i

DECLARATION
I, Abdirizak Mohamed Ahmed do declare that this surgery report is my own work and has never been
submitted in this University or any other higher institution of learning for the award of a degree.



Signature.. Date ..


ii

ACKNOWLEDGEMENT
I am very grateful to Dr. Dennis Mugisi, the lead surgeon in this case, for allowing me the opportunity to
work and learn from him during the surgery. My sincere thanks go to the teaching staff of the department
of surgery. Finally, I am thankful to my classmates.
iii

ABBREVIATIONS
%- Percentage
0
C- Degree Celcius
CoVAB- Collage of Veterinary Medicine, Animal Resources and Biosecurity
I.M- Intramusculat
I.V- Intravenous
Kg- Kilogram
Mg- Miligram
Ml- Mililiter


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v

TABLE OF CONTENTS
DECLARATION ................................................................................................................................................ i
ACKNOWLEDGEMENT ................................................................................................................................... ii
ABBREVIATIONS ........................................................................................................................................... iii
TABLE OF CONTENTS ...................................................................................... Error! Bookmark not defined.
CASE REPORT: AN ELECTIVE CAESARIAN SECTION ON A GOAT ................................................................... vi
1 INTRODUCTION ..................................................................................................................................... 1
2 CASE REPORT ........................................................................................................................................ 2
2.1 CASE HISTORY ............................................................................................................................... 2
2.2 ANIMAL BIODATA ......................................................................................................................... 2
2.3 PHYSICAL EXAMINATION .............................................................................................................. 2
3 PREPARATION AND THE PREOPERATIVE TECHNIQUE .......................................................................... 3
3.1 SURGICAL INSTRUMENTS .............................................................................................................. 3
3.2 ASEPSIS .......................................................................................................................................... 3
3.3 SEDATION ...................................................................................................................................... 3
3.4 THE ANAESTHESIA ......................................................................................................................... 4
3.5 THE SURGICAL TECHNIQUE ........................................................................................................... 5
4 POST-OPERATIVE MANAGEMENT ......................................................................................................... 7
5 DISCUSSION ........................................................................................................................................... 8
6 CONCLUSION ....................................................................................................................................... 10
REFERENCES ................................................................................................................................................ 11



vi

ABSTRACT
A two and a half year female pregnant goat has been presented to the clinic of theriogenology of
Makerere University. An elective caesarian section has been performed. The goat delivered twin
fetuses through a caesarean operation from the left para-lumber fossa. The goat has been put into
a two weeks post-operative antibiotic therapy












1

CASE REPORT: AN ELECTIVE CAESARIAN SECTION ON A GOAT
1 INTRODUCTION
Caesarian Section is defined as the extraction of Fetus or Fetuses from the mother animal,
through a surgical opening in the abdominal wall and the uterus (Laparohysterotomy). It is an
emergency surgery performed when manual vaginal delivery is not possible. The goal of CS is
survival of mother, survival of calf and maintenance of future fertility (Vermunt JJ, 2008)
The indications of caesarian section in sheep and goats are mainly in narrowness in pelvis,
failure of cervical dilation, fetal oversize, pregnancy toxaemia, uterine torsion, simultaneous
presentation of twins, vaginal prolapse and fetal abnormalities (D. Zahraddeen et al, 2010).
However, caesarean section procedure can also be done for research and teaching purposes.
Caesarean Section provides rapid and planned intervention to kids, improving its chance of
survival. Nowadays, the caesarean operation is one of the most common surgical procedures
performed by veterinarians in cattle practice and is considered as a routine obstetrical technique.
It has high maternal and fetal survival rates, and often is less exhausting, speedier and safer than
fetotomy (Vermunt JJ, 2008)
The present report describes a successful elective caesarian section in a 2.5 months pregnant doe.
Though her pregnancy had not come to term, it was assumed that the goat was in labor and had
difficulty to give birth through the normal birth canal, and hence the caesarean operation was
sought an immediate requirement.



2

2 CASE REPORT
2.1 CASE HISTORY
A two and half year old pregnant female goat, weighing 30kgs was presented to the Animal
reproduction clinic, CoVAB, University of Makerere. The goat was purchased from the abattoir,
and there was no any further history.

2.2 ANIMAL BIODATA

Parameters description
Species Goat
Breed Mubende
Sex Female
Age 2.5 years
Pregnancy status Pregnant
Body weight 30 Kg
Body score 4.5
2.3 PHYSICAL EXAMINATION
The normal parameters were; Temperature 40.4C
0
, Pulse rate 90 beats/minute and 64
cycles/minute for respiratory rate. Mucus membranes were pink, capillary refill time was 2
seconds.






