksi sekunder. Setelah hewan dioperasi
ditempatkan pada tempat yang kering dan bersih, luka operasi dijaga
kebersihannya dan pemeriksaan dilakukan selama 4 – 6 hari berturut –
turut. Penggantian penutup luka atau perban dilakukan 3 hari sekali.
Jahitan dapat dibuka setelah luka operasi benar-benar kering dan
sembuh serta telah tertutup, kemudian diolesi kembali iodiun tinkture 3%.
PASCA OPERASI

Pasca Operasi Rumenotomy


 Terapi pasca operasi yang dapat diberikan pada kambing adalah injeksi
ampicillin, secara IM 2x sehari. Pengobatan antibiotik bertujuan
untuk mencegah terjadinya infeksi, dengan dosis ampicillin pada
kambing 10-20 mg/kg BB secara per-oral, dan 5-10 mg/kg BB secara
parenteral, Mengganti perban sekitar 7-10 hari. Umumnya jahitan dibuka
setelah operasi 10-14 hari.
SEKIAN DAN TERIMAKASIH
Vet Clin Food Anim 24 (2008) 341–347

Rumenotomy
Andrew J. Niehaus, DVM, MS
Department of Veterinary Clinical Sciences, College of Veterinary Medicine,
The Ohio State University, 601 Vernon L. Tharp Street, Columbus, OH 43210-1089, USA

The rumen in the adult cow comprises approximately 80% of the abdom-
inal cavity [1] with a capacity around 80 L (roughly 16% of body weight) [2].
Some sources report capacities varying from 102 to 148 L for mature cattle
[3]. The rumen lies primarily on the left side of the abdomen and its length
extends from the seventh or eighth rib to the pelvis [1]. The ventral sac of the
rumen extends to the right side of the abdomen. The rumen is typically
described as a ‘‘fermentation vat.’’ Through the process of fermentation,
microbes within the rumen convert complex carbohydrates that are useless
to the host animal into volatile fatty acids, microbial protein, and B vita-
mins, which are useful products. By-products of fermentation include meth-
ane, carbon dioxide, ammonia, and nitrate, which need to be cleared [2]. The
neonate has a very small rumen and relatively large abomasum. The relative
size of the rumen increases with the age of the animal. Ingestion of forage
and fermentation products is stimulus for rumen enlargement. The ratio
of rumen volume to abomasal volume is 0.5:1 at 4 weeks of age and even-
tually reaches 10:1 in adult cattle [1].

Indications for rumenotomy


The apposition of the rumen against the left body wall makes it an easy
portal though which to access other proximal gastrointestinal (GI) struc-
tures including the reticulum, the reticulo-omasal orifice, and the rumen
itself. Indications for rumenotomy include traumatic reticulitis, reticuloper-
itonitis, or reticulopericarditis (hardware disease). It can also be used to re-
move rumenal or reticular foreign bodies not associated with inflammatory
conditions (most commonly for removal of instruments that have been inad-
vertently swallowed during administration of enteral medications such as
balling guns, Frick speculums, or broken or chewed off esophageal tubes).

E-mail address: andrew.niehaus@cvm.osu.edu

0749-0720/08/$ - see front matter Ó 2008 Elsevier Inc. All rights reserved.
doi:10.1016/j.cvfa.2008.02.011 vetfood.theclinics.com
342 NIEHAUS

Using the rumen as access, the reticulum can be explored and foreign bodies
penetrating the wall of the reticulum or causing reticular irritation can be
removed. Perireticular abscesses that develop secondary to penetrating
reticular foreign bodies can be surgically drained into the reticulum via
a rumenotomy. In the author’s practice, the indication for performing
approximately half of the rumenotomy surgeries is for retrieval of a foreign
body in cases of hardware disease. Other indications for performing a rume-
notomy include removal of rumen contents in cases of acute toxin ingestion,
grain overload, or frothy bloat.
Rumenotomy has also been used to decrease rumen fill to aid in other
abdominal surgeries such as cesarean section. Rumen impaction leading
to decreased rumen outflow can also be relieved by decreasing rumen fill
and rumen lavage through rumenotomy. Impaction caused by ingestion of
hair can be seen in calves and camelids (Fig. 1).

