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Livestock Research International | April-June, 2015 | Vol 3 | Issue 2 | Pages 47-50 © 2015 Jakraya Publications (P) Ltd LIVESTOCK RESEARCH INTERNATIONAL Journal homepage: www.jakraya.com/journa/lri CASE REPORT Grade II Vaginal Prolapse In A Buffalo Due To Uneven Flooring: A Case Report *1,2 Faez Firdaus Jesse Abdullah, 1 Eric Lim Teik Chung, 3 Lawan Adamu, 4 Yusuf Abba, 3 Abdulnasir Tijjani, 3 Muhammad Abubakar Sadiq, 3 Konto Mohammed, 5 Mohd Azmi Mohd Lila and 1 Abdul Wahid Haron 1 Department of Veterinary Clinical Studies, 5 Department of Veterinary Pathology and Microbiology, Faculty of Veterinary Medicine, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia. 2 Research Centre for Ruminant Disease, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia. 3 Department of Veterinary Medicine, 4 Department of Veterinary Pathology and Microbiology, Faculty of Veterinary Medicine, University of Maiduguri, PMB1069, Borno State, Nigeria. *Corresponding Author: Faez Firdaus Jesse Abdullah Email: [email protected] Received: 29/03/2015 Revised: 17/04/2015 Accepted: 18/04/2015 Abstract The two main factors that contribute to this clinical case are the uneven flooring and dietary factor. This reports a clinical case of grade II vaginal prolapse in a two year old female Murrah Buffalo managed in an intensive farm with uneven flooring. The particular buffalo had just calved down a day before presentation. Physical examination findings revealed the buffalo was in pyrexic condition, dull and depressed with congested mucous membrane. There was also protrusion of mass from the vulva region. The therapeutic plan for this case was reduction, reposition and retention of the prolapse via Buhner’s method. The buffalo was administered with flunixin meglumine, 1.1mg/kg, intramuscularly, as anti inflammatory, Benacillin, 1ml/16kg, intramuscularly, as broad spectrum antibiotic and theracalcium 100 ml, intravenously as calcium supplement. Prompt management and treatment of grade II vaginal prolapse are necessary to prevent further complications that will predisposed the buffalo to uterine infection, infertility or even death. Keyword: Vaginal prolapse, Nutritional factor, Uneven flooring. 1. Introduction Prolapse is defined as falling down, or downward displacement, of a part or viscus (Blood et al., 2007). Vaginal prolapse is the edematous enlargement of vaginal tissue during estrus and is common problem presents in mature females during their last trimester of pregnancy. There are 4 grading scale that recognize four different type of vaginal prolapse (Wolfe and Carson, 1999). For grade I, the prolapse can be seen intermittently especially when the cow is lying down. This grade can be progress to grade II if left untreated. For grade II, the prolapse is continuous with plus or minus urinary bladder retroflexed. In this type of prolapse, involvement of urinary bladder can interfere urination and cause persistent straining. Both grade I and II require temporary retaining suture or cull after calving or perform permanent fixation technique if embryo flush cow. As for grade III, the prolapse is continuous with urinary bladder and cervix. This condition can compromise urine outflow and ureters and should be treated quickly to prevent life threatening injury. Grade IV occur when grade II and grade III together with trauma, infection or necrosis of vaginal wall. Both grade III and IV require permanent fixation or induce parturition or C-section for commercial cow. Besides nutritional imbalance, higher incidence of genital prolapse was also recorded in farms with uneven flooring (Bhatti et al., 2006). This clinical case reports the management grade II vaginal prolapse due to nutritional factor and uneven flooring. 2. Case Report 2.1 History A 2 year old female Murrah buffalo weighing 450kg was presented with complain of a mass protruding out from the vulva region. The vaccination and deworming status were up-to-date. The particular buffalo had just calved down a day before presentation. 2.2 Physical Examination Physical examination findings revealed that the buffalo was having pyrexia (39.4C), dull and -

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Livestock Research International | April-June, 2015 | Vol 3 | Issue 2 | Pages 47-50 © 2015 Jakraya Publications (P) Ltd

