#52’s Case of a Uterine Torsion A TWIST OF FATE By: Amy Sanders Advised by Dr. Jenna Bayne
#52’s Case of a Uterine
TorsionA TWIST OF FATE
By: Amy Sanders Advised by Dr. Jenna Bayne
March 28 th, 20147 years oldCharolais Approximately 1000 lbsBCS 5/9Full term Owner rectally palpated:
Uterus felt twisted Fetus still was presumptively alive
CASE PRESENTATION OF #52
Usually occurs at the termination of gestation (Gestation length 280 days)
Prolonged Stage I ParturitionNo clear age or season predisposition Multiparous > PrimiparousCommonly Reported Breeds: Brown Swiss, Holstein,
and Charolais is a high-risk breed. Can be twisted CLOCKWISE or COUNTERCLOCKWISECan range from 180-720
WHAT IS A “TWISTED UTERUS”?
Instability of the gravid uterus Small non-gravid horn
Excessive fetal weight Broad ligament: Body vs. HornsWhen a cow lies down gravid uterus is
suspended in abdominal cavity. a sudden slip or fall could cause the gravid uterus to twist
Increased fetal movements during 1 st-stage labor
Decreased amounts of uterine fluidFlaccid uterine wallConfinement in stables for long periods can
contributeFUN FACT: TWINS can PREVENT torsion
WHAT IS A “TWISTED UTERUS”?
Normal Presentation
Clockwise (twisted to the RIGHT)
Counter Clockwise (twisted to the LEFT) MORE COMMON
DO THE TWIST
FeverTachycardiaTachypneaAnorexiaStrainingVaginal Discharge
CLINICAL SIGNS OF UTERINE TORSION
HOW TO DIAGNOSE WHAT WAS FOUND WITH #52
VAGINAL EXAM Twist will be caudal to cervix CORKSCREW EFFECT Torsion <360 may be possible to reach
the cervix #52 had a 180 twist Fetal limb could be felt through the
cervix: Upon stimulation of the limb there was no
reaction from the fetus
RECTAL EXAM Feel Broad Ligaments
The Right Broad Ligament was stretched= COUNTER CLOCKWISE TWIST
Manual Detorsion via VaginaRolling the cowDetorsion RodCesarean Section
HOW TO UNTWIST
COUNTERCLOCKWISE TORSION Lay in LEFT lateral and roll LEFT 360
CLOCKWISE TORSION Lay in RIGHT lateral and roll RIGHT 360
NON-SURGICAL CORRECTION:“PLANK IN DA FLANK”
Roberts, Stephen J and Hillman, Robert B. An Improved Technique for the Relief of Bovine Uterine Torsion.
Place chains as far up the limbs you can reach as possible
Place chains through one eye on the barPush into cow between calf limbs and start to hand
twist until tightPlace a bar in the outside eye and rotate.
NON-SURGICAL CORRECTION:DETORSION ROD
Uterus cannot be corrected by rollingCervix does not dilate to suffi ciently deliver the fetusFetal proportion or anomalies prevent delivery of the
fetus
APPROACHS: RECUMBANT LEFT FLANK VENTRAL MIDLINE OBLIQUE PARAMEDIAN STANDING LEFT FLANK
SURGICAL OPTIONS:CESAREAN SECTION
PROS The cow is standing so more comfortable for the surgeon Closure Simplified
CONS Less exposure Cow can go down Peritoneal contamination
PROS AND CONS OF STANDING LEFT FLANK
Pre-Op Treatment: Epinephrine 10 mL IM injection Flunixin Meglumine (1.1 mg/kg) 15 mL IV injection Florfenicol (6 ml/100lbs) 90 mL Subcutaneous injection
Inverted “L” block with 250 mL 2% Lidocaine Incision midway between last rib and the wing of the
ilium ending approximately ten inches vertically, individually incising through: Skin External Abdominal Oblique Internal Abdominal Oblique Transversus Abdominus Peritoneum
LEFT FLANK C-SECTION STEPS
Palpate the uterus, pull limb If forelimb:
Carpus to toe pulled out of incision site
If hindlimb: Hock to toe pulled out of
incision site
Make vertical incision through uterus and placenta
Remove calf and uterine fluid
LEFT FLANK C-SECTION STEPS
Uterus Utrect Pattern
Want an INVERTING pattern for luminal seal
Chromic Gut #2 Cleansed with Sterile Saline
solution around the incision site to reduce the chance of infection and reduce uterine fluid in the abdominal cavity
IMPORTANT Place uterus back into
CORRECT position The uterus was pulled to the
left so then the uterus was pushed back into the abdominal cavity placing the right horn into the right abdominal space
CLOSURE
Peritoneum, Transversus Abdominus, Internal Abdominal Oblique Simple Continuous
Chromic Gut #2
External Abdominal Oblique Simple Continuous
Chromic Gut #2
Skin Fords Interlocking Pattern
Appositional Nylon 3 ply
CLOSURE
DeadMaleWeighed approximately 100 lbsFetal-maternal mismatch
UNEXPECTED “TWIST”
Can be good- worsens with timeDepends on:
Severity of torsion Systemic compromise
Complications of the C-section can include: Retained Placenta Metritis Incisional edema Peritonitis Infertility Adhesions
THE FATE OF THE COW
FATE OF #52
Pearson H. Uterine Torsion in Cattle: A review of 168 cases. Veterinary Record 1971:597-603.
Noakes DE. Ferti l i ty and Obstetr ics in Cattle . 2 ed. Cambridge, MA: Blackwell Science, 1997.
Schonfelder AMaS, Axel. Cesarean Section and Ovariohysterectomy After Severe Uterine Torsion in Four Cows. Veterinary Surgery 2006;35:206-210.
Roberts, Stephen J and Hi l lman, Robert B. An Improved Technique for the Rel ief of Bovine Uterine Torsion. Cornel l Vet . 1973, 63:111-116
Youngquist RS. Current Therapy in Large Animal Theriogenology . Phi ladelphia, PA, 1997.
Zaborski Review Factors aff ecting dysotcia in cattle http:/ /
www.vin.com/members/proceedings/proceedings.plx?CID=WVC2002&PID=1051&O=VIN
http:/ /www.vet.uga.edu/lam/teaching/mueller/FemaleBovUrogen.swf http:/ /www.ncbi.nlm.nih.gov/pmc/artic les/PMC2275340/#!po=60.9375 http:/ /www.ncbi.nlm.nih.gov/pmc/artic les/PMC1687017/?page=1 http:/ /
books.google.com/books?id=DYGUFOLiGWkC&pg=PA50&dq=uterine+torsion+in+cow&hl=en&sa=X&ei=cVxHU4eMMYnu2QWU2IHoCw&ved=0CCsQ6AEwAA#v=onepage&q=uterine%20torsion%20in%20cow&f=false
REFERENCES
GodMy Amazing FamilyFriends all over the countryDr. Jenna Bayne All the Large Animal CliniciansFood Animal Block Crew “You pick me up when I fall”Radiology Rotation Trimac FarmSebastian and Colby
A GREAT BIG “WAR EAGLE” THANKS