Surgical techniques
Multiple techniques have been described for performing laprorumenot-
omy in cattle. All techniques involve making an approach in the left paral-
umbar fossa to gain access to the rumen, exteriorization of the rumen,
securing the rumen to the body wall or skin, and limiting contamination
is a picture of a completed rumenotomy incision [4–6]. The techniques dif-
fer by the method in which the rumen is secured to the body wall or skin.
A standard laparotomy incision is made in the left paralumbar fossa
through the skin and external, internal, and transverse abdominal muscles
followed by the peritoneum. It has been suggested to always perform an

Fig. 1. Trichobezoar removed from the first stomach compartment (C1) of an alpaca cria.
RUMENOTOMY 343

abdominal exploratory before performing the rumenotomy [4,7]. Although


a thorough abdominal exploratory is limited from the left flank because of
the overwhelming size of the rumen, the cranioventral abdomen can be
palpated for the presence of reticular adhesions, a common sequela to re-
ticuloperitonitis. Peritonitis can also be diagnosed from the left paralum-
bar fossa approach. Both of these findings are indications for continuing
with the rumenotomy to search for penetrating foreign bodies [7]. It is rec-
ommended to palpate the area of suspected peritonitis last to avoid
spreading contamination throughout the abdomen. The dorsal sac of the
rumen is then exteriorized and secured before creation of the rumenotomy
incision.
One technique described securing the rumen to the peritoneum [5]. The
disadvantage with this technique is that the peritoneum can be weak and al-
low for retraction of the rumen into the abdomen. Contamination of the
muscle layers will also result since the body wall muscle layers are exposed.
The stay suture technique uses four stay sutures to anchor the rumen to
the skin at the dorsal, ventral, cranial, and caudal parts of the incision [6].
The stay suture technique has areas where rumen contents can pass between
the rumen and the body wall and allow contamination of the peritoneal
cavity. Similarly, the skin clamp technique uses towel clamps to secure the
rumen to the skin in an overlapping fashion in several discrete locations
around the incision.
Several devices have been developed to anchor the rumen following exte-
riorization and expedite the rumenotomy procedure. In 1954, a report on
a rumenotomy ring was published. This consisted of an aluminum ring
with a rubber ring attached to its inner circumference [8]. It was designed
so that the rumen could be hooked to this rubber ring. The idea was that
it would keep the rumen exteriorized and prevent abdominal contamination.
The hook placement is faster than suturing the rumen to the skin and thus
decreases time of the rumenotomy. Weingarth’s ring was based on this pre-
vious ring with some modifications for securing the hooks and lacked the
inner rubber ring. The Gabel rumen retractor (rumen board) is another
similar instrument used to keep the rumen exteriorized (Fig. 2). This device
has a hole in the center that the rumen is pulled through. A series of bolts
around the circumference of the hole allows hooks to attach the rumen to
the board. The board helps to decrease abdominal contamination and expe-
dites the procedure but limits the accessibility of the rumen.
The technique used most commonly in the author’s practice is skin suture
fixation. With this technique, the rumen is sutured to the skin using a contin-
uous inverting suture pattern such as a Connell or a Cushing [6]. If done
properly, this suture everts the rumen and inverts the skin edge to form
a continuous seal (Fig. 3).
Dehghani and Ghadrdani [6] compared skin suture fixation, stay suture
fixation, Weingarth’s ring, and the skin clamp technique in 20 cattle. They
found that stay suture fixation was inferior to the other techniques with
344 NIEHAUS

Fig. 2. Gabel rumen retractor with hooks for securing the rumen to the board.

increased incidence of infection. The rumen shroud is a device that has been
developed to help limit abdominal contamination with rumen contents. It is
a rubber device that has a large flat surface similar to a rumen board on one
side and an inner flange that secures it to the inside of the temporary rumen
fistula [9].
An underlying principle with all of these techniques is to achieve a good
seal between the rumen and the skin so that abdominal contamination is
minimized. Blood and fibrin accumulation around the incision can be
advantageous, as it can help to seal the incision and limit leakage of liquid
contents from the rumen into the abdomen. It, however, can also trap debris
and contamination from the rumen. Before release of the rumen back into

Fig. 3. Rumenotomy procedure. The rumen has been sutured to the skin in an inverting pattern
achieving a seal. (Courtesy of Bruce L. Hull, DVM, MS, Columbus, OH.)
RUMENOTOMY 345

the abdomen, an effort should be made to remove excess blood and fibrin
that has clotted around the incision.
Before opening the rumen, some surgical instruments should be set aside
and kept sterile while the rumen is opened. These instruments will be used to
close the body wall and skin following lavage and rumen closure. The min-
imum set of instruments to be set aside includes new drapes, surgery gowns,
gloves, needle holders, suture, needles (if not using suture with swedged on
needles), scissors, and towel clamps.
After completion of the rumen exploratory, the rumen is closed. A dou-
ble-layer inverting pattern is typically recommended to achieve a good seal
on the rumenotomy incision. The author typically uses a double-layer Cush-
ing pattern. After the first layer of rumen closure (while the rumen is still
attached to the skin), the rumen surface is lavaged multiple times to remove
any rumen contents that may be adhered. Usually serosal irritation to the
surface of the rumen will cause roughening and fibrin exudation, which
will allow debris to stick. Any blood and fibrin clots should be removed.
Following a good cleaning of the rumen surface, the stay sutures that are
attaching the rumen to the skin are removed and the second layer of closure
is performed before allowing the rumen to retract into the abdomen. The
second layer of rumen closure should incorporate the suture holes made
by the prior stay sutures. The animals should then be redraped, the surgeon
regowned, and the instruments should be changed to a sterile set. From this
point forward, the procedure should be considered a clean surgery.

