Cesarean section in camels G N Purohit* Pramod Kumar and J S Mehta Department of Veterinary Gynecology and Obstetrics, College of Veterinary

and Animal Science, Rajasthan University of Veterinary and Animal Science, Bikaner, Rajasthan, India 334001 * Corresponding author email: gnpobs@gmail.com Abstract Cesarean section is often performed in the camel because of lateral head/neck deviation, uncorrectable postures or pelvic immaturity. The indications, anesthesia, operative technique and post operative care is described. Key words: Camel, cesarean, postoperative care. Cesarean section is widely described for most farm animal species but it is less described for camel. The gestation length is highly variable in camels varying from 315 to 440 days in the dromedary camel (Tibary and Anouassi, 2001). Parturition in the camelids is a unique process with a variable first stage of labor (2-6 hr) and short second stage of labor (10-45 min). Because of the exceptionally long neck and limbs and the fact that most fetuses are born in an anterior longitudinal presentation (Sharma and Vyas, 1970; Hussein et al., 1991; Arthur, 1992; Purohit et al., 2011) a possibility of limb/neck deviation always exists. Dystocia is rare in the camel but in when it occurs it is often difficult to correct due to the exceptionally long extremities and neck. Indications Cesarean section in dromedary camels is often performed when sufficient delay has occurred in presentation of the animal to referral centers because at this time the fetus is usually dead and the birth canal is too contracted making manipulations in the birth canal impossible. It is also usual to perform the operation in camels when an

unusual deviation of the head and neck has occurred which is beyond the approach of the obstetricians hand. Rarely an uncorrectable presentation, uterine torsion and monstrosities are an early indication for performing the operation in camels (Purohit et al., 2000; Purohit, 2011; Purohit et al., 2011). Pelvic immaturity, posterior presentations with hip flexion and fetal emphysema are some of the other uncommon indications for performing a cesarean section in camels. When performed in conditions of dead putrefied fetuses the survival of the dam is always at risk due to development of a fatal peritonitis. The skin sutures heal poorly in the dromedary camel and the sutures on the muscles may break due to movements of the animal predisposing to a post operative hernia. However, referral centers have no choice other than to perform the operation whilst it is known that the prognosis would be guarded when dead putrefied fetuses are present. However, with an early decision to perform the operation and with sufficient perioperative care the survival rate of dams is good. Diagnosis of dystocia Camels are often presented with one or both limbs protruding out of the birth canal (Fig 1). Early diagnosis of dystocia is important; however, many times the diagnosis is very late and frequently noticed only when the limbs of the fetus are protruding through the birth canal and the animal straining vigorously. The most important sign of dystocia is the increased duration of the second stage of labor. Dystocia should be suspected if the first stage, or second stage of labor exceeds 6 and 2 hours respectively. In addition the dam may show signs of distress frequently alternating between standing and sitting with frequent side to side rolling and excessive straining. Many dromedary females will show diarrhea and frequent vocalization in such cases. At times, females are depressed and show no signs except slight straining and a blood stained discharge. When, a problem is suspected a vaginal and rectal examination should be performed (Fig 2), preferably with the animal secured in a sitting posture. Straining may be initiated by examination, and hence examination should be gentle. It is important to evaluate the extent of dilation of the birth canal, condition of the water bags, and the disposition of the fetal limbs and head if possible, and if present in the birth canal. Because of the long limbs a deviated head may be many times beyond

