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Rumenotomy

RUMENOTOMY This operation, also known as gastrotomy or paunching, is sometimes performed for explora tory purposes in obscure cases of rummal, reticular, or omasal indigestion, for the removal of foreign bodies, sand, or poisonous material that the animal is known to have swallowed, for the partial unloading of the paunch in cases of impaction with food before the animal is unduly exhausted, and a modification of the operation is of marked value in a certain type of acute and in some cases of chronic tympanites.

(1)

Complete rumenotomy, which includes the suturing of the wounds made, is likely to be successful in those cases in which it is possible to avoid or remove such contamination of the serous surfaces and the wound in the abdominal wall as would interfere with healing and in which the operation is not likely to be followed by the occurrence of tympany. The animal should be secured by the neck in a stall, with its right side to the wall. The hair is then shaved from the operation site in the flank. An assistant should hold a horn in the right hand and the nose in the left hand, using, if necessary, bull-dog nose-pincers. To restrain and steady the animal effectively he should stand with his back against its neck, pressing it against the wall and flexing it on his body by pulling the nose to the left. The tail should be tied to the right thigh if it is not used to steady the patient against the wall posteriorly. The operator then inserts a sharp-pointed bistoury through the abdominal wall into the stomach at the usual seat of"puncture of the rumen,"and, cutting outwards and downwards in a slightly forward direction through all the structures simultaneously, he makes a wound from 3 to 6 inches long. If only an explora tion of the stomach for foreign bodies or other obscure causes of digestive trouble is intended and the rumen is not distended, the lips of the stomach wound will not bulge through the outer gap, and the examination of the interior may be done as soon as a piece of jaconet or other suitable material steeped in antiseptic solution has been placed over the lower edges of the wound to prevent soiling and protect the peri toneum. But, should the extraction of more than a little bulky food be necessary, involving repeated insertion of the hand and arm into the stomach, several temporary stitches should be put through the abdominal and gastric walls, binding them together during the emptying process, and two of them may be made to in clude and secure in position the protecting anti septic cloth. This prevents displacement of the stomach during unloading and escape of fluid into the peritoneal cavity. Before closing the wounds the condition of the oesophageal canal, the reticulum, and the omasum should be examined. The temporary stitches and pro tecting cloth are now removed, the edges of the wounds and the adjacent serous surfaces are cleansed with an antiseptic solution, and the stomach opening is closed with sutures of strong catgut so placed that the mucosa will be inverted and the serous surfaces brought firmly together. Thereafter the external wound is recleansed with the antiseptic solution and closed with interrupted sutures of strong silk cord or catgut. Perfect healing should result if due care is exercised to prevent sepsis. For several days after the operation the patient should be restricted in diet to small rations of cooked food, gruels, bran mashes, boiled roots, etc.

(2) Incomplete Rumenotomy . Up to a certain point this operation is essentially the same as that already described, but the binding sutures are not removed and the wound is left to heal at leisure. It is an operation that can be strongly advised in cases where a complete rumenotomy would be likely to fail from sepsis or in which a patent aperture is an advantage for a period to enable excess of gas to escape which, if the wound were closed, would accumu late with disastrous results, forcing us to reopen the stomach or use the trocar and cannula.

This modified rumenotomy should be adopted more often in chronic tympanites, since it not only provides a venue for more accurate etio logical diagnosis and, it may be, the removal of the actual causal factor, but also affords for some weeks absolute immunity from further tympany and its attendant distress and depression. In animals that are subject to chronic indigestion, but especially in milch cows, it is the tympany that chiefly matters so far as their immediate utility in milk-production is concerned, and when its occurrence is provided against by an operation that is not followed by peritonitis the animals do very well and often recover entirely. On the other hand, the repeated use of the trocar and cannula, which implies periods of hoven and depression, usually begets a painful localized peritonitis that hastens the undoing of the animal. But the operation is of the most signal service in these cases of acute tympanites wherein the barmy, semi fluid ingesta bursts out so soon as the stomach is opened. In some cases, and accord ing to the consistence of the material, two or three pailfuls may be voided in a forcible stream with no other assistance than manual retrac tion of the lips of the wound, the fingers being in contact with the mucosa of the stomach. Until the escaping food has ceased to flow spontaneously, there is no danger of any part of it finding its way into the peritoneal cavity, as the viscus is still in close contact with the wall of the abdomen. At this point, not less than six stitches of strong cord should be inserted joining the stomach wall to the abdomen, and as the in-contact serous surfaces are unsoiled there is speedy and healthy union. The needle should be washed and disinfected before the insertion of each stitch. Thereafter the further emptying of the stomach can be carried out until only two or three pailfuls remain. This is accomplished by exerting upward pressure on the abdomen by means of a sheet or sack placed below it and by using a long iron spoon or spatula for the removal of masses that may block the opening. Active fermentation of the remaining ingesta soon ceases; the side of the animal is then washed and the wound cleansed and disinfected. The patient is afterwards placed in a stall with its left side to the wall and warmly clothed, though only a thin sheet should cover the wound. The edges of the wound are subject to soiling if the animal coughs, and should be cleansed and disinfected every day. It usually heals up in five or six weeks, leaving a hollow, puckered scar. The stomach is now permanently fixed to the abdominal wall, but this does not seem to prejudice its functions materially. After-treat ment includes putting the animal on easily digested food for a few days, the administration of a mild purge if necessary, and afterwards stimulants, nerve tonics, and stomachics. The medicaments may be poured directly through the opening into the rumen. It is our experi ence that much value is lost annually in bovine animals because owners are afraid, or hesitate until it is too late, to open the rumen. They should be instructed how to act in an emergency, and the opening, however roughly made, should be large enough in cases occurring in a clover field to admit the escape of the frothy ingesta. The after-treatment of the cases can then be carried out successfully by the practitioner when he arrives.

stomach, wound, wall, operation and animal