Perioperative management
At best, rumen surgery is considered a clean-contaminated surgery, since
a hollow, contaminated viscus is penetrated. Antibiotics are recommended
in any surgery that is considered less than clean [10]. Haven and colleagues
[10] showed that prophylactic use of penicillin significantly decreased the in-
cidence of abscess formation following rumenotomy. They also demon-
strated that an initial antibiotic dose at the time of surgery was all that
was necessary and continuing the therapy for several postoperative days
had no significant decrease on the incidence of abscess and infection rate.
Medical management should include treatment of concurrent diseases.
Animals should be treated for peritonitis or pericarditis in severe cases of
hardware disease. Animals diagnosed with grain overload should be treated
medically for the severe rumenitis that results from acute rumen acidosis.
Mycotic rumenitis and liver abscesses are possible sequela to grain overload
and should be prophylactically treated if grain overload is diagnosed.

Complications
Overall in the authors practice, the apparent complication rate associated
with rumen surgery is low (!5%). The prognosis and outcome largely
346 NIEHAUS

depends on the presenting complaint and preoperative condition of the


animal and not operative factors.
Peritonitis is a major complication associated with rumen surgery. Any
spillage of rumen contents in the abdomen will result in some degree of
peritonitis. The degree of peritonitis is dependent on the amount of contam-
ination, blood and tissue levels of antibiotics, and the health status of the
animal. Frequently in cases of hardware disease, peritonitis is already pres-
ent before the surgical procedure so determination of whether peritonitis is
a result of the surgery or the primary problem can be difficult to assess. An-
imals with peritonitis will show signs of a painful abdomen, and a mild fever
may be observed. In lactating dairy cattle, affected animals will show an
immediate and drastic drop in milk production.
In addition to contamination and infection of the abdomen, the body
wall tissues may also be contaminated. Animals undergoing rumen surgeries
will frequently develop incisional infections, seromas, and abscesses. These
incisions are prone to dehiscence. If an incisional seroma or abscess de-
velops, we recommend partly opening the incision at the ventral-most aspect
to facilitate drainage. Warm water hydrotherapy can also be a useful
adjunct to facilitate drainage and resolution of an infected incision.

First stomach compartment surgery in camelids


Camelids (llamas and alpacas) are pseudoruminants. They have two forest-
omach compartments that precede the true stomach, as opposed to three for-
estomach compartments in true ruminants. Their compartments are labeled
C1, C2, and C3, which stand for the first, second, and third compartments.
The third stomach compartment (C3) is the ‘‘true stomach’’ of the camelid,
while the C1 compartment is analogous to the rumen in these species.
The same principles can be applied to ‘‘rumen’’ surgery in camelid species
as in true ruminants. An anatomic difference between the rumen and the C1
compartment is the C1 compartment has sacculations. This can make crea-
tion of a seal between the stomach and the skin more challenging; however,
the thinner nature of the wall usually allows a seal to be created. The thinner
walled C1 is also more prone to tear from the skin so care must be taken to
not place too much force on C1 after it has been sutured to the skin. An-
other difference that could pose complications for the novice surgeon is
the lack of stratification of rumen contents in camelids. Where ruminants
have a rumen mat and gas dorsal to the rumen mat, camelids have
a more homogeneous makeup to their C1 compartment. In a ruminant, if
the rumen is approached from the dorsal third, only gas will be encountered,
decreasing the risk of spilling rumen contents. However, in camelids, C1
contents are more ‘‘frothy’’ in consistency even in the dorsal parts of the
C1 compartment, and spillage of contaminated C1 contents is more likely.
It is the author’s impression that camelids are more sensitive to abdom-
inal contamination and subsequent peritonitis than are true ruminants. In
RUMENOTOMY 347

cattle, the hallmark clinical signs of peritonitis are a mild fever and a sharp
drop in milk production; a clinical sign of peritonitis in camelids is fre-
quently acute death.

Summary
If performed correctly, the rumenotomy procedure can be a safe and ef-
fective way to retrieve ingested foreign bodies and address other problems of
the ruminant forestomachs. In the author’s practice, rumen surgery has been
associated with few postoperative complications. Morbidity and mortality
in cases that have had a previous rumenotomy have mostly been associated
with complications related to the original presurgical condition or from
causes unrelated to the rumen surgery.