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CASE REPORT

Grade II Vaginal Prolapse In A Buffalo Due To Uneven Flooring: A Case Report

*1,2Faez Firdaus Jesse Abdullah, 1Eric Lim Teik Chung, 3Lawan Adamu, 4Yusuf Abba, 3Abdulnasir Tijjani, 3Muhammad Abubakar Sadiq, 3Konto Mohammed, 5Mohd Azmi Mohd Lila and 1Abdul Wahid Haron 1Department of Veterinary Clinical Studies, 5Department of Veterinary Pathology and Microbiology, Faculty of Veterinary Medicine, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia. 2Research Centre for Ruminant Disease, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia. 3Department of Veterinary Medicine, 4Department of Veterinary Pathology and Microbiology, Faculty of Veterinary Medicine, University of Maiduguri, PMB1069, Borno State, Nigeria.

*Corresponding Author: Faez Firdaus Jesse Abdullah Email: [email protected] Received: 29/03/2015

Revised: 17/04/2015

Accepted: 18/04/2015

Abstract The two main factors that contribute to this clinical case are the

uneven flooring and dietary factor. This reports a clinical case of grade II vaginal prolapse in a two year old female Murrah Buffalo managed in an intensive farm with uneven flooring. The particular buffalo had just calved down a day before presentation. Physical examination findings revealed the buffalo was in pyrexic condition, dull and depressed with congested mucous membrane. There was also protrusion of mass from the vulva region. The therapeutic plan for this case was reduction, reposition and retention of the prolapse via Buhner’s method. The buffalo was administered with flunixin meglumine, 1.1mg/kg, intramuscularly, as anti inflammatory, Benacillin, 1ml/16kg, intramuscularly, as broad spectrum antibiotic and theracalcium 100 ml, intravenously as calcium supplement. Prompt management and treatment of grade II vaginal prolapse are necessary to prevent further complications that will predisposed the buffalo to uterine infection, infertility or even death.

Keyword: Vaginal prolapse, Nutritional factor, Uneven flooring.

1. Introduction Prolapse is defined as falling down, or

downward displacement, of a part or viscus (Blood et al., 2007). Vaginal prolapse is the edematous enlargement of vaginal tissue during estrus and is common problem presents in mature females during their last trimester of pregnancy. There are 4 grading scale that recognize four different type of vaginal prolapse (Wolfe and Carson, 1999). For grade I, the prolapse can be seen intermittently especially when the cow is lying down. This grade can be progress to grade II if left untreated. For grade II, the prolapse is continuous with plus or minus urinary bladder retroflexed. In this type of prolapse, involvement of urinary bladder can interfere urination and cause persistent straining. Both grade I and II require temporary retaining suture or cull after calving or perform permanent fixation technique if embryo flush cow. As for grade III, the prolapse is continuous with urinary bladder and cervix. This condition can compromise urine outflow and ureters and should be treated quickly to prevent life threatening injury. Grade

IV occur when grade II and grade III together with trauma, infection or necrosis of vaginal wall. Both grade III and IV require permanent fixation or induce parturition or C-section for commercial cow. Besides nutritional imbalance, higher incidence of genital prolapse was also recorded in farms with uneven flooring (Bhatti et al., 2006). This clinical case reports the management grade II vaginal prolapse due to nutritional factor and uneven flooring. 2. Case Report 2.1 History

A 2 year old female Murrah buffalo weighing 450kg was presented with complain of a mass protruding out from the vulva region. The vaccination and deworming status were up-to-date. The particular buffalo had just calved down a day before presentation. 2.2 Physical Examination

Physical examination findings revealed that the buffalo was having pyrexia (39.4⁰C), dull and -

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Abdullah et al…Grade II Vaginal Prolapse In A Buffalo Due To Uneven Flooring: A Case Report

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Fig 1: Congested mucous membrane of the vagina.

Fig 3: Location of epidural anaesthesia

depressed with congested mucous membrane (Fig 1). There was protrusion of mass from the vulva of the buffalo (Fig 2).