3

3 PREPARATION AND THE PREOPERATIVE TECHNIQUE
3.1 SURGICAL INSTRUMENTS
Kidney dish, Scalpel blades, Scalpel handles, Tissue Forceps, Sponge forceps, Needle holder,
Pair of scissors, Chromic Catgut suture materials (75cm), Nylon suture materials (75cm), drapes

3.2 ASEPSIS
The patient was manually restrained while standing, and the left Para-lumber fossa was identified
for the surgical incision. The area of the skin extending from the last rib to the fold of the stifle
flank (cranio-caudally), and from the lumber vertebrae to Just above the ventral midline (dorso-
ventrally) was aseptically prepared; by washing clean with water and soap, shaved; then
disinfected with mild antiseptic solution containing Chlorhexidine.

Fig1. The surgical area shaved and aseptically prepared Fig2. The surgical area being draped

3.3 SEDATION
The patient was sedated with an intra-muscular injection of 0.4mls[0.015-0.5mg/kg] of 2%
Xylazine.
The above volume of 2% Xylazine dose was calculated as follows:
Normal Xylazine dosage rate for goats = 0.05-0.5 mg/kg, average dosage= 0.05+0.5/2=
0.275mg/kg. Dosage rate used= 0.275mg/kg im
4

Estimated body weight 30kg
Therefore the required amount of Xylazine is 0.275 mg x 30kg= 8.25mg (rounded off to
8mg)
2% xylazine means 2000mg in 100 mls= 20mg in 1ml
If 20 mg is contained in 1 ml, 8 mg is contained (8x1/20) mls=0.4 mls
Or Dosage rate=body weight x dosage/concentration= 30kg x0.275mg/20=0.4125mls
(4mls)

3.4 THE ANAESTHESIA
The Caesarian Section was performed under local anesthesia (through line infiltration) using
2% Lignocaine hydrochloride while the animal was on right lateral recumbency. Using 18
gauge needle, a vertical line of about 20 cm long was created, then 20 mls of the local
anaesthesia were administered at several points along the line, starting around 10 cm ventral
to the lumbar vertebrae.

Fig. 3 Infiltration of local anaesthesia Fig 4. Incision of the abdominal wall

5

3.5 THE SURGICAL TECHNIQUE
After the animal was draped, a vertical skin incision was made ventral to the lumber transverse
process by using a scalpel blade. The external and internal oblique muscles and transversus
muscle were incised parallel to the skin incision. The fascia and the peritoneum were elevated,
carefully incised to avoid cutting any underlying viscera and the incision continued dorsally and
ventrally.

Fig. 5 Opening of the abdominal wall Fig. 6 Uterine incision closed with an inverting suture pattern
After the uterus was located, the apex of the left gravid horn was positioned closer to the
abdominal wound. Uterine forceps were used to hold the uterus in between the incision lips of
the abdominal wound. The uterus was cut, first with a scalpel and then extended with a scissor,
through the dorsal greater curvature of the pregnant uterus to create an opening of around 20cm
long.
The fetal membranes were incised and 2 fetuses were found, one fetus from each horn, and then
were exteriorized. A transfixation ligatures were placed proximal to the cervical and large uterine
vessels, then 2 hemostatic forceps were placed on uterus body and at that spot the uterus was
transected. The remaining part of the uterus body was placed back into the abdomen and the 2
fetuses were withdrawn alive.
The uterine incision was closed with chromic catgut size 2.0 Usp using two inverting layers of
Shimedine and Cushing suture patterns respectively.

6


Fig. 7 The 2 fetuses after being removed from the dam Fig. 8 Closure of the abdominal wall
Before completely closing the uterine incision, a prophylactic Antibiotic dose (Disemptoprim
boluses containing 400mg Trimetoprim) was put in the uterus. Duofast (Intramammary
suspension containing Trimetoprim and Sulfonamide) antbiotic was then applied over the sutures
of the uterine wall after cleaning it from any blood clots and other debris that remained on it.
The uterus was replaced in the abdominal cavity, and covered it by the omentum. The
peritoneum, fascia and transversus abdominis muscle were closed as one layer with chromic
catgut size 2.0 Usp, using simple continuous suture pattern. The internal and external oblique
muscles were closed as one layer with chromic catgut size 2.0 Usp using simple interrupted
suture pattern. The subcutaneous tissue was closed with chromic catgut size 2.0 Usp using
simple continuous suture pattern. The skin was lastly closed with nylon size 2.0 Usp using
horizontal mattress suture pattern to avoid tension on the skin line.