References
[1] Ducharme NG. Surgery of the bovine forestomach compartments. Vet Clin North Am Food
Anim Pract 1990;6(2):371–97.
[2] Church DC. The ruminant animal: digestive physiology and nutrition. Englewood Cliffs
(NJ): Prentice-Hall; 1988. ix, p. 564.
[3] Oehme FW. Textbook of large animal surgery. Baltimore: Williams & Wilkins; 1988. p. xii,
714. p. 399–449.
[4] Noordsy JL. Rumenotomy in cattle. In: Food animal surgery. Lenexa (KS): Veterinary
Medicine Pub. Co.; 1989. p. x, p. 286. p. 105–9.
[5] Hofmeyr CFB. The digestive system. In: Oehme FW, editor. Textbook of large animal
surgery. Baltimore: Williams & Wilkins; 1988. p. xii, p. 714, p. 364–449.
[6] Dehghani SN, Ghadrdani AM. Bovine rumenotomy: comparison of four surgical tech-
niques. Can Vet J 1995;36(11):693–7.
[7] Donawick W. Abdominal surgery. In: Amstutz HE, editor. Bovine medicine and surgery.
Santa Barbara (CA): American Veterinary Publications; 1980. p. 2 v. (1269 p.) 1207–20.
[8] Michael SJ, McKinley RE. Rumenotomy simplified. J Am Vet Med Assoc 1954;124(922):
26–7.
[9] Turner AS, McIlwraith CW, Hull BL. Techniques in large animal surgery. Philadelphia:
Lea & Febiger; 1989. xv, p. 381.
[10] Haven ML, Wichtel JJ, Bristol DG, et al. Effects of antibiotic prophylaxis on postoperative
complications after rumenotomy in cattle. J Am Vet Med Assoc 1992;200(9):1332–5.
Case Report

ISSN: 2574 -1241 DOI: 10.26717/BJSTR.2020.27.004509

Rumenotomy due to Metallic Foreign Bodies


in Rumen of Adult Dairy Cow
Haben Fesseha*
School of Veterinary Medicine, Wolaita Sodo University, Ethiopia
*Corresponding author: Haben Fesseha, School of Veterinary Medicine, Wolaita Sodo University, Ethiopia

ARTICLE INFO Synopsis

Received: April 23, 2020 A nine years old cross-breed Holstein Friesian dairy cow weighing 280kg with
medium body condition was presented to Mekelle University Veterinary Teaching
Published: May 07, 2020
Hospital Mekelle, Ethiopia. The cow was presented with the signs of frequent
abdominal distention, abdominal pain, grunting, grinding of teeth, reduced feed intake,
Citation: Haben Fesseha. Rumenotomy progressive weight loss, and falling behind as the owner complains. The detailed clinical
due to Metallic Foreign Bodies in Rumen of examination revealed that dull, depressed, reduced appetite and weakness, and the
Adult Dairy Cow. Biomed J Sci & Tech Res case was confirmed as traumatic reticuloperitonitis. The case was handled surgically by
27(3)-2020. BJSTR. MS.ID.004509. exploratory rumenotomy after preparing the surgical site was prepared aseptically and
stabilizing with fluids and electrolytes preoperatively. Para-vertebral nerve block by
Keywords: Dairy Cow; Metallic Foreign using 2% lignocaine hydrochloride was done. A long skin incision starting about eight
Bodies; Exploratory Rumenotomy to ten centimeters below the transverse process of the lumbar vertebrae was made
vertically. The abdominal muscles and peritoneum were also incised following the skin
incision. The rumen was fixed with the stay suture and metallic foreign bodies were
removed using magnetic material through exploration. After removing the content of
the rumen, it was closed by double lambert suture. Then closing the peritoneum and
muscle with catgut by simple continuous pattern. The skin was sutured with nylon using
a cross mattress suture. The cow was completely recovered after 20 days of follow-
up observation. In the current case report, the successful management of traumatic
reticuloperitonitis due to metallic foreign bodies in a cow is discussed.

Introduction
acute perireticular inflammation followed by peritonitis, pleuritis,
Ingestion of foreign bodies by ruminants is extremely common
and/or pericarditis, in addition to sepsis, restrictive adhesions, and
especially in developing countries, like Ethiopia, where the standard
abscess formation., Perireticular adhesions, and abscesses [5,6].
of animal management is unsatisfactory, and low nutritional statuses
of ruminants have forced them to scavenge for food [1]. Rapid The condition is usually caused by long, thin, sharp foreign bodies
urbanization, industrialization, and acute mineral deficiencies (wire, needles, nails) that penetrate the reticulum, peritoneum,
are that predispose them for foreign body ingestion. Accordingly, diaphragm, and pericardial sac, eventually leading to traumatic
they cause great production loss and decrease reproductive pericarditis. This leads to inflammation of the pericardium, with
performance [2]. Ruminants frequently ingest irregular objects with the accumulation of serous or fibrinous inflammatory products
potential risk of rumeno-reticular damage. Non-metallic foreign [7]. The influencing factors of TRP include remodeling of livestock
bodies, plastic foreign bodies, ropes, and pieces of old clothes are housing, careless handling of baling wires, pins, feed sack bags,
commonly ingested by cattle and accumulated in the reticulorumen and wires. The incidence is more in females than males shortly
causing a variety of ailments [3,4].Traumatic Reticuloperitonitis after calving [8,9]. Most cattle owners with hardware disease often
(TRP), also called hardware disease, is a relatively common disease present with complaints of rumeno-reticular dysmotility (bloat),
in adult cattle that impairs reticuloruminal motility. It is caused abdominal discomfort (colic), anorexia, lethargy, and weight
by the ingestion and perforation of the reticular wall resulting in loss (falling behind). Recurrent rumen tympany, pale mucous

