Traumatic reticuloperitonitis (TRP) often referred to as hardware disease is a common disease of cattle, which is considered the most frequent cause of anterior abdominal pain in cattle (7). Although the incidence of TRP has been shown decreasing due to advances in farm management practices and preventative strategies, TRP remains a clinically significant disease due to the severe loss of production it causes and the high mortality rate (1,5,10). TRP occurs when a cow ingests sharp foreign objects, such as wire, nails, or screws, which then perforate the reticulum (7). Cattle ingest foreign objects due to poor farm management practices and their behavioral characteristics of having a comparatively insensitive mouth (4,7,10). The most common clinical signs of TRP are abnormal general behavior (87%), reduced rumen motility (72%), poorly digested feces (57%), decreased or absent intestinal ruminal motility (50%), reduced rumen fill (49%), fever (43%), and spontaneous signs of pain (39%) (3). Cows displaying these clinical symptoms should undergo a back grip test. If the cow exhibits sign of discomfort during the test, it is diagnosed as TRP (1,5). Currently, with the advances in imaging diagnostics, radiography and ultrasound are also used for diagnosis (1,5,7,9). The treatment methods for TRP can be divided into conservative medical treatment and surgical approaches. Conservative medical treatment involves the oral administration of a reticular magnet into the reticulum and the administration of antibiotics. Surgical treatment involves performing a rumenotomy to remove the foreign bodies manually (2,5,7). Surgical treatment has been found to yield slightly better outcomes than conservative medical treatment (2). This paper reports a case of a TRP in a Mongolian cow, detailing the diagnosis, surgical preparation, and surgical procedure successfully carried out through the cooperation of the Korean (College of Veterinary Medicine, Jeju National University)–Mongolian (School of Veterinary Medicine, Mongolian University of Life Science) volunteer team (KMVT) in the field of suburban farm of Mongolia.

An eight-year-old female Mongolian cow weighing 400 kg pastured in Batsümber, Töv Province, near Ulaanbaatar, Mongolia, was presented to the KMVT during their outreach activity for veterinary volunteer service because of the clinical signs of depression and anorexia. The owner stated that the cow was grunting and falling behind. The body temperature, heart rate, and respiratory rate were 39.3°C, 80 beats per minute, and 32 times per minute, respectively. A physical examination showed that the body condition score (BCS) was in between 3/9 and 4/9 closer to borderline from the thin condition (Fig. 1A). The amount of feces was reduced and contained many undigested particles. The abdominal auscultation indicated decreased ruminal motility (Fig. 1B). The back grip test was positive; the cow exhibited severe abdominal pain during the test (Fig. 1C). Because ultrasound or X-ray imaging was unavailable in the field, the diagnosis of TRP was established based on the clinical symptoms and the results of physical examination, auscultation, and back grip test. With the owner’s consent, an emergency rumenotomy was decided.

Figure 1. Diagnostic procedures performed in the field of suburban farm. (A) The patient at presentation. The patient was not grazing due to abdominal pain and isolated from the herd and the BCS was in between 3/9 and 4/9 closer to borderline from the thin condition. (B) The abdominal auscultation indicated decreased ruminal motility. (C) The back grip test was positive; the cow exhibited severe abdominal pain during the test.

