INTERNATIONAL JOURNAL OF VETERINARY AND ANIMAL MEDICINE (ISSN:2517-7362)

Large number of species can suffer because of gastro-intestinal foreign bodies (bezoars); the word bezoar is derived from Arabic “badzehr” or the Persian word “padzahr”, meaning an antidote for poisons, and those found in the goat were considered to have healing properties. Depending on the content, there can be phytobezoars, trichobezoars, trichophytobezoars, lactobezoars, lithobezoars or pharmacobezoars. In the last decades, due to urban development and pollution, it became difficult to ignore the adverse effects of nylon debris on the hayfield or pastures. Although small ruminants have a different prehension than bovines, they can introduce indigestible materials like plastic that may represent a core for the future bezoars. In this paper, a 5-year-old, 17 Kg body weight Tibetan doe was referred in January 2017 to the Teaching Veterinary Hospital (OVUD) at the Department of Veterinary Medicine University of Perugia, Italy, with a sudden occurrence of lateral recumbence, anorexia and opisthotonus. On presentation, the goat had poor body condition score, opisthotonus, congested mucous membranes, tachycardia, dyspnea, tympanic and atonic rumen. Body temperature was 34.7 °C and on transabdominal palpation, a large and consistent intra-abdominal mass was appreciated. At the ultrasound scan, the mass was characterized by a hyperechoic and irregular surface, extending from pelvic inlet to the cranial abdomen. A diagnosis of phytobezoar/trichobezoar was advanced. A left paralumbar fossa laparotomy was carried out in order to remove the foreign body; briefly, a local anesthesia was performed with 10 ml of lidocaine chlorhydrate 2% in a reverse L block technique. Upon partial rumen exteriorization and rumenotomy, the phytobezoar (35 X 30 X 25 cm and 2.3 Kg), composed of a compact mixture of ropes, jute packaging, electric wires, and plastic material, was removed; at external examination, it assumed the shape of the rumen. Postoperative therapy included administration of antibiotics and anti-inflammatory drug. An improvement of the clinical signs was observed in the following two days; then, nervous signs worsen and nystagmus appeared inducing us to perform euthanasia with 6 ml of Tanax® intravenously. At necropsy, the rumen contained a green and dense fluid and its mucosa papillae were alternatively thin and short, whereas the abomasum a compact and mixed foreign body. In conclusion, plastic litter and other indigestible materials could be lethal in small ruminants that are grazing in urban context. Late diagnosis and appearance of nervous symptoms did not allow the recovery of the clinical features even if a prompt rumenotomy was performed. 

Intra-rumen; Unusual; Phytobezoar; Tibetan goat

Large numbers of species, including humans, pets, ruminants and wild animals have been noted as suffering because of foreign bodies (bezoars) at different levels of the gastrointestinal tract [1-11]. The word bezoar is derived from Arabic “badzehr” or the Persian word “padzahr”, meaning an antidote for poisons, and those found in the goat were considered to have healing properties and were therefore much sought after for medicinal purposes [2, 6,12]. In 1662, the English king, James the Ist, had a bezoar stone covered in gold included in his crown [2]. Goats were first connected with the term bezoar in the 12 century BC after stone-like concretions were found in the stomach of a Syrian goat [6]. Depending on the content, there can be phytobezoars, trichobezoars, trichophytobezoars, lactobezoars, lithobezoars or pharmacobezoars [4,13-14,8,11,12]. Mainly in young ruminants, because of fibers or trace element deficiency (copper, zinc cobalt, calcium, phosphorus, sodium, chloride, manganese, as well as vitamin or a protein deficiency) trichophagia could be noticed; this behavior is characterized by persistent suckling of congeners or excessive licking as a result of lice or mange infestation [1,9].

In the last decades, because of urban development and pollution, it became difficult to ignore the adverse effects of nylon debris on the environment, especially on the hayfield or pastures. Although small ruminants (sheep and goats) have a different prehension than bovines, they can ingest indigestible materials like plastic that may represent a core for the future bezoars, alongside of undigested nutrients [7,11]. Poorly digestion of plants / or hair results in fibers accumulation in the rumen, but especially in the abomasum. Here, under the influence of ruminal and abomasal movements, numerous conglomerates (possibly around plastic debris or milk clot as nucleus) can agglutinate firmly in one single forestomach. If the trichobezoars are small, they can go through intestines causing ulcer and melena [12].

In goats, clinical signs of phytobezoars are much more pronounced than sheep. It can be seen progressive loss of rumen contractions, distended rumen or abomasum (gas, hair, balls, feces), abdominal pain, lower milk production, anorexia, weight loss, decreased fecal production, lethargy [1,11]. Obstruction of the reticulo-omasal orifice by phytobezoars causes rumenitis, regurgitation, aspiration, pneumonia, and even death [10].

After a clinical (clinical signs and abdominal palpation) and paraclinical (abdominal computed tomography, radiography and ultrasonography) diagnosis, a surgical treatment must be applied depending both on the localization and the size of the bezoars [10, 12].

The aim of this case report was to present a chronic wasting syndrome secondary to a ruminal foreign body in a 5-year old Tibetan goat.

An intravenous access was applied through an 18G catheter into the right cephalic vein and a warm saline solution was administered in order to increase body temperature, alongside with an infrared lamp placed upon the animal. Ultrasound scan was performed and the intra abdominal mass was characterized by a hyperechoic and irregular surface, with posterior shadows, extending from pelvic inlet to the cranial abdomen, on both sides. A diagnosis of phytobezoar/ trichobezoar was advanced. Therefore, unwilling of the poor prognosis, we performed a left flank celiotomy.

Rumen wall was closed with a 2-0 metric absorbable suture (PGA®), in a two introverting layers suture pattern and the incision site was carefully washed with sterile saline solution. Finally, abdominal wall was closed with a 2-0 absorbable suture (PGA®), through simple continuous pattern.

Temperature at the end of the surgery was 35.7 °C and the doe was treated with antibiotics (1g Ceftriaxone®, diluted into 10 ml of saline solution, spread in peritoneal cavity) and anti-inflammatory drug (Desashock® 2mg/Kg, IV). Warmed saline solution supplemented with vitamin B complex (Superton® 50 mL, IV) was perfused during the surgery. Systemic antibiotic therapy was started with Clamoxyl® RTU (7mg/Kg, IM) and was continued the following days.

In Tables 1 and 2 are reported the hematology and biochemistry profiles that evidenced a marked hypocalcaemia and a slightly altered renal functionality. High creatinine kinase concentrations were due to muscle damage occurred during surgery. Therefore a slow calcium gluconate infusion was started and cardiac activity was monitored by activating an ECG.

The day-2 after surgery, hypocalcaemia was still present, opisthotonus worsen and body temperature dropped again to 35.7°C. A second infusion of calcium was then administered, together with vitamin complex, anti-inflammatory and antibiotics.

On third day, there were any improvement of the nervous signs and nystagmus appeared. Therefore, the doe was subjected to euthanasia with 6 ml of Tanax® intravenously.