Research in Veterinary Science 93 (2012) 448–456

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Research in Veterinary Science

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Ultrasonographic evaluation of abdominal distension in 52 camels(Camelus dromedarius)

Mohamed Tharwat a,1, Fahd Al-Sobayil a, Ahmed Ali a, Sébastien Buczinski b,⇑a Department of Veterinary Medicine, College of Agriculture and Veterinary Medicine, Qassim University, Saudi Arabiab Bovine Ambulatory Clinic, Departement des Sciences Cliniques, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-Hyacinthe, Canada

a r t i c l e i n f o

Article history:Received 28 April 2011Accepted 12 July 2011

Keywords:CamelIntestinal obstructionRuptured bladderTrypanosomiasisUltrasonography

0034-5288/$ - see front matter � 2011 Elsevier Ltd. Adoi:10.1016/j.rvsc.2011.07.009

⇑ Corresponding author.E-mail address: s.buczinski@umontreal.ca (S. Bucz

1 Permanent address: Department of Animal MedMedicine, Zagazig University, Egypt.

a b s t r a c t

The purpose of this study was to assess the diagnostic value of ultrasonography in the evaluation ofabdominal distension in 52 camels (Camelus dromedarius). The conditions included trypanosomiasis(n = 35), intestinal obstruction (n = 12) and ruptured urinary bladder (n = 5). Fifteen clinically normalcamels were included as controls. Transabdominal and transrectal ultrasonography was carried out onall camels. In animals with trypanosomiasis, ultrasonographic findings included accumulation of massiveamounts of hypoechoic abdominal fluids where liver, intestine, kidney, spleen and urinary bladder wereimaged floating. Except in two cases of bile duct calcification and one of hepatic abscessation, no detect-able abnormal sonographic lesions were detected while imaging the hepatic and renal parenchyma, andthe heart and its valves and major blood vessels. In camels with intestinal obstruction, ultrasonographicfindings included distended intestinal loops with markedly reduced or absent motility. In one camel, theintestinal lumen contained localised hyperechoic material that was consistent with a foreign body. Hypo-echoic fluid with or without fibrin was seen between intestinal loops. In camels with ruptured urinarybladder, ultrasonographic findings included collapsed and perforated bladder, echogenic blood clotswithin the urinary bladder and peritoneal cavity, increased thickness of the bladder wall, floating intes-tines in hypoechogenic fluid and echogenic calculi within the urethra. Ultrasonography was considered auseful tool for the evaluation of dromedary camels with abdominal distension.

� 2011 Elsevier Ltd. All rights reserved.

1. Introduction

In camels, abdominal distention is a common clinical presenta-tion (Köhler-Rollefson et al., 2001; Fowler, 2010). There are manyconditions in which abdominal distension has been reported.These conditions include trypanosomiasis, cardiomyopathy, hypo-protenaemia, hepatic and renal diseases, septic peritonitis anddiffuse malignant neoplasia (Köhler-Rollefson et al., 2001). Othercauses of abdominal distention include uroperitoneum due toruptured bladder, intestinal obstruction, ruminal tympany, for-eign bodies, vagus indigestion and advanced pregnancy (Fowler,2010).

Ultrasound has been widely used lately in veterinary medicine.Ultrasound imaging has the advantage over radiology of offeringbetter contrast resolution and acquiring slice images of organs indifferent planes in real time—all with portable and noninvasive

ll rights reserved.

inski).icine, Faculty of Veterinary

and nonionising equipment (Blond and Buczinski, 2009). Duringthe past 15 years, the use of ultrasonography has become wide-spread in veterinary medicine through its ease of application in vir-tually every facet of veterinary medicine and for almost all species(King, 2006). The procedure is a reliable tool to detect various typesof disease in different farm animal species (Braun, 2005; Mohamedand Oikawa, 2007; Mohamed, 2010; Mohamed and Oikawa, 2011).In camel practice, the application of ultrasonography is still lim-ited. It is mostly used for reproductive examination and for preg-nancy diagnosis (Skidmore et al., 2009; Wani and Skidmore,2010; Skidmore and Billah, 2011). In the field of internal medicine,however, sonographic studies have not been reported in camelswith either abdominal or thoracic disorders.