2.3 Treatment

The therapeutic plan for this case wasreposition, and retention of the prolapsemethod. Epidural anesthesia was the 1st and 2nd coccygeal vertebrae before repositioning(Fig 3). Firstly, the vulva and part of vagina was cleaned with diluted chlorhexidine Buhner’s needle was inserted through the skin at the dorsal part of the perivulva. Then, thewas passed through the needle. The same technique was applied on the other side (Fig 5)

Abdullah et al…Grade II Vaginal Prolapse In A Buffalo Due To Uneven Flooring: A Case Report

April -June, 2015 | Vol 3 | Issue 2 | Pages 47-50 Jakraya Publications (P) Ltd

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Congested mucous membrane of the vagina. Fig 2: Vagina protruding out from the vulva.

Location of epidural anaesthesia. Fig 4: Vulva and part of vagina was cleaned with

diluted chlorhexidine.

depressed with congested mucous membrane (Fig 1). There was protrusion of mass from the vulva of the

plan for this case was reduction, prolapse via Buhner’s

performed between before repositioning part of vagina was (Fig 4). Then, the

needle was inserted through the skin at the , the umbilical tape

was passed through the needle. The same technique (Fig 5). A cross suture

pattern was performed (Fig 6)lace’ suture was applied wheretied (Fig 7). Acriflavine applied at the suture site andaround it (Fig 8). As for the medication, meglumine, 1.1mg/kg, was given three days as anti inflammatory,was given intramuscularly doses as broad spectrum borogluconate 100 mL, was as calcium supplement. 2.4 Progression

Revisit of the case was done two weeks after the treatment and the buffalo responded well to the

Abdullah et al…Grade II Vaginal Prolapse In A Buffalo Due To Uneven Flooring: A Case Report

Vagina protruding out from the vulva.

Vulva and part of vagina was cleaned with

(Fig 6). In this case, the ‘shoe-where the end of the lace was

Acriflavine as antiseptic cream was and woundsarex was sprayed

As for the medication, Flunixin was given intramuscularly for

as anti inflammatory, Benacillin, 1ml/16kg, intramuscularly every 72 hours for three broad spectrum antibiotic and Calcium

was given intravenously once

Revisit of the case was done two weeks after the treatment and the buffalo responded well to the -

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Fig 5: Buhner’s needle was inserted at dorsal part of the perivulva

Fig 7: The end of the lace was tied. treatment. The buffalo was bright and alert with no protrusion observed at the vulva region. Thus, suture removal was performed. The prognosis of this case was good in term of recovery but poor for breeding performance because the recurrence of vaginal prois very high. 3. Discussion

Parturition, excess hormone production, nutrition, hypocalcaemia, and flooring are a few predisposing factors leading to the occurrence of vaginal prolapse (Miesner and Anderson, 2008). In this case, the buffalo was in the last trimester of pregnancy. Firstly, hormonal changes at last trimester of pregnancy especially increase level of estrogen and production of relaxin will cause a relaxation at the pelvic ligaments and surrounding tissue structures 1999). Secondly, increase in intra

Abdullah et al…Grade II Vaginal Prolapse In A Buffalo Due To Uneven Flooring: A Case Report

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Buhner’s needle was inserted at the

dorsal part of the perivulva Fig 6: Cross suture pattern was performed

The end of the lace was tied. Fig 8: The end product of Buhner’s method

treatment. The buffalo was bright and alert with no protrusion observed at the vulva region. Thus, suture removal was performed. The prognosis of this case was good in term of recovery but poor for breeding performance because the recurrence of vaginal prolapse

excess hormone production, and flooring are a few

predisposing factors leading to the occurrence of vaginal prolapse (Miesner and Anderson, 2008). In this case, the buffalo was in the last trimester of pregnancy.