Copyright@ Haben Fesseha | Biomed J Sci & Tech Res | BJSTR. MS.ID.004506. 20824
Volume 27- Issue 3 DOI: 10.26717/BJSTR.2020.27.004509

membrane, rumen impaction, atony, reduction of rumen motility, last three months. Upon arrival and physical examination, the cow
scanty faces, partial anorexia, labored breathing, grunting, weight was lethargic and highly depressed with a rough hair coat and
loss, and colic are common clinical signs of TRP [7,10]. dehydrated. Further close examination of vital organ parameters
such as heart rate, respiratory rate, pulse rate, and mucous
Evidence of pain localized to the cranioventral abdomen,
membrane revealed slightly elevated. Besides, upon poll and pinch
ruminal atony during auscultation, and pleural/peritoneal/
grip test, the cow showed signs of pain, discomfort. Moreover,
pericardial effusion during percussion should be performed during
the cow was having difficulty in regurgitation, ruminal atony up
physical examination. Additionally, inflammatory leukogram, X-ray
auscultation, and intermittent straining at frequent intervals.
(detection of the presence of foreign body), and ultrasonography
Accordingly, based on the history and clinical observation, the
(characterizing pericardial effusion as well as determine the
case was diagnosed as traumatic reticuloperitonitis and the team
extent of the lesions and assess the prognosis) are best and
decided to manage surgically using exploratory rumenotomy.
preferred methods of diagnosis for before exploratory laparotomy
or rumenotomy. Even though prevention should be the primary Animal Handling, Anesthetic Protocol, and Preoperative
emphasis, the surgical management of hardware disease should Patient Preparation
aim at controlling infection and removing foreign bodies [1,4]. The
Preoperatively, the cow was kept on antibiotics for three
present case report describes the history, signalment, physical,
consecutive days and fluid therapy (5% Dextrose solution plus
and surgical findings and result in adult dairy cattle following
0.9% NaCl, 1000ml stat, I.V., Addis pharmaceutical, Adigrat
exploratory rumenotomy.
Ethiopia) to correct the dehydration status. The cow then was
Case Report properly restrained with the combination of physical (using
rope) and chemical methods (Detomidine hydrochloride, Dechra
Case History and Clinical Examination Veterinary Products Ltd., the United Kingdom at a dose of 20µg/kg
A multiparous nine-years-old cross-breed Holstein Friesian Intravenously). Then, the skin surface on the left paralumbar fossa
dairy cow weighing 280 kg with a medium body condition was was prepared aseptically by washing with water, soap, and salvon®
presented to Veterinary Hospital, College of Veterinary Science (Cetrimide 3% and Chlorhexidine gluconate 0.5% solution). Then
(CVS), Mekelle University (MU), Ethiopia. The owner also told as the the hair was first clipped with sharp scissor and shaved with a razor
cow was suffering from grunting, grinding of tooth, abdominal pain, blade and cleaned thoroughly with a standard solution of salvon®.
reduced feed intake, progressive weight loss, frequent abdominal Finally, the area was scrubbed three times with a povidone-iodine
distention, and falling behind. Besides, the cow graze extensively 1% solution to decrease the microbial load in the area and left dried
on the nearby premises and decreased milk production over the till ready for Rumenotomy (Figure 1A).

Figure 1: Surgical procedure during Rumenotomy in Crossbreed Holstein Friesian dairy cow
A) Physical restraining and aseptic preparation of the cow on standing position using rope.
B) A sharp vertical incision on the skin and abdominal muscle of the left flank area.
C & D) Presentation of metallic foreign bodies taken out from the Rumen.
E) Post-surgical appearance of the crossbreed Holstein Friesian dairy cow.