In this case, the surgery had to be performed in the field because transporting the patient to an operating theatre was impossible. Therefore, a makeshift restraint frame was produced using the barn walls, ropes, and wooden blocks. Two wooden blocks, measuring 250 cm in length and 30 cm in width, were nailed to the barn walls 180 cm and 100 cm above the ground. Two ropes were attached to the wooden blocks to restrain the patient (Fig. 2A). The sedative administered was xylazine hydrochloride (Rompun; Bayer, Germany) at a dosage of 0.12 mg/kg, given via an intravascular injection. The surgical incision area, in the left paralumbar fossa, was cleansed thoroughly with water and soap. After clipping the area, it was sterilized with 10% povidone-iodine (Povidin Iodine Liquid 10%; Sungkwang, Korea) twice before the surgery to produce the most sterile environment possible. After waiting for approximately 10 minutes, distal paravertebral anesthesia was applied for the surgery. An 18-gauge, 1.5-inch needle was inserted parallel to the horizontal plane of the L1, L2, and L4 transverse processes. The cow was injected with 10 mL of 2% lidocaine (Daihan Lidocaine HCL Hydrate Inj. 2%; Daihan Pharm, Korea) at a dosage of 0.2 mL/kg, in multiple directions above the transverse processes, and the same method was used to inject below the transverse processes (Fig. 2B). Furthermore, infiltration anesthesia was performed at the anticipated incision site using the inverted L block technique with 2% lidocaine. After anesthesia, the cow was restrained using the makeshift restraint frame by attaching two ropes around its chest and abdomen and waited for 10 minutes (Fig. 2C). A sharp vertical skin incision, approximately 30 cm long, was made on the left flank region. After a blunt skin dissection from the subcutaneous tissue, the external oblique muscle, internal oblique muscle, transverse abdominal muscle, and peritoneum were incised sequentially to expose the abdominal cavity (Fig. 2D). After the laparotomy, the rumen was pulled out of the incision and anchored firmly to the skin dorsally and ventrally using towel clamps. The rumen was incised, and the edges of the rumen were fixed to the cranial and caudal parts of the skin using additional towel clamps. The handles of the clamps were positioned away from the incision site to facilitate the surgery, and the edges of the rumen and skin were overlapped by 2 to 3 cm for fixation. After fixation, a sufficient amount of its contents was emptied manually to allow a thorough exploration (Fig. 2E). Three stones and four sharp metallic foreign bodies were removed after exploring the rumen and reticulum. The sharpest nail had penetrated the base of the reticulum wall (Fig. 2F). After the contents were removed, the rumen was rinsed with sterile saline. For closure, only the dorsal and ventral towel clamps were left in place; the rest were removed. The rumen was sutured with a double lambert suture using sterile absorbable polyglycolic acid of size 2-0 (Dexon II; Covidien, USA). The peritoneum and transverse abdominis were sutured using a simple continuous method with sterile absorbable polyglycolic acid of size 2-0 (Dexon II; Covidien, USA). The internal and external oblique muscles were sutured separately using the same simple continuous method with absorbable polyglycolic acid of size 2-0 (Dexon II; Covidien, USA). Each layer was irrigated with sterile saline after suturing. Finally, the skin was sutured using a monofilament non-absorbable 1-0 (Prolene; Ethicon, USA) in a Ford interlocking pattern. Immediately after surgery, fluid therapy consisted of 1,000 mL of 5% dextrose (5% Dextrose Inj.; JW Pharmaceutical, Korea), 1,000 mL of saline (0.9% Normal Saline Inj.; JW Pharmaceutical, Korea), vitamin B complex (Vitacom; Handong, Korea) and amino acids (Amitop-D; Handong, Korea) was administered intravenously. The surgery was completed successfully, and the cow showed a normal recovery trajectory. Feeding was resumed by the owner immediately after the cow defecated (Fig. 2G). The cow was also treated with antibiotics (PPS; Daesung, Korea) at a dosage of 0.05 mL/kg consisting of 5,000 IU/kg of penicillin G benzathine hydrate, 7,500 IU/kg of penicillin G procaine, and 10 mg/kg of dihydrostreptomycin sulfate and anti-inflammatory medication flunixin meglumine (Fortis; Dongbang, Korea) at a dosage of 1 mg/kg administered intramuscularly for five days. Approximately three weeks after surgery, the wound had healed, and the cow maintained a good condition.

Figure 2. Preparation process for rumenotomy and the surgical procedure in a chronological order. (A) A makeshift restraint was constructed on-site using a wooden fence to perform the emergency surgery. (B) After sedation, distal paravertebral anesthesia was applied. (C) Two ropes were connected to the makeshift restraint to tie around the cow’s chest and abdomen, securing its movements. (D) An approximately 30 cm incision was made through the left paralumbar fossa. (E) The rumen was incised, and a manual exploration was conducted. (F) Three stones and four sharp foreign objects were discovered during the exploration. The sharpest nail had penetrated the base of the reticulum wall (red arrow). (G) The surgery was completed successfully, and the cow showed a normal recovery trajectory. Feeding was resumed by the owner immediately after the cow defecated.

Cattle ingest foreign objects due to poor farm management practices and their comparatively insensitive mouth (4,5,7). The incidence of TRP is sporadic and associated with farm management, but outbreaks have occurred when sharp foreign bodies have become mixed into feed supplies (5,7). Therefore, in well-managed farms, the likelihood of exposure to foreign objects is reduced significantly, resulting in a markedly lower incidence of TRP compared to cattle raised on pasture. According to a survey conducted in Korea, the presence of foreign objects in the internal organs was confirmed in only 5.5% of cases in Korea (4). The incidence of TRP is lower in Korea than in other countries because, while other countries primarily use pasture-based farming, most cattle in Korea are confined in well-managed farms, resulting in a lower chance of cattle ingesting foreign objects. In contrast, the prevalence of TRP is expected to be higher in Mongolia, where pasture-based farming is common due to the characteristics of climate and nomadic livestock farming of Mongolia, which inevitably requires frequent setup and dismantling of the temporary structures including fences resulting in the remnants of the structures left behind on the pasture (8).