the approach of the obstetrician. The fetal viability should also be ascertained, but it is not uncommon to find the fetus to be dead when female camels are presented to referral centers. Obstetrical examination and manipulation can be very difficult if the birth canal is very small (young camels). It is frequently not possible to assess the presentation, position and posture especially when camels are presented after sufficient delay. The birth canal is contracted in such cases. Pre operative preparation restraint and anesthesia Pre operative fasting is not possible in camels because cesarean is most of the times an emergency. The general condition of the patient must be cared for before attempting to perform a cesarean section. When the animal is dehydrated or depressed sufficient fluid therapy (10-20 liters of ringers lactate or dextrose saline depending upon the condition) and antibiotics must be given along with corticosteroids when required. This would often delay the operation by 2 to 4 h but is necessary. Camels are restrained by tying both fore legs and both hind limbs separately with ropes. One attendant should hold the nose rope when the paralumbar fossa is to be used as the operative site. When the operation is to be performed at the ventrolateral site camels should be restrained in right lateral recumbency. Sedation with xylazine is required for vicious animals. Regional anesthesia of the surgical site by inverted L and line block (60 ml to 120 ml of 2% xylocaine or lidocaine solution) with good restraint is sufficient for dromedary camels. Different anesthetic combinations have been described in the past including chloral hydrate (Petris, 1956; Rathore, 1962), premedication with chlorpromazine hydrochloride followed by a chloral hydrate and magnesium sulfate mixture (Sharma and Pareek, 1970), premedication with triflupromazene (Nigam et al., 1977). However, currently the use of xylazine as a sedative administered by intravenous route (Sharma et al., 1982; Purohit et al., 1985; Purohit et al., 2000) along with local infiltration anesthesia is suggested. The dose of xylazine suggested for camels is 0.25 mg/Kg (Bolbol et al., 1980; Sharma et al., 1982; Ali et al., 1989). A higher dose of 2.2 mg/Kg

given IM has also been suggested (Tibary and Anouassi, 2000). An initial dose of 140180 mg (6-8 ml) of xylazine is administered IM or IV but some dromedary camels may require repetition of the dose during the operation sometimes even three times with the total dose reaching 450 mg (20ml). Pre medication with atropine sulfate would thus be beneficial. Reversal of xylazine can be achieved using 0.125mg/Kg of yohimbine or 1-2 mg/Kg of tolazoline. Operative sites and operative procedure Two operative sites suggested for cesarean in the camels are; the paralumbar fossa and oblique ventrolateral. A ventral midline approach is considered to be improper due to severe postoperative complications. The left paralumbar fossa is a site on which the operation is easy to perform because the animal is in sitting position and surgeons can sit parallel to the camel. Two techniques have been described for operation at this site a) incision (30-40 cm long) in the middle of the fossa 6 cm below the second lumbar transverse process and parallel to the last rib extending through skin, muscles and peritoneum (Sharma and Pareek, 1970; Purohit et al., 2000) or b) an oblique incision in the lower flank 10 cm posterior to the last rib (Nigam et al., 1977). In the ventro lateral approach a skin incision (30-40 cm) is made 5-10 cm above and parallel to the subcutaneous abdominal vein in an oblique fashion (Elias, 1991, Sharma et al., 1982). Alternatively the incision may be just lateral to arcus cruralis or the stifle joint on the left side in dromedary camels with the animal restrained in right lateral recumbency (Purohit, 2011). After incising the skin (Fig 3) the sub cutaneous tissues are deflected by blunt dissection, the muscle layers are cut with scissors carefully ligating all bleeding vessels (Fig 3). The peritoneum is grasped with tissue forceps and cut with scissors. A nick is first made and then the entire peritoneum is cut with scissors guiding with the finger. Extreme care must be exercised in cutting the peritoneum to avoid incising the spleen which is just underneath when using the paralumbar fossa as an operative site (Purohit et al., 2000). The uterus is grasped over the fetal part (like limb) on the sides with sterile drapes (Fig 3). The uterus is incised along the greater curvature avoiding major vessels. The fetus is taken out and the uterus is flushed with normal saline (2-6 liters) and metronidazole. The uterus is sutured with Lambert sutures using catgut or