Copyright@ Haben Fesseha | Biomed J Sci & Tech Res | BJSTR. MS.ID.004509. 20825
Volume 27- Issue 3 DOI: 10.26717/BJSTR.2020.27.004509

Additionally, regional or field block was performed by on fluid therapy (5% Dextrose solution, 1000ml stat, I.V.) antibiotic
infiltrating the 5 ml lidocaine per each paravertebral space (Ceftriaxone, 5gm/kg, I.V.), and Meloxicam (0.5mg/kg, IM) for
(Lidocaine hydrochloride 2%, Vedco Inc. Saint Joseph Missouri) five successive days. Tetracycline wound spray was also applied
to block T13, L1 and L2 nerves using an 18-gauge syringe having around the wound (Figure 1E).The owner was also advised to
a 10-cm needle, to desensitize the flank area, abdominal muscles closely monitor the cow and to provide good nutrition to facilitate
and alleviate pain during the surgical procedure. The needle was wound healing. After 20-day post-operation, the wound was healed
inserted halfway between the intervertebral transverse process completely and after two months of follow-up, the cow was under
and the needle is slightly angled to reach and deposit the lidocaine good health status (Figure 1).
in the subarachnoid space. Finally, two linear infiltrations were
made in the pattern of inverted ‘T’ using local anesthetic lidocaine Discussion
(60ml) to desensitize and put in sufficient analgesia enclosing the Surgical affections of the ruminant forestomach due to ingested
site of incision and waited for 10-minutes. foreign bodies are the subject of attention almost all over the world
and of major economic importance due to severe loss of production
Surgical Correction
and production ability [1,2,4]. These findings agree with the current
Abdominal surgery such as rumenotomy is a clean- cases in that there were weight loss and debilitation due to the
contaminated operation. For the rumenotomy, an operation presence of plastic foreign bodies in the cow’s rumen.In the present
room is necessary. However, as there was no operation room we case report, emaciation, pale mucus membrane, scanty feces,
operated outside. A sharp vertical skin incision with a distance of anorexia, rough hair coat, and distended abdomen were among the
approximately (~40 cm long) was made on the left flank region common clinical findings in the affected cow. These results were
below the lumbar transverse process (Figure 1B). After blunt in agreement with the report by [1,4,11] in which animals with
dissection of the skin from the subcutaneous tissue, the incision indigestible foreign body cannot able to digest feeds normally so
was continued chronologically through the external and internal that prone to feed deficiency which can be manifested by different
abdominal oblique, transverse abdominal muscle, and peritoneum. clinical signs. Besides, most of the foreign bodies were removed
Then all muscular layers together with skin were grasped with from the rumen while the rest were removed from the reticulum.
handheld retractor to get sufficient surgical field and exposure to This finding was in line with the findings of [1,2,12] that may result
the rumen. Stay suturing of the rumen was performed to fix. After in enlargement of the rumen.
the incision of the rumen, exploration of the rumen and reticulum
Rumenotomy is the most preferable method of removing
was conducted and different metallic, as well as plastic foreign
metallic and plastic foreign bodies from the rumen and reticulum.
bodies, were removed (Figure 1C &1D).
It is a clean-contaminated surgery since a hollow viscous is
Moreover, bleeding during the procedure was managed penetrated. Wound dehiscence, hemorrhage fever, edema, wound
by applying sterile gauze, using different straight and curved infection (peritonitis), death, intestinal obstruction/adhesion, and
hemostatic forceps and topical infiltration of epinephrine on physiological bloat are among the commonly observed postoperative
bleeding site depending on the site and condition. Then, the rumen complications. Post-operative care should be emphasized through
and surrounding area were rinsed copiously with sterile isotonic the administration of antibiotics and analgesics to minimize the risk
saline solution and is closed by double lambert suture using sterile of post-operative complications [8,13]. This was inconsistent with
absorbable polyglycolic acid of size 1-0 (Shandong Sinorgmed the current case report in terms of case handling, treatment, and
Int’l Co., Ltd, China) and replaced in the abdomen to its normal post-operative care.Surgical removal of foreign bodies improved
position. The peritoneum was closed by simple continuous suture the body condition, feed intake, productivity, and wellbeing of the
and muscle with a continuous lockstitch pattern using 2-0 size cow. This finding agreed with an experimental study conducted by
sterile absorbable polyglycolic acid. Then subcutaneous suture [14] who concluded that the surgical removal of the foreign body
and skin suture for closing the skin. After that, the skin together did improve the health of the animals by increasing the feed intake,
with subcutaneous facia was closed with horizontal interrupted weight gain, and productivity following removal of the foreign body.
mattress using silk (2-0 size). Lastly, the area was properly cleaned
In Ethiopia, the extensive management system, shortage
and dressed in a 2% povidone-iodine solution and admitted home.
of forage during the dry season, and nutritional deficiency are
Post-Operative Follow Up and Result considered as a major predisposing factor for acquiring indigestible
Postoperatively, small skin bleeding was noticed but it is normal rumen foreign bodies in ruminants. This resulted in a serious health
and helps to heal the wound unless continued for a long period. impact on the cattle and a threat to the environment [1,2,4,8].
Antiseptic wash of the incised area was done at second- and third- Similarly, the findings of the current study revealed the frequent
days post-operative up to fourteen days until it completely healed. occurrence of rumen foreign bodies in cattle. The indiscriminate
The suture was removed after 14days. Besides, the cow was kept ingestive behavior of cattle [9] as compared to small ruminants