7

4 POST-OPERATIVE MANAGEMENT
The goat was given some water immediately after the operation was finalized. 5mls of penstrep
was administered intramuscularly, and continued for a period of two weeks with the dosage then
reduced to 2mls/day. 2mls of Oxytocin (each one ml containing 10 I.U) were given
intramuscularly five hours after the operation. Supona (insecticide) topical spray was sprayed
daily on the wound to avoid insects from the wound. The animal was closely observed for the
expulsion of placenta. The surgical wound was observed for several weeks for presence of
discharges or signs of infection. Skin sutures were removed on 12
th
postoperative day and animal
was recovered uneventfully















8

5 DISCUSSION
In countries where caesarian section is an elective procedure, the complications are less frequent
because the decision process is quicker and obstetrical manipulations are minimal (Desrochers
A.2010). In the rest of the world, the complications are more frequent because Caesarian section
will only be performed hours after manual tractions fail, and frequent obstetrical manipulations
through the vagina were made, which will increase the chance of puerperal infection (Ectors F. et
al,1999). The case we present here is an elective caesarean section that was purely done for study
purposes and therefore cannot be compared to the above studies.
The presence of an embryo in the uterus was considered possible after abdominal palpation and
a laparotomy for caesarian section was decided. Goats are common in having twins or triplet
pregnancies. In this case, one fetus was found from each of the two horns.
The animal was sedated with Xylazine 2% at a dosage rate of 0.3mg/kg bodyweight
intramuscularly. Xylazine has been reported to induce deep sedation in sheep and goats at 50-
I00ug/kg intramuscularly. Goats tend to be more sensitive to sedatives than sheep; hence a lesser
dose is recommended (P.Taylor, I99I).
Goats are known to be sensitive to pain and stress, therefore it is important to perform surgical
procedures under adequate sedation and with adequate analgesics (N.Caulgert, 2003). This goat
had her temperature and respiratory rates raised above the normal, and this could be due to the
fact that the animal has been under stress for a while, as she was brought from the abattoir, and
different people handled her. However, the temperatures and respiratory rates were again in
normal ranges later on as the operation progressed.
The twin kids spent alive only few minutes outside from their maternal abdominal cavity,
probably because they were prematurely terminated before their vital organs could fully develop,
hence suffered from poor adjustment to their new world. Different diseases or conditions have
been reported to challenge the lives of clone calves delivered through caesarian section:
immature lungs, pulmonary hypertension, compromised immunity, and congenital abnormalities
(Hill JR, et al. 1999). Similarly, conditions like immature lungs and compromised immunity
among others could be the probable cause of their immediate death.
9

Achieving a perfect suture of the different incisions made during the caesarean section is vital in
avoiding post-operative complications leading to the death of the dam. Peritonitis is the leading
cause of mortality associated with maternal death followed by shock, metritis, concurrent
diseases and hemorrhages (Vaughan L. et al, 1999). According to one study in France, 40% of
maternal deaths following caesarean section were from a defect of the uterine suture; therefore
the surgeon is required to achieve a perfect uterine suture (Mangematin G, 1998). Based on these
findings, the surgeon is required to do 2 layers to close the uterine incision. This is in line with
the inverting 2 layers of suture patterns that were done to close the uterine incision in this case.
Post-operative antibiotic therapy is vital for any veterinary surgical operation, as more
contaminants as well as secondary opportunistic bacteria may take advantage and cause
complications that may cost the life of the patient. In this case, the animal was put into a two
weeks antibiotic therapy













10

6 CONCLUSION
The respiratory rate and the temperature of the doe were above the normal ranges, rendering it a
poor anaesthetic choice. Before administering any anaesthetic agent, it is highly recommended
that physiological parameters be stabilized first to the normal ranges. Therefore this patient
should be allowed to rest for a while, and only if the physiological parameters get back to their
normal range would be an ideal candidate for anaesthesia.
The post-operative management provided was ideal, which made the animal to recover
uneventfully following the caesarian procedure.

















11

REFERENCES
1. D. Zahraddeen, I.S.R Butswatt, LS Taimako: Assessment of reproductive problems in
some ruminants under small holder husbandry system in Bauchi, Nigeria. Continental J.
veterinary sciences 4: 1-8, 2010
2. Vermunt JJ. 2008. The caesarian operation in cattle: a Review Iraninan J Vet Surg suppl:
82-100