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Herniation of distal jejunum into the partially everted urinary bladder of a cow.

Eversion of the urinary bladder through the urethra has been reported in dairy cows (1-4). Eversion of the urinary bladder may occur during parturition (5), or early within the puerperium (1). In one case, eversion of the bladder was accompanied by uterine torsion (4). Eversion of the urinary bladder must be differentiated on physical examination from prolapse of the urinary bladder, vaginal prolapse, vaginal or vulvar tumors, a mass of fat protruding through a rupture in the floor of the vagina, or vaginal or vulvar hematomas (5,6). Herniation of the intestine may occur into the everted urinary bladder, posing a serious threat to the life of the dam, but this event is rare (4). We document herein a case of the distal jejunum herniated into a partially everted urinary bladder. A five-year-old, 600 kg, Holstein cow was referred to the Veterinary Medical Teaching Hospital of the University of Wisconsin-Madison for correction of dystocia and a protruding mass from her vagina. The cow had had two normal calvings; the present calving was three weeks past the due date. Physical examination revealed a normal rectal temperature (38.2°C), pulse rate of 104 beats/minute, and respiratory rate of 40 breaths/minute. She had been straining since the previous day. She appeared bright and alert and was in stable condition. Examination of the protruding mass revealed the structure to be about 16 cm diameter; it appeared fluidfilled and was hyperemic (Figure 1). Vaginal examination confirmed that the mass was protruding through the urethral opening and was thought to be the everted urinary bladder, and also revealed a dead calf in posterior presentation, dorsopubic in position with extended limbs. The ureteral orifices were not visible on the surface of the bladder. There was no evidence of a vaginal tear. The cow was placed in sternal recumbency with hindlegs extended caudally for effective repositioning of the everted urinary bladder. A high epidural block was performed with 30 mL of 2% lidocaine hydrochloride (Vedco Inc., Overland Park, Kansas), and reduction of the everted urinary bladder was attempted. When this was not possible, reduction of the everted bladder was attempted, first by needle puncture and then by passing a urinary catheter into the urethra. Needle puncture was made on the ventral surface of the everted bladder. Catheterization was performed by lifting the everted bladder and passing the catheter on the ventral side beneath the mass. One hundred milliliters of fluid were retrieved via the needle puncture and 50 mL via urinary catheter. The fluid from the needle puncture of the