Diagnosing TRP is challenging because it does not present with specific clinical symptoms or characteristic findings in blood tests (1,3). The clinical symptoms of TRP include abnormal behavior, decreased rumen motility, and fever (3). These symptoms can also appear in cattle with other diseases, making diagnosing TRP based on a single symptom difficult. In addition, blood tests often show signs of hyperfibrinogenemia and hyperproteinemia, but these findings do not provide significant diagnostic accuracy (3). There are foreign body tests available to diagnose TRP. The principle of these tests aims to apply pressure to the abdominal cavity and observe the pain response caused by foreign bodies. The most important foreign body tests are the back grip, pain percussion over the reticulum with a mallet, and the pole test. Although the sensitivity of these methods vary, they are the most effective TRP diagnostic methods that can be performed immediately in the field (1). Although diagnostic imaging including radiography and ultrasonography are useful complementary methods that provide useful information for the diagnosis and management of TRP, they present significant challenges when performed in the field. In this context, observing abnormal behavior in a cow and conducting a thorough clinical examination is important. In this case, the primary complaints were depression and loss of appetite, so auscultation was performed first. During deep abdominal palpation, a faint grunt was detected using a stethoscope. In addition, the back grip test, the most critical of the foreign body tests, was performed eliciting obvious pain response of the patient. Although the diagnosis of TRP in this case was established based on the observation of abnormal clinical symptoms, auscultation, and foreign body test results, the availability of portable imaging equipment in the field would have allowed for a more definitive diagnosis.

After the diagnosis, the main challenge was preparing for surgery. The necessary medications and equipment were brought from Korea, and additional supplies were sourced locally in Mongolia. The surgery had to be carried out in the suburban area far from Ulaanbaatar, necessitating the adaptation to suboptimal surgical conditions. Proper restraint is essential for performing a rumenotomy on a cow. The restraint frame can support standing cattle and prevent movement to avoid contamination. Consequently, a makeshift restraint frame was constructed from wooden fences from the ranch. Two parallel wooden beams were set up, one higher than the cow and the other at mid-body height. Ropes were then used to secure the cow to the wooden beams, with one rope around the chest and another around the abdomen to prevent forward, backward, or lateral movement. This makeshift restraint frame, quickly and creatively assembled by the KMVT, allowed for safer surgery in the field.

The surgery for TRP was performed using a rumenotomy in a standing position to ensure easy access to the surgical site, prevent rumen prolapse, maintain respiratory function, and reduce contamination in the field. The surgical procedure was carried out in the following order: anesthesia, rumen fixation, evacuation of rumen contents, exploration of the rumen and reticulum, and closure. The distal paravertebral anesthesia and the inverted L block minimized the patient’s pain and movement during the procedure, while the makeshift restraint frame effectively stabilized the patient and prevented contamination of the surgical site. In this surgery, the rumen was fixed using the rumen skin clamp fixation technique, allowing for quick and easy fixation with fewer postoperative complications than other techniques (6). The rumen skin clamp fixation technique facilitated a thorough exploration of the rumen and reticulum, reducing the risk of postoperative complications. The combination of effective anesthesia, proper restraint, and surgical techniques contributed to the successful outcome of the surgery in this case performed in the field of suburban farm in Mongolia.

TRP can be prevented by managing foreign objects, but another effective preventive method is the administration of reticular magnets (1,4). Reticular magnets, which are small and rounded, are used to prevent reticuloperitonitis and minimize the penetration of foreign bodies in acute cases. Administering these reticular magnets orally before age two can significantly reduce economic losses (5,7). These magnets have been shown to reduce the incidence of the disease and its complications significantly (5). Little is known regarding the use of reticular magnets as the preventive measure for TRP in both Korea and Mongolia yet. According to a previously study conducted in Korea, the overall prevalence of traumatic reticular disease (TRD) in 3,121 slaughter cattle was 5.5% but the major lesions related to foreign bodies were reticulitis (96%) and peritonitis (86%), which could be fatal (4). Therefore, administering reticular magnets as the preventive measure for TRP needs to be encouraged in Korea and Mongolia due to their low cost and ease of use.

An eight-year-old female Mongolian cow was diagnosed with TRP based on clinical symptoms, auscultation, and a positive response to the back grip test. The surgery was successfully performed in the field of suburban farm of Mongolia under distal paravertebral anesthesia, aided by a makeshift restraint frame constructed on-site. The foreign object causing a perforation of the reticulum was identified and removed, followed by antibiotics and anti-inflammatory treatment post-surgery. The postoperative condition and prognosis of the patient were favorable. The authors hope this clinical report will assist veterinarians in diagnosing TRP, establishing anesthesia protocols, managing emergency field surgeries, and providing postoperative care for TRP as TRP is ongoing problem that needs to be overcome until today.

This research was supported by the 2023 scientific promotion program funded by Jeju National University.

The authors have no conflicting interests.