Hemorrhagic bowel syndrome: an update (Proceedings)
Following the initial report of jejunal hemorrhage syndrome (JHS) in 1992 by Ruggles et al, the disease has subsequently been reported in dairy cows in the US, dairy and beef cows in Canada, dairy cows in Europe and dairy cows in the Middle East. It has emerged as an economically important disease, particularly within the higher density dairy areas of the United States. The published literature on JHS has concentrated on retrospective case series from a number of countries and investigations into potential risk factors for the disease in dairy cattle in the United States.
JHS is more common in mature dairy cows than in first calf heifers and bulls according to the published literature, but herd investigations at our institution have involved dairies that also report problems in cattle of all ages and stages of lactation. The largest retrospective published to date reported that JHS showed a predilection for older cattle 100-110 days in milk2 but we have seen the disease at any stage of lactation, in dry cows and even in mature breeding bulls at stud. Most cattle appear to be in good health immediately prior to the development of JHS. There does not appear to be a consistently increased level of other production related diseases such as subclinical milk fever (hypocalcemia), mastitis or ketosis on dairies that experience JHS but there is undoubtedly much about this condition that we do not yet understand.
The typical cow with JHS becomes depressed, goes acutely off feed, and frequently has cold ears and extremities. Mild, ventral abdominal distension may develop, manure production is scant or absent and pain may be demonstrated by teeth grinding, kicking at the abdomen, or getting up and down frequently. The condition usually advances quite rapidly from initial onset. Affected cattle usually have no fever but heart and respiratory rates are high commensurate with the degree of pain and dehydration. Upon rectal examination, the veterinarian usually finds scant manure that contains fresh blood, blood clots and digested blood. Palpable, distended small intestine is not a common feature per rectum but transabdominal ultrasound examination typically reveals numerous distended loops of small intestine in the right ventral, mid and caudal abdomen. JHS can be difficult to distinguish from other causes of small intestinal obstruction particularly when the animal is presented peracutely, prior to the presence of blood clots in the rectum. Many cows with JHS die within the first 6-36 hours of showing clinical signs. Some progress more slowly over a couple of days and others appear to improve over the first 24 hours only to dwindle and do poorly over the following days. We have seen affected cattle that survive for up to 10 days from the initial episode of pain and abnormal manure without surgical intervention. These individuals may survive longer because the intestine is not completely blocked but death results due to intestines that gradually lose their integrity and leak resulting in peritonitis.