Ultrasonography is of particular interest as an ancillary tool forthe diagnosis of common causes of colic and abdominal distensionin cattle and horses (Radostits et al., 2007; Braun, 2005; Tayloret al., 2010). In our clinic, abdominal distension in camels is a com-mon reason for referral. The present study was designed to inves-tigate the ultrasonographic findings in camels with abdominaldistension as a main clinical sign. To the best of the authors’knowledge, this is the first study that uses ultrasound to evaluateabdominal distension in dromedary camels.

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2. Materials and methods

2.1. Animals, history and physical examination

Fifty-two camels (Camelus dromedarius), aged from 6 months to12 years, were examined in the present study. Cases were primar-ily referred to determine the cause of abdominal distension, andthese animals had also inappetance, loss of body condition, ventralor presternal oedema, urine retention and vomition. Duration of ill-ness ranged from 2 days to 5 weeks. The passive hemagglutinationtest showed that 35 camels (70%) were positive for Trypanosomaevansi. Thirty-two of the positive camels (91%) were females, nine(28%) lactating. The remaining camels included cases of intestinalobstruction (n = 12) and ruptured urinary bladder (n = 5). Fifteenapparently healthy camels (age: 2.5 ± 1.1 year) were enrolled inthis study as controls. Animals were examined at the VeterinaryTeaching Hospital, Qassim University, Saudi Arabia, between2007 and 2011. Clinical examinations of camels were carried outas previously described (Köhler-Rollefson et al., 2001). This in-cluded general behavior and condition, auscultation of the heart,lungs, rumen and intestine, measurement of heart rate, respiratoryrate and rectal temperature, swinging auscultation, percussionauscultation of both sides of the abdomen and rectal examination.

2.2. Treatment and follow-up

After the initial examination, camels with trypanosomiasiswere injected subcutaneously with two doses of a trypanosomi-cide, Alquin�-1.5 (Quinapyramine sulphate, Vetnex, Riyadh, SaudiArabia, 5 mg/kg BW) two weeks apart, and intramuscularly (IM)with five successive daily doses of an antioedematous – anti-inflammatory agent, Diurizone�, (hydrochlorothiazide and dexa-methasone, Vetoquinol, LURE Cedex, France, 12 ml IM). Animalswere also injected with five successive daily doses of iron, cobalt,

Table 1History and clinical findings in 52 camels with abdominal distension.

Clinical findings Number (%) of camelsmanifesting clinical signs

Trypanosomiasis (n = 35)Weight loss 13 (37)Abdominal distension 35 (100)Ventral and subcutaneous presternal oedema 25 (71)Weak and irregular gastric contractions 31 (89)Inappetance 33 (94)Fever 1(3)Recumbency 5 (14)Diarrhoea 9 (26)Decreased milk production 9 (100)*

Intestinal obstruction (n = 12)Sunken eyes 11 (92)Vomition 10 (83)Inappetance 12 (100)Ruminal stasis 12 (100)Abdominal distension 12 (100)

Ruptured urinary bladder (n = 5)Sunken eyes 3 (60)Colicky pain 3 (60)Anorexia 5 (100)Ruminal stasis 3 (60)Abdominal distension 5 (100)Abdominocentesis (red urine) 2 (40)Head oedema 2 (40)Anuria 2 (40)Dribbling 3 (60)

* All the nine lactating camels examined in this study had a decreased milkproduction.

vitamin B1, vitamin B12 and copper containing agent (Fercobsang,Vetoquinol, LURE Cedex, France, 20 ml IM). Camels with partialintestinal obstruction due to ruminal foreign bodies were sched-uled for rumenotomy.

2.3. Haematological and biochemical analyses

Two blood samples were collected from each camel: one placedin a plain tube, and the other in an EDTA tube. Direct smear, buffycoat and haematological examinations (haematocrit, haemoglobinand total and differential leukocyte count) were carried out on theEDTA, the later with the use of an automated veterinary haemato-logical analyser (Vet Scan HM5, ABAXIS, Hungary). Samples inplain tubes were centrifuged at 1200g for 10 min, and serum sam-ples were harvested and stored at �20 �C for future analysis. Com-mercial kits were used to determine the concentrations of totalprotein, albumin, glucose, blood urea nitrogen (BUN) and creati-nine. The activities of aspartate aminotransferase (AST) and c-glut-amyl transpeptidase were measured in serum samples using anautomated biochemical analyser (Biosystems A15, Spain). Globulinconcentration was obtained by calculating the difference betweentotal protein and albumin.