Copyright@ Haben Fesseha | Biomed J Sci & Tech Res | BJSTR. MS.ID.004509. 20826
Volume 27- Issue 3 DOI: 10.26717/BJSTR.2020.27.004509

could be given as an explanation for the higher prevalence in this 5. Fubini S, Ducharme N, Erb H, Smith D, Rebhun W (1989) Failure of
omasal transport attributable to perireticular abscess formation in
species. Moreover, widespread use and improper disposal of the
cattle: 29 cases (1980-1986). Journal of the American Veterinary
non-bio-degradable free polythene or plastic shopping bags for Medical Association 194(6): 811-814.
packaging and other garbage and the poor waste management 6. Rehage J, Kaske M, StockhofeZurwieden N, Yalcin E (1995) Evaluation
system in the country and shortage of animal feed could be reasons of the pathogenesis of vagus indigestion in cows with traumatic
reticuloperitonitis. Journal of the american veterinary medical
for the occurrence of the problem in ruminants [1,12].
association 207(12): 1607-1611.

Conclusion 7. Braun U, Lejeune B, Schweizer G, Puorger M, Ehrensperger F (2007)


Clinical findings in 28 cattle with traumatic pericarditis. Veterinary
The cattle owner should be advised to give a balanced type Record 161(16): 558-563.
of feed to minimize the risk of ingesting foreign materials due to 8. Anteneh M, Ramswamy V (2015) Hardware disease in bovine. Acad J
Anim Dis 4(3): 146-159.
mineral deficiency. Besides, the movement of the animals should
be restricted to avoid the predisposition to metallic and plastic 9. Reddy Y, Latha P, Reddy S (2014) Review on metallic and non-metallic
foreign bodies: A threat to livestock and environment. Int J Food Agric
foreign bodies. The owner should understand the outcome of the Vet Sci 4: 6-14.
disease. So, recommend that once the case occurred it should have
10. Chanie M, Tesfaye D (2012) Clinico-pathological findings of metallic and
to bring the animals as early as possible before it is emaciated and non-metallic foreign bodies in dairy cattle: A review. Acad J Anim Dis
immunologically compromised. 1(3): 13-20.
11. Bakhiet AO (2008) Studies on the rumen pathology of Sudanese desert
References sheep in slaughter house. Sci Res Essays 3(7): 294-298.
1. Kebede S, Bekele T, Fesseha H (2020) Prevalence of Indigestible Rumen 12. Tiruneh R, Yesuwork H (2010) Occurrence of rumen foreign bodies in
and Reticulum Foreign Bodies in Cattle Slaughtered at KombolchaElfora sheep and goats slaughtered at the Addis Ababa Municipality Abattoir.
Abattoir, Kombolcha Town, Amhara Regional State, Ethiopia. Int J Rec Ethiopian Veterinary Journal 14(1): 91-100.
Biotech 8(1): 25-34.
13. Fubini S, Ducharme N (2016) Farm Animal Surgery-E-Book. Elsevier
2. Ramaswamy V, Sharma HR (2011) Plastic bags-threat to environment Health Sciences.
and cattle health: A retrospective study from Gondar city of Ethiopia.
IIOAB J 2(1): 6-11. 14. Ghurashi M, Seri H, Bakheit A, Ashwag E (2009) Effect of surgical
removal of foreign body from goat’s rumen with special reference to
3. Bassa K, Tesfaye W (2017) Study on rumen and reticulium foreign the prevalence of foreign body in goats in Southern Darfur. Australian
bodies in cattle slauthered at WolaitaSodo municipal Abattoir, Ethoipia. Journal of Basic and Applied Sciences 3(2): 664-668.
Int J Adv Multidiscip Res 4(1): 11-19.
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and Medicine 5(1): 5.

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Gastrotomy for Retrieval of Thoracic Oesophageal Foriegn Body Using Long


Forceps Technique in Three Dogs

Article · July 2011

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Journal of
Advanced Veterinary Research
Volume 1 (2011) 74-75 Case Report
Gastrotomy for Retrieval of Thoracic Oesophageal Foriegn Body Using Long
Forceps Technique in Three Dogs
Suresh Kumar R.V., Sankar P.*, Kokila S., Reetu, Sailaja B., Ravikumar P., Dhana Lakshmi N.,
Veena P.
Department of Veterinary Surgery and Radiology, College of Veterinary Science, Tirupati-517 502, Sri Venkateswara Vet-
erinary University, Andhrapradesh, India

(Recieved 20 May 2011/ Accepted 10 July 2011)

