Cecal Dilatation and Torsion Associated with Phytobezoar Obstruction in a Heifer
Authors: Waterloo Mateus De Melo Lima , Gonçalves Saulo Romero Felix , Araújo Ebla Lorena Sales de , Lima Gustavo Simões , Albuquerque Karoline Antunes de , Albuquerque Pedro Paulo Feitosa de , Rizzo Huber , Oliveira Andrea Alice da Fonseca 
Published: June 2021

Background: Dilatation of the cecum associated with intestinal torsion is a fermentative digestive disease that has a low occurrence in veterinary medicine, particularly in large animal practice. This condition is most prevalent in dairy cattle. The etiology of this digestive system disorder is related to changes in nutritional management. As it is an uncommon condition that is frequently observed in the practice of veterinary medicine, the objective of this report was to describe a case of dilatation and torsion of the cecum associated with phytobezoar obstruction in a heifer that was examined at the Veterinary Hospital of the Federal Rural University of Pernambuco (HOVET-UFRPE), Recife, Brazil.Case: A 55-day-old heifer, with a history of abdominal distension associated with difficulty feeding and neurological signs of hind limb paresis, intentional head tremors, and prostration, was examined at the HOVET-UFRPE large animal clinic.A clinical examination demonstrated the presence of enophthalmos, abdominal distension, pale coloration of the ocular mucous membranes, and a moderate level of dehydration (3%). The dehydration was treated through the administration of 1.150 L of saline solution along with 6 mL of Bionew (Vetnil®), 15 mL of calcium solution, and 5 mL of 50% glucose. Subsequently, the animal underwent intestinal washing through the insertion of an oral probe, which resulted in the expulsion of putrid content. Afterward, the animal’s blood was collected and sent to the Clinical Pathology Laboratory of the Department of Veterinary Medicine at HOVET-UFRPE for a complete blood count and analysis of the total protein. The complete blood count showed intense anisocytosis, mild polycythemia, and leukocytosis associated with neutrophilia. The subject died 24 h after the initial consultation at HOVET-UFRPE. The corpse was subsequently sent for a necropsy examination at the Animal Pathology Department of the School of Veterinary Medicine of UFRPE. The necropsy examination of the abdomen showed dark coloration of the intestines and dilatation extending from the small intestine to the large intestine, which was associated with torsion at the level of the ileocecal junction. The rumen contained five structures that were compatible with phytobezoars. These were measured to be between five and 15 cm. The kidney was dark red in color, and the spleen was pale and retracted. The cause of death was a circulatory shock secondary to cecal dilatation and torsion caused by the phytobezoar obstruction.Discussion: Insufficient nutritional management is one of the most important factors associated with cecal dilatation and torsion, as it can influence the formation of phytobezoars. Intestinal obstruction caused by phytobezoars has a higher prevalence in dairy cows during the first two weeks of lactation, after a period of activity or in the final stages of pregnancy. Additionally, an increased intake of fast-fermenting foods rich in carbohydrates can also result in the occurrence of digestive disorders of the cecum. Therefore, a rapid and appropriate diagnosis is essential for a more favorable prognosis. Cecal dilatation and torsion associated with phytobezoar obstruction are considered a rarely occurring digestive disorder that can go unnoticed. Adequate nutritional management is an essential component in the prevention of this fermentative disorder.