2.4. Serological detection of T. evansi

Serum samples were also tested for T. evansi antibodies by pas-sive haemaggluination test as previously described (Omer et al.,

Fig. 1. Clinical manifestation in 2 camels with chronic trypanosomiasis. Image (a)shows severe abdominal distension and image (b) shows presternal oedema(asterisks).

Fig. 2. Vomition in a camel with intestinal obstruction.

Fig. 3. Findings of rumenotomy in camels with partial intestinal obstruction. Together wiwires, glass, and other metal objects (d) were discovered.

Table 2Haematological and biochemical findings (mean ± SD) in 52 camels with abdominal disten

Parameters Trypanosomiasis (n = 35) Intestinal obs

Haematocrit (%) 20 ± 4* 24 ± 10Haemoglobin (g/dL) 10 ± 4 16 ± 5Leukocyte count (/lL) 15,400 ± 5241** 19,725 ± 1431Neutrophils (/lL) 9086 ± 6251 12,624 ± 8876Lymphocytes (/lL) 4928 ± 2589 5129 ± 6115Total protein (g/dL) 5.2 ± 2.2* 7.2 ± 2.5Albumin (g/dL) 2.0 ± 1.4** 3.4 ± 0.9Globulin (g/dL) 3.2 ± 0.6 3.8 ± 0.9AST (U/L) 136 ± 88* 304 ± 154*

GGT (U/L) 52 ± 9 32 ± 15BUN (mg/dL) 35 ± 11 112 ± 72**

Creatinine (mg/dL) 1.6 ± 0.4 1.5 ± 0.5Glucose (mg/dL) 110 ± 40 157 ± 36*

AST = aspartate aminotransferase; GGT = c-glutamyl transferase; BUN = blood urea nitro* P < 0.05.* P < 0.01.* P < 0.001

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1998). Briefly serum samples were diluted in Tris buffer solution,pH 8.0. Each serum sample was tested using the microtitre tech-nique. Two-fold dilutions of sera from 1:8 to 1: 14,096 were madein V-bottomed microtitre plates (Greiner – Germany). After dilu-tion the T. evansi/red blood suspension was added and incubatedat room temperature for 3 h. Sera from uninfected and infectedcamels were used as negative and positive controls, respectively.Samples showing agglutination at 1:16 were considered positivefor T. evansi infection (Ali et al., 2011).

2.5. Ultrasonographic examination

Ultrasonographic examination of control and sick camels wascarried out in sternal recumbency using 3.5 and 5.0 MHz transduc-ers (SSD-500, Aloka, Tokyo, Japan). The procedure was carried out

th hair balls (a, b, asterisks), plastic bags and ropes (b, c, white and black arrows) and

tion compared to controls.

truction (n = 12) Uroperitoneum (n = 5) Controls (n = 15)

45 ± 11* 32 ± 1.418 ± 6* 12 ± 3

*** 38,289 ± 16,528*** 8250 ± 2284** 34,843 ± 17,592*** 7900 ± 1800

2680 ± 3064 3800 ± 18007.5 ± 1.2 7.9 ± 0.43.2 ± 1.5 4.2 ± 0.44.3 ± 1.1 3.7 ± 0.5

* 88 ± 27 69 ± 4452 ± 13 44 ± 22

195 ± 86*** 17 ± 103.5 ± 2.7** 1.3 ± 0.2

168 ± 29* 61 ± 19

gen.

Fig. 4. Flowchart summarising the key ultrasonographic findings that allow thedifferentiation of the three examined conditions.

Table 3Ultrasonographic findings in 52 camels with abdominal distention.

Ultrasonographic findings Number (%) ofcamels

Trypanosomiasis (n = 35)Ascites 34 (97)Oval to round caudal vena cava 7 (20)Distended portal and hepatic veins 6 (17)Bile duct calcification 2 (6)Hepatic abscessation 1 (3)Hydropericardium 7 (20)Hydrothorax 7 (20)Splenomegaly 7 (20)Hepatomegaly 7 (20)

Intestinal obstruction (n = 12)Distended intestinal loops 12 (100)Reduced or absent intestinal motility 12 (100)Intestinal foreign bodies 1 (8)Hypoechoic fluid with fibrin between intestinal loops 6 (50)Hypoechoic fluid without fibrin between intestinal loops 4 (33)