Abstract

Three dogs age between 3- 6 years old was presented to the Department of Veterinary Surgery and Radiology with the
history of anorexia, attempt for vomiting, regurgitation, dysphagia, gagging, mild salivation after taking a piece of bone.
Clinical examination revealed heart rate and respiratory were within physiological limits. Lateral plain radiograph of thorax
revealed radio opaque foreign body was lodged between heart and diaphragm. Surgical invention was planned to retrieve
thoracic oesophageal foreign body through gastrotomy incision. This clinical paper reports the successful surgical management
of thoracic oesophageal foreign body through gastrotomy incision using long forceps without complication.
Keywords: Oesophageal foreign body; Gastrotomy; Long forceps

Introduction opaque foreign body was lodged between heart and


diaphragm (Kaiser et al., 2003). Surgical invention
The ingestion of a foreign body is common prob- was planned to retrieve thoracic esophageal foreign
lem in dogs. Rarely foreign body may become body through gastrotomy incision using long for-
blocked in the oesophagus, particularly near the ceps (Fig. 2).
caudal oesophageal sphincter or between the heart
and diaphragm which is the most inaccessible part
of the oesophagus and it is easy to retrieve thoracic
oesophageal obstruction through gastrotomy inci-
sion using long forceps (HunYoung et al., 2009).

Case history and observations

Three dogs age between 3- 6 years was presented


to the Department of Veterinary Surgery and Radi-
ology, College of Veterinary Science, Sri
Venkateswara Veterinary University, Tirupati
Andhrapradesh, India with the history of anorexia,
attempt for vomiting, dysphagia, gagging, mild
Fig. 1. Lateral plain radiograph show thoracic oe-
salivation for 2 days after taking a piece of bone.
sophageal obstruction.
Clinical examination revealed heart rate and respi-
ratory were within physiological limits. Lateral
plain radiograph of thorax (Fig. 1) revealed radio Treatment and Results

Under aseptic precaution site was prepared for gas-


*Corresponding author: Sankar P.
Address: Department of Veterinary Surgery and Radiology, College trotomy. Atropine sulphate at 0.044 mg/kg body
of Veterinary Science, Tirupati-517 502, Sri Venkateswara Veteri- weight subcutaneously and xylazine hydrochloride
nary University, Andhrapradesh, India at 0.5 mg/kg body weight intramuscularly were
E-mail address: sansurvet@gmail.com

ISSN: 2090-6277/2090-6269, www.advancedvetresearch.com


Suresh Kumar et al. / Journal of Advanced Veterinary Research 1 (2011) 74-75

given as premedication. Ketamine hydrochloride Post operatively animal was maintained with in-
was given at 8.0 mg/kg body weight intramuscu- travenous dextrose normal saline and ringers lac-
larly and anaesthesia was maintained with the com- tate for first 5 days twice daily followed by once
bination of Ketamine hydrochloride- daily along with liquid diet, ceftriaxone at 10
Diazepam10:1 ratio. To dislodge the foreign body mg/kg body weight and dexamethazone 0.5 ml/kg
in to the stomach stomach tube were used unsuc- body weight and ranitidine hydrochloride 0.5 ml
cessful. Gastrotomy was performed through ventral were given intravenously for 5 days with alternate
midline incision from the xiphoid to the pubis. Ab- day dressing with povidone iodine ointment. All
dominal wall is then retracted using Balfoure re- the animals were recovered uneventfully on 9th
tractor. Stomach was isolated from the abdominal post operative day.
content with moistened laparotomy sponges to re-
duce the contamination and incision was made at References
ventral aspect of the stomach between the greater
and lesser curvatures, through the incision long Haragopal, V., Suresh Kumar, R.V., 1996. Surgical removal of a fish
bone from the canine esophagus through gastrotomy. Canadian
foreceps (HunYoung et al., 2009) was introduced Veterinary Journal 37, 156.
gently to dislodge the bone piece (Meffert, 2010) HunYoung,Y., MyungGon, K., SoonWuk, J., 2009. Gastrotomy ap-
from the oesophagus and removed through stom- proach retrieval of esophageal foreign body using long forceps
technique in five dogs. Journal of Veterinary Clinics 26, 628-
ach (Haragopal and Suresh Kumar, 1996). Gastro- 631.
tomy wound incision was closed by simple Kaiser,S., Forterre, F., Kohn, B., Brunnberg, L., 2003. Oesophageal
continuous followed by cushing suture pattern foreign bodies in dogs: a retrospective study of 50 cases (1999-
2003). Kleintierpraxis 48, 397-400.
(Fig.3) using 2/0 chromic catgut. Meffert, F.J., 2010. Canine oesophageal foreign bodies: a retrospec-
tive study of 49 cases (2001-2009). Australian Veterinary Prac-
titioner 40, 90-94.

Fig. 2. Retrieved foreign body (Bone) through


stomach

Fig. 3. Showing gastrotomy closure- Cushing su-


ture pattern

75

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