ormonal changes at last trimester of pregnancy crease level of estrogen and production of

relaxin will cause a relaxation at the pelvic ligaments and surrounding tissue structures (Wolfe and Carson,

intra- abdominal pressure

will occur due to uterus distention, rumen distenaccumulation of intra-abdominal fat (Kahn, 2005). Besides that, this buffalo was fed with high level of concentrates and very little forage. such as low quality of forage, high level of concentrate and hypocalcaemia are contributes to the incidence of Hypocalcaemia due to the insufficient calcium in the diet will predispose the buffaloal., 2014). In this case, flooring also becomes one of the predisposing factors oUneven flooring contributes to the gravity that assists the eversion and prolapseobserved by Bhatti et alincidence of genital prolapse was recorded in uneven floor compared with the brick floor and slopping floor condition. This case reportsthe prolapse is continuous with plus

Abdullah et al…Grade II Vaginal Prolapse In A Buffalo Due To Uneven Flooring: A Case Report

Cross suture pattern was performed

The end product of Buhner’s method

due to uterus distention, rumen distention or abdominal fat (Kahn, 2005).

this buffalo was fed with high level of concentrates and very little forage. Nutrition factors such as low quality of forage, high level of concentrate

are the common factor that the incidence of vaginal prolapse. due to the insufficient calcium in the

buffalo to the prolapse (Jesse et In this case, flooring also becomes one of

the predisposing factors of the vaginal prolapse. Uneven flooring contributes to the gravity that assists

prolapse. The similar finding was also et al. (2006), where higher

incidence of genital prolapse was recorded in uneven floor compared with the brick floor and slopping floor

reports of grade II prolapse where prolapse is continuous with plus or minus urinary

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bladder retroflexed (Wolfe and Carson, 1999). Grade II require temporary retaining suture where Buhner’s suture technique was used in this case (Pitmann, 2010). 4. Conclusion

Control of vaginal prolapse can be achieved by considering the predisposing factors in the management of the herd. In this report, the farmer was advised to

improve the feeding quality and flooring of the farm to avoid further cases of vaginal prolapse.

Acknowledgment

The authors wish to acknowledge Encik Nazim Razali Kanini, Encik Mohd Jefri Noraidin, University Veterinary Hospital (UVH), and Faculty of Veterinary Medicine Universiti Putra Malaysia for their technical assistance.

References Bhattacharyya HK, Fazili MR, Buchoo BA and Akand AH

(2012). Genital prolapse in crossbred cows: prevalence, clinical picture and management by a modified Buhner’s technique using infusion (drip) set tubing as suture material. Veterinarski Arhiv, 82(2): 11-24.

Bhatti MS, Ahmad I, Ahmad N, Lodhi LA and Ahmad M (2006). Epidemiologycal survey of genital prolapse in buffaloes kept under different systems and serum micro mineral contents. Pakistan Veterinary Journal, 26(4): 197-200.

Blood DC, Studdert VP and Gay CC (2011), Saunders Comprehensive Veterinary Dictionary (4th Edition), Saunders, London.

Jesse FFA, Abba Y, Adamu L, Tijjani A, Osman AY, Saharee AA and Wahid A (2014). Management of grade I vaginal prolapse in a Friesien cross: A case report. IOSR Journal of Agriculture and Veterinary Science, 7(1): 74-77.

Kahn CM and Line S (2005). The Merck Veterinary Manual 9th Edition, Merial, USA.

Konig HE and Liebich HG (2004). Veterinary Anatomy of Domestic Mammals. (4th Edition, Schattauer, New York.

Miesner MD and Anderson DE (2008). Management of uterine and vaginal prolapse in the bovine. Veterinary Clinics of North America: Food Animal Practices, 24: 409-419.

Pittman T (2010). A retention stitch technique for vaginal prolapse repair in cattle. Canadian Veterinary Journal, 51(12): 1347-1348.

Wolfie DF and Carson RL (1999). Large Animal Urogenital Surgery (1st Edition), Williams and Wilkins, USA.

Yotov S, Atanasov A, Antonov A and Karadaev (2013). Post oestral vaginal prolapse in a non-pregnant heifer. Trakia Journal of Science, (11)1: 95-101.