Ruptured urinary bladder (n = 5)Echogenic blood clots within the urinary bladder and

peritoneal cavity2 (40)

Increased thickness of bladder wall 2 (40)Uroperitoneum 5 (100)Urethral calculation 2 (40)Perforated bladder wall 1 (20)

Fig. 5. Abdominal ultrasonogram in a camel with trypanosomiasis. Image wastaken from the 10th right intercostal space using a 3.5 MHz sector transducer. Theliver appears hyperechogenic on ultrasonograms and is floating in a hypoechoicfluid. 1 = hepatic parenchyma; 2 = lung shadow; 3 = anechoic abdominal fluid;4 = small intestine; DS = dorsal; VT = ventral.

Fig. 6. Hepatic ultrasonogram in a camel with trypanosomiasis. Images were takenfrom the right 11th intercostal space. Calcification of the bile ducts (white arrow)and hepatic abscessation (black arrow) was detected. PV = portal vein; AS = acousticshadowing; AE = acoustic enhancement; AB = abscess.

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twice, one before, and three weeks after, treatment. Animals weresedated using xylazine 2% (0.3 mg/kg BW IV, Alcomed, Holland).Hair was clipped and shaved on both sides of the abdomen andthorax from the dorsal midline to linea alba. Camels were exam-ined percutaneously and transrectally. After the application oftransmission gel to the transducer, the camel was examined start-ing from the caudal abdomen and extending forward to the thirdintercostal space on both sides of the thorax. The abdominal vis-cera including the abdomen, peritoneum, stomachs, spleen, smalland large intestines, liver, pancreas and kidneys were imaged. Inthe thoracic cavity, the lungs, heart and its major blood vesselsand the mediastinal region were scanned. Due to a poor prognosis,camels with complete intestinal obstruction and/or ruptured uri-nary bladder were euthanized and necropsied.

2.6. Statistical analysis

Data were presented as means ± SD and the analysis was con-ducted using SPSS, 2007 program, version 16.0. Haematological

and biochemical data of diseased and control camels were com-pared, using repeated measures of ANOVA. The level of significancewas set at P < 0.05.

3. Results

3.1. Clinical presentations

Of the 52 camels with distended abdomen, 35 (67%) had try-panosomiasis, 12 (23%) had intestinal obstruction and five (10%)had a ruptured urinary bladder. The history and clinical findingsof the 52 camels with abdominal distention are summarised inTable 1. The most prominent clinical presentations seen in camels

Fig. 7. Ultrasonographic findings in camels with intestinal obstruction. Ultrasonographic findings included distended intestinal loops with markedly reduced or absentmotility (A, B, C). Image D shows a hypoechoic fluid with fibrin (white arrow) between intestinal loops; black arrow points to the intestinal wall. In one camel with partialobstruction, the intestinal lumen contained localised hyperechoic material consistent with foreign body (E). Corrugated ruminal wall was scanned in one camel withintestinal obstruction (F). IL = intestinal loops; FB = foreign body; F = fluid; DS = dorsal; VT = ventral.

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with trypanosomiasis were inappetance, weak and irregular rumi-nal contractions, weight loss, abdominal distension and ventraland subcutaneous presternal oedema (Fig. 1). On clinical examina-tion, ascites was detected by a fluid thrill on ballottement, by fluidsounds on succussion, or by the demonstration of excess fluid inthe peritoneal cavity by abdominocentesis. On admission, exami-nation of blood smears from the affected camels showed that the

parasites were detected in only one camel (3%). Twenty days aftertreatment, abdominal distension and ventral and presternal oede-ma disappeared in 23 (66%) cases. A telephone-based follow-uprecorded that all operated animals made a full recovery. Unfortu-nately, we could not contact the owners of the other 12 (33%).

Partial and complete intestinal obstructions were observed infive and seven camels, respectively. When presented, all cases

Fig. 8. Ultrasonographic images in 2 camels with ruptured urinary bladder. Image A shows blood clot (BC) within the urinary bladder and image B shows blood clot (BC)within the abdomen. Note the thickened bladder wall (1). UB = urinary bladder; UP = uroperitoneum.