other absorbable suture materials (2 or 3 number). Any ruptures on the uterus must be sutured. The uterus is washed with sterile normal saline and placed back in the abdominal cavity. Antibiotic powder must be sprinkled and the peritoneum, muscles and subcutaneous tissue repaired. The muscles and peritoneum should be sutured carefully avoiding dead space and it would be an added advantage if interrupted sutures are used. The skin is sutured using silk employing simple interrupted or interlocking sutures (Fig 3). Post operative care and complications Antibiotics and anti-inflammatory drugs must be given for 5-7 days along with fluids. Administration of 30-40 IU of oxytocin IM is suggested to stimulate uterine contractions and hasten placental expulsion (Tibary and Anouassi, 2000). Fluid therapy must be continued for 3-5 days to hasten the removal of toxins and prevent the development of peritonitis. The skin sutures heal with difficulty in the camel. Also, fluid accumulation at the operative site is common (Purohit et al., 2000; Purohit, 2011). Herniation at the operative site is a common complication (Purohit et al., 1989; Elias, 1991). It is imperative to monitor the general condition of the patient. The first 72 h are critical as peritonitis often develop during this period. The skin sutures must only be removed after complete healing which may take up to 20 days in the dromedary camel (Purohit et al., 2000; Purohit et al., 2011). Less frequent complications noted in the include vaginal tears, vulvar swelling, metritis, retained placenta, hyperglycemia and uterine prolapse.

References
Ali BH, el Sanhouri AA, Musa BE (1989) Some clinical, haematological and biochemical effects of four tranquilizers in camels (Camelus dromedarius). Rev Elev Med Vet Pays Trop 42:13-17. Arthur GH (1992) An overview of reproduction in camelids. Proc 1st Int Camel Conf Dubai UAE. P 109-113.

Bolbol AE, Hassanein A, Ibrahim H (1980) Some investigations in the camel after sedation with Rompun (xylazine) Veterinar Medizinische Nachrichten 1:55-60. Elias E (1991). Left ventrolateral cesarean section in three dromedary camels (Camelus dromedarius). Vet Surg. 20: 323-325. Hussein MF, Noseir MB, El-Bawab IE, Paccamonti DL (1991) Prenatal assessment of weight and dimensions of the camel conceptus (Camelus dromedarius). Anim Reprod Sci 26:129-36. Nigam. JM, Gupta RC Khar SK et al (1977). Torsion of the uterus in a camel. The Haryana Vet 116:33-36. Petris MA (1956). Caesarean operation in camels. Vet Rec. 374-376. Purohit GN, Mehta JS, Garg N Vyas K, Gupta AK, Pareek PK, Sharma SS (2000). Caesarean section in a dromedary camel a case report. Indian J Anim Reprod 21: 76-77. Purohit GN (2011) Dystocia in camels: The causes and approaches of management. Open Journal of Animal Sciences (Under Publication). Purohit GN, Mehta JS, Dholpuria S, Barolia Y, Kumar P, Shekher C and Yadav SP (2011). Dystocia in dromedary camels: handling and outcome of fourteen cases. Theriogenology Insight (Submitted). Purohit NR, Chauhan DS, Chaudhary RJ (1989) Post cesarean ventral hernia in two camels. Br Vet J 145:294. Rathore SS (1962). Cesarean operation in camels. Indian Vet J 39:42-44. Sharma DK, Pareek PK (1970). Clinical communication: caesarean section in a camel. Ceylon Vet J 18:7-9.

Sharma SS, Vyas KK (1970) Parturition in the camel (Camelus dromedarius). Ceylon Vet J 18:7-9. Sharma DK, Behl SM, Khanna BM et al (1982) Use of xylazine as anesthetic in cesarean in a camel. Haryana Vet 21:50-51. Tibary A, Anouassi A (2000) Surgery of the reproductive tract in camels. In: Skidmore JA, Adams GP eds. Recent advances in camelid reproduction. International Veterinary Information Service. www.ivis.org. A.1008.1100. Tibary A, Anouassi A (2001) Obstetrics in camels. In: Skidmore L, Adams GP eds. Recent Advances in Camelid Reproduction. International veterinary information service. www.ivis.org A1005.0501.

Figure 1 The two fore limbs and one hind limb protruding through the birth canal in a camel.

Figure 2 Examination of the birth canal of a camel with dystocia

Figure 3 Cesarean section in camel 1) Incising the skin 2) Dissection of the subcutaneous layers 3) Incision of the muscle layers 4) Dissection of the peritoneum and exposure of the abdomen 5)Packing of the uterus with drapes 6)Removal of the fetus 7)Suture of the uterus and 8)Skin sutures.