Surgical management of gravid uterus hysterocele in a goat

Introduction

Passage of body organs or tissues via natural or acquired openings is known as hernia. This condition can be observed in almost all animal species. Lateral abdominal hernia in advanced pregnant ruminants occur occasionally and more frequently to the right side of abdomen (Roberts, 1971) [13] . It may also lead to dystockia (Oeheme and Prier, 1974) [9] . However, cases of dystocia in goat are not commonly reported (Bhattacharyya et al., 2015) [4] . Trauma which may be a kick, blow, horn injury or falling on blunt objects or accident from automobile was reported to be the main cause of ventral abdominal hernia (Radhakrishnan et al., 1993) [12] and rupture of prepubic tendon (Frank, 1981; Arthur, 1989) [6,3] . Such conditions are usually observed in pluriparous animal in advance pregnancy where the abdominal muscles and prepubic tendon became weak and fragile (Vijayanand et al., 2012) [15] . The present case report discuss a rare condition in goat where gravid uterus hysterocele and dystocia thereof has been resolved successfully with surgical intervention.

Case History and Diagnosis

A five year old pregnant goat with a history of swelling over leftventro-lateral abdomen and udder (Fig. 1). The animal was about to complete her gestation period in three days but hit at abdomen with horn by other goat one day ago. On physical examination the skeleton of fetus was felt over skin swelling. The physiological parameters like rectal temperature (101.3 0 F), heart rate (68 per minute), Respiration rate (14 per minute) were found within normal range. The case was diagnosed as hysterocele of gravid uterus.

Treatment

The goat was restrained in lateral recumbency. For surgical preparation of the animal the left lateral abdomen from last rib to stifle fold was shaved and scrubbed thoroughly using chlorhexidine scrub. Antisepsis was achieved using povidone iodine solution (10%). Keeping in view of the pregnancy status of the animal only local anesthetic Inj. Lignocaine HCL 2% (15 ml) was given at the site of incision. A fifteen centimeter long obliquevertical incision was given over the hernia. After skin incision the uterine wall was directly approached after some blunt muscle separation as the hernial ring was enough wide to easily approach the uterus. The uterine wall was incised at an area where there was minimum vasculature present. Threelive fetuses were retrieved from uterus. All this procedure was made quickly work the safety of fetus.

The fetuses were cleaned and dried with towel and their umbilicus was ligated. The uterine lumen was flushed with metronidazole solution. The uterus was closed with suture vicryl no. 2/0 applied in cushing and then lambert pattern (Fig. 4). The muscles were closed in two layers using suture chromic catgut no. 2 in interlocking continuous pattern. Skin was opposed with suture silk no. 1 applied in horizontal pattern (Fig. 2). Post operatively, the animal was given antibiotic (Inj. Ceftriaxone @ 20 mg/Kg b. wt. Intramuscular), analgesic (Inj. Flunixinmeglumine @ 1 mg/Kg b. wt. Intramuscular) and Inj. Tribivet 5 ml intramuscular for one week. Antiseptic dressing of skin sutures was done using povidone iodine (10%) for fifteen days after which skin sutures were removed. The animal showed uneventful recovery and all three kids survived (Fig. 3).

Discussion

A hernia lower to the stifle fold is considered as ventral abdominal hernia and above the stifle fold or any other site on abdomen is considered as lateral abdominal hernia (Tyagi and Singh, 1993) [14] . It may further be reducible or irreducible depending upon the ease to push back the hernia contents to their normal anatomical location (Tyagi and Singh, 1993) [14] . In this case the hernia is traumatic, ventral abdominal reducible hernia. The hernia swelling reached from last rib to stifle fold horizontally and from paravertebral fossa to udder vertically. A hernia must be differentiated from abscess, cyst, tumor, haematoma etc. so that proper line of treatment can be decided. In collaboration with history, clinical sign and examination of animal, plain and contrast radiography and ultrasonography can play pivotal role to differentiate hernia from other confusing conditions (Abidin and Ramadan, 2001) [1] . Lack of availability of resources and poor economic condition of animal owner restrict our diagnosis to history, physical examination and clinical signs and symptoms which ultimately proved to be true.

In present case horn trauma from other goat lead to ventral hernia of full term gravid uterus with three live fetuses confirmed only with their movement felt during physical examination.

In most of such cases fetuses found dead or not survive (Kumar et al., 2018 and Parvez et al, 2016) [8,10] . In such traumatic cases the uterine wall may rupture compromising life of fetus. Lately reported cases may develop adhesions, necrosis, and ruptured hysterocele (Peker et al, 2019) [11] . In such timely reported cases emergency caesarian is always the treatment of choice (Erdogan et al, 2015 and Khan et al, 2018) [5,7] . Diseases associated with reproduction always give an economic set back to the farmers (Ali et al, 2019) [2] . Such cases are rarely reported either due to lack of knowledge of the goat rears or lack of available facilities. The success of this case depended mainly upon the timely reporting of the case and emergent caesarian section done. It can also be concluded that lack of high end diagnostic facilities should not overcome the zeal to save life of animal and farmer's economy.

References

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