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were depressed with reduced gastrointestinal motility. The abdo-men was distended bilaterally in all affected camels. The eyes weresunken and the animals were recumbent, with vomition in ten(Fig. 2). If stimulated to stand, camels would struggle and wanderin an ataxic manner. In camels with partial obstruction, rectalexamination revealed the presence of very hard, spiny faecal parti-cles and distended viscera. In animals with complete obstruction,rectal findings showed a small amount of black faeces stained withmucus or no faeces at all. One camel with complete obstructiondied 24 h after admission. In animals with partial intestinalobstruction, the owners reported that their animals had beenchewing foreign bodies, especially plastic bags and ropes. In thesecases, rectal examination revealed the presence of small amountsof hard feces and distended rumen. Rumenotomy performed inthese cases showed presence of plastic bags, ropes, glass, hairballs,wires and nails (Fig. 3).

In the five camels with ruptured urinary bladder, attacks of colicand abdominal distention were recorded. One animal with severecolic has died shortly after admission to the hospital. Rectal exami-nation revealed a collapsed bladder and abdominocentesis revealedthe presence of urine. Bloody urine was collected from the abdomenof two camels and in each case the head was oedematous.

3.2. Haematological and biochemical findings

Compared to control animals, those with trypanosomiasisshowed reduced packed cell-volume, neutrophilic leukocytosis, areduction in haemoglobin concentration and presence of a macro-cytic hypochromic anaemia, hypoproteinaemia and hypoalbumin-aemia. In camels with intestinal obstruction, laboratory dataincluded neutrophilic leukocytosis, elevated AST activity andhyperglycaemia. In animals with a ruptured bladder, neutrophilicleukocytosis, hyperproteinaemia, hyperglycaemia and elevatedconcentrations of BUN and creatinine were observed. Comparedwith the controls, other measured serum values did not differ sig-nificantly (Table 2).

3.3. Ultrasonographic findings

Fig. 4 summarises ultrasonographic findings in camels with try-panosomiasis, intestinal obstruction and ruptured urinary bladder.Ultrasonographic findings in the 52 camels with abdominal disten-tion are summarised in Table 3. In camels with trypanosomiasis,ultrasonographic findings included accumulation of massiveamounts of abdominal fluid, where liver and intestines were im-aged floating in a hypoechoic fluid (Fig. 5). Transrectal examinationalso revealed the presence of excessive amounts of anechoic fluidwhere the urinary bladder and other pelvic organs were also float-ing. Other ultrasonographic findings included oval to round caudalvenae cavae, distended hepatic and portal veins, bile duct calcifica-tion and hepatic abscessation (Fig. 6), which was confirmed at nec-ropsy. Ultrasonographic examination of the thorax revealed thepresence of anechoic fluid. Compared to the controls, the liverwas imaged beyond the 12th rib and at the right ventrum indicat-ing organ enlargement. Except for two cases of bile duct calcifica-tion and one of hepatic abscessation, there were no detectableabnormal sonographic findings detected while imaging the hepaticand renal parenchyma and heart, and its valves and major bloodvessels. Three weeks after treatment, twenty-three camels (66%),showed no fluids imaged in the peritoneum, pericardium or pleura.The caudal venae cavae, hepatic and portal veins appeared normal.

Compared to the control animals (2.62 ± 0.47 cm), those withintestinal obstruction had ultrasonographic findings which in-cluded distended small intestinal loops (5.9 ± 1.8 cm) with mark-edly reduced or absent motility. In one camel with partialobstruction, the intestinal lumen contained localized hyperechoicmaterial consistent with a foreign body. Hypoechoic fluid with orwithout fibrin was seen between intestinal loops (Fig. 7). In twocamels with a ruptured bladder, ultrasonographic findings in-cluded presence of echogenic blood clots within the urinary blad-der and peritoneal cavity, with increased thickness of the bladderwall (Fig. 8) that was confirmed at necropsy. Floating intestinesin a hyperechogenic fluid were imaged in two camels. In the

Fig. 9. Ultrasonographic images in a six-month old camel-calf with ruptured urinary bladder. Image A shows urinary calculi within the urethra (white arrow) with acousticshadowing (arrowhead). Image B shows perforated urinary bladder (white arrow) and image C show floating intestines in uroperitoneum. UB = urinary bladder; DS = dorsal;VT = ventral.

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remaining case, floating intestines in a hypoechogenic fluid, echo-genic calculi within the urethra and a perforated bladder were im-aged clearly in a 6-month-old male camel calf (Fig. 9).

3.4. Postmortem findings

Table 4 summarises the postmortem findings in 24 camels withabdominal distension. In camels with trypanosomiasis, 23 animals(66%) recovered after treatment, but 12 (34%) did not, their condi-tions deteriorated and they were killed and necropsied. Necropsyfindings included emaciation, subcutaneous oedema, ascites, hepa-tomegaly, splenomegaly, hydrothorax and hydropericardium. In

camels with complete intestinal obstruction, necropsy findings in-cluded presence of constricted intestines around enteroliths, para-lytic ileus and mesenteric torsion (Fig. 10). In camels with rupturedbladder, necropsy findings included uroperitoneum, abdominalhaemorrhages and perforated bladders (Fig. 11).

4. Discussion

In camels, trypanosomiasis is usually chronic but can be acutewith a 90% mortality rate if not treated (Luckins, 1992). Clinicalsigns and lesions caused by T. evansi in camels are unreliable fora definitive diagnosis (Olaho-Mukani and Mahamat, 2000). In the

Table 4Postmortem findings in 24 camels with abdominal distention.

Postmortem findings Number (%) of camels showinglesions

Trypanosomiasis (n = 12)Emaciation 10 (83)Subcutaneous edema 9 (75)Ascites 12 (100)Hydrothorax 7 (58)Hydropericardium 7 (58)Hepatomegaly 7 (58)Splenomegaly 7 (58)

Complete Intestinal obstruction (n = 7)Mesenteric constricted intestines around

enteroliths3 (43)

Paralytic ileus 3 (43)Mesenteric torsion 1 (14)

Ruptured urinary bladder (n = 5)Uroperitoneum 5 (100)Perforated bladder 5 (100)Abdominal haemorrhages 2 (40)

Fig. 10. Postmortem findings in a camel with intestinal obstruction. Mesenterictorsion was the most outstanding finding.

Fig. 11. Postmortem findings in a six-month old camel-calf with ruptured bladder.Image A shows uroperitoneum and image B shows perforated urinary bladder wall(black arrow).

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present study, trypanosomiasis was suspected clinically in camelsshowing a chronic weight loss, subcutaneous oedema and ascites.These clinical findings were in agreement with those of other re-ports (Wernery and Kaaden, 2002). Clinical manifestations includ-ing chronic weight loss, subcutaneous oedema and ascites may beassociated with trypanosomiasis but not necessarily indicative ofthe disease in camels (Fowler, 2010). In cases with suspected asci-tes, a full clinical examination, including a rectal examination andabdominal percussion/ballottement, help to rule out a number ofother causes of abdominal distension. The detection by rectalexamination of viscera floating in a fluid medium, and a fluid waveon abdominal ballottement suggests the presence of ascites(Radostits et al., 2007). Finding the parasite in the peripheral bloodof infected camels may be highly problematic because of low num-bers of the organisms and fluctuating parasitaemia. The develop-ment of a suitable serological ELISA test resulted in effectivelydecreasing the economic losses associated with trypanosomiasis;other DNA technologies are being used in endemic countries (Fow-ler, 2010). In this study, definitive diagnosis was made on the basisof detecting trypanosomes in a blood smear or antibodies in serum.

In camels with trypanosomiasis, ultrasonography of the abdo-men confirmed the presence of free abdominal fluid. Non-inflamma-

tory ascites due to other disorders, such as right-sided cardiacinsufficiency, hepatic and renal disorders, could be ruled out basedon the results of the clinical and ultrasonographic findings. The dif-ferential diagnosis also included chronic parasitism.

Intestinal obstruction is relatively rare in camels (Köhler-Rollef-son et al., 2001; Fowler, 2010). Massive intestinal parasite infesta-tion, plastic foreign bodies and enlarged mesenteric lymph nodesmay all cause intestinal obstruction (Ramadan et al., 2008). Camelssuffering from pica usually eat hair, leading to the formation ofphytobezoars and trichobezoars that may reach the intestine caus-ing obstruction (Tanwar, 1985). Other causes of intestinal obstruc-tion include impaction of the spiral colon, dilatation and torsion ofthe caecum and strangulation of the intestine in inguinal hernia(Köhler-Rollefson et al., 2001). Ultrasonographic findings, such aschanges in luminal diameter, motility and intestinal wall thick-ness, have been used to diagnose intestinal problems in otherruminant species (Braun et al., 1995). In this study, the mostimportant ultrasonographic finding in camels with either partialor complete intestinal obstruction was dilation of the small intes-tine with a marked reduction or absence of intestinal motility.Fluid was seen between loops of intestine. Accumulation of ingestain the omasum/abomasum chamber was detected, some of whichalso had accumulation of ingesta in the rumen. When taken to-gether, these findings were indicative of ileus (Braun, 2005). Sim-ilar ultrasonographic findings were reported in cows with ileusattributable to other causes (Braun et al., 1995), and rarely wasthe cause determined. In this study, we could determine the cause

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of ileus and make a definitive diagnosis of intestinal obstruction inonly one of the seven camels (14%). We could also see the foreignbody in the intestine in one of the four operated animals (25%).Failure to make an accurate diagnosis may be attributed to thelarge abdominal circumference in examined camels. Because thedepth of penetration of the ultrasound waves 20 cm, only a smallpart of the intestinal tract is accessible to ultrasonography. Thecause of mechanical obstruction is usually beyond the depth ofpenetration of the ultrasound transducer. Thus, the veterinarianmust decide whether exploratory laparotomy is indicated on thebasis of the results of the clinical examination, haematologicaland biochemical analyses and ultrasonography, as well as the va-lue of the camel.

Urolithiasis is common as a subclinical disorder among rumi-nants raised in management systems where the ration is composedprimarily of grain, or where animals graze certain types of pasture.In these situations, 40–60% of the animals may form calculi in theirurinary tract (Radostits et al., 2007). Rupture of the urinary bladderand subsequent uroperitoneum is a common problem in cattle, andin males, urolithiasis is the underlying cause in the majority ofcases (Divers et al., 1982; Bertone and Smith, 1984). Uroperitone-um may be caused by trauma when the bladder is distended orfrom rupture of the bladder following urethral obstruction. Urinein the abdomen may not arise only from a single or multiple tearsin the bladder wall, but also from seepage through the thinlystretched bladder wall in an over-distended bladder (Fowler,2010). A ruptured urethra has been reported in camels (Gahlot,1992; Roussel and Ward, 1985). After the bladder ruptures, uro-peritoneum results in a series of abnormalities that arise from fail-ure of the excretory process combined with solute and fluidredistribution between the peritoneal fluid and extracellular fluid.Osmotic pressure from hypertonic urine promotes the movementof extracellular water into the peritoneal cavity resulting in clinicaldehydration (Radostits et al., 2007). Bladder rupture then leads togradual development of ascites from uroperitoneum, ruminal sta-sis, constipation and depression. Finally, uraemia may take 1–2 weeks to develop to the point where euthanasia is necessary(Roussel and Ward, 1985). Calculus was identified ultrasonograph-ically in only one of the three camels (33%) with uroperitoneum. Itwas impossible to pass a catheter because of the dorsal urethral re-cess and restrictive diameter of the urethra.

5. Conclusions

In camels with abdominal distention, it would have been diffi-cult to reach a confirmatory diagnosis without the use of ultraso-nography. The actual causes of distension could not be verifiedwith clinical certainty in the camels, whereas this was possiblemost of the time with ultrasonography, thus making the prognosiseasier. In camels with trypanosomiasis, ultrasonography washighly effective in supporting the clinical and laboratory data andin excluding other conditions that lead to abdominal distensionsuch as hepatic, renal or cardiac lesions. We believe that this ap-proach would expedite the diagnosis. Because of the large body cir-cumference of camels, the cause of intestinal obstruction can bedetermined by ultrasonography only rarely, which means thatthe cause is usually beyond the depth of penetration of the ultra-sound transducer. In camels with ruptured urinary bladder, ultr-asonographic examination of the abdomen has simplified thedetection of either intact or perforated urinary bladder and thepresence of uroperitoneum. Finally, it is suggested that ultrasonog-raphy be used in camels with abdominal distension to assist in dif-ferentiating gastrointestinal and urinary affections from otherconditions.

Acknowledgements

The authors would like to thank Dr Osama M. (Professor ofPathology) and Dr Hussein O. (Professor of Parasitology), QassimUniversity for their constructive comments. Appreciation is ex-tended to Dr N. Peachy (Professor of English) Qassim Universityfor language revising. This study was supported by the Deanshipfor Scientific Research (SR-D-010-078), Qassim University, SaudiArabia.

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