Permanent Fistula Research Articles

VAAFT: a new minimally invasive method in the diagnostics and treatment of anal fistulas – initial results

The aim of the study was to present our own experience in the treatment of anal fistulas by means of VAAFT (Video-Assisted Anal Fistula Treatment). Twenty patients were qualified for the VAAFT procedure. All were subjected to diagnostics. Two patients after the diagnostic stage underwent classical fistula surgery. The remaining 18 patients were subjected to the full procedure (diagnostic fistuloscopy, supply of the internal ostium, and coagulation of the fistula canal). The mean observation period was 10 months. In most cases the trans-sphincter fistula was observed during the diagnostic phase, including three with additional fluid compartments. There was one intersphincteric fistula. Considering the 18 patients subjected to the full VAAFT procedure the internal ostium was supplied by means of an advancement flap in 3 cases, while in 11 by means of a mattress suture, including one with additional tissue glue. In 4 cases the internal ostium was tightly covered by mucosa. Surgical complications were not observed during the procedure. During further observation a permanent fistula was observed in 4 (22%) patients, and in two (17%), recurrence of anal fistula. In the remaining 12 patients one observed healing without fistula recurrence. Complications were not observed, including stool and gas control deterioration (based on the FISI scoring). The VAAFT method does not affect sphincter efficiency, no intra- and postoperative complications were observed. As compared to other minimally invasive procedures a comparable recovery rate is observed without the risk of incontinence. It is the only method enabling the intraoperative identification of the internal ostium and fistula canal under visual control. Initial optimistic results require further investigations on a larger group of patients.

Botulinum toxin treatment of salivary fistulas following parotidectomy: follow-up results

BackgroundSalivary fistulas are a well-known sequel of parotidectomy, and successful treatment with botulinum toxin has been demonstrated in individual cases. Here, we report on 12 patients with fistulas treated following parotidectomy for various indications.Methods and resultsInjection of botulinum toxin type A into the residual gland tissue was the initial treatment. After early intervention (within 6 weeks after development of the fistula), only one fistula remained (9 of 10 fistulas treated early only with botulinum toxin). One patient with early intervention did not want to wait for the botulinum toxin treatment to take effect and demanded early surgical revision, which was successful. In one patient with a permanent fistula, botulinum toxin treatment began 420 days after the operation and was unsuccessful. No side effects were evident after the treatment.ConclusionIn summary, botulinum toxin injections into the parotid tissue remaining after surgery appear to be an effective treatment for salivary fistulas following parotidectomy.

Bilateral parotid duct transposition for keratoconjunctivitis sicca in a Connemara stallion

A 7-year-old Connemara stallion was presented with a 4 month history of blepharospasm, recurrent corneal ulcerations, mucopurulent ocular discharge, and keratoconjunctivitis sicca (KCS) in both eyes unresponsive to medical therapy. Ophthalmic examination revealed lackluster corneas, axial corneal scarring and pigmentation with associated neovascularization, and absolute KCS in both eyes. Computed tomography scan and endoscopic evaluation of the upper airway and guttural pouches revealed no structural abnormalities to indicate neurogenic KCS. The stallion was diagnosed with immune-mediated dacryoadenitis as all other causes of KCS were excluded. Parotid duct transposition (PDT) was performed in the right eye followed by PDT in the left eye 4 weeks later. The right PDT was functional 2 years post-operatively with significant improvement in ocular comfort and reduced corneal fibrosis and neovascularization. The left PDT developed a salivary-cutaneous fistula over the left masseter muscle post-operatively due to avascular necrosis of the distal parotid duct (PD). Surgical reconstruction of the PDT using an expanded-polytetrafluoroethylene (e-PTFE) tube graft, an e-PTFE tube graft to autogenous caudal auricular vein graft, and an autogenous saphenous vein graft were all unsuccessful. Tear production in the left eye improved at 1 year post-surgery as a result of long term lacrostimulant therapy, and a permanent PD-cutaneous fistula was performed on the left PD at the level of the ventral mandible. Bilateral PDT in the horse is effective in resolving clinical signs associated with KCS; however, morbidity associated with avascular necrosis of the transposed PD may be significant and can result in surgical failure.

Reliability of Two Surgical Methods for Oroantral Communication Closure; A Clinical Study of 20 Patients

Background/Purpose: Communication between the maxillary sinus and oral cavity, referred to as Oroantral Communication (OAC), is an uncommon complication in oral surgery and occurs mostly at the maxillary first molar, followed by the second molar, third molar, and bicuspid. Although smaller defects of <5 mm in diameter may close spontaneously, larger communications always require proper surgical closure techniques. In the present study, we evaluated the reliability of two OAC closure techniques. Material and methods: A total of 20 patients with OAC were selected for this study. The age, gender, location, size, and duration of the OAC and features of antral infection were recorded. Ten patients were treated with buccal advancement flaps, and 10 patients were treated with palatal rotation–advancement flaps. The results were assessed at 1 and 3 months postoperatively. All surgeries were performed by the same surgeon. Results: Of the 20 patients, 19 healed uneventfully. The donor site of the palatal flap was completely healed 3 months postoperatively, and grafts were not necessary. No flap necrosis was found in either group, with the exception of one patient who had undergone the Caldwell–Luc procedure and the palatal island flap technique. Conclusion: If OAC is not diagnosed and is managed improperly, there is a risk that an epithelialized permanent oroantral fistula and maxillary sinusitis may develop. The choice of closure procedure is influenced by not only the amount and condition of the tissue available for repair but also the size and location of the defect. It is important that the influence of various clinical parameters on the success rate be analyzed so that a proper technique can be applied to achieve successful closure of the defect.

Feasibility of Surgery After Systemic Treatment with the Humanized Recombinant Antibody Bevacizumab in Heavily Pretreated Patients with Advanced Epithelial Ovarian Cancer

The aim of this study was to assess operative feasibility and outcome after bevacizumab treatment (BT) in ovarian cancer (OC) patients. We retrospectively identified all OC patients operated between April 2006 and September 2010 after BT. We identified 733 OC operations, 10 of which (1.36%) were performed in a mean time of 134days (range, 10-288) after BT. Indication was secondary cytoreduction in 3 patients (mean days after BT, 181; range, 82-256) and palliation in 7 due to bowel obstruction and/or intestinal perforation or fistula (mean days after BT, 114; range, 10-288). All but 1 acutely operated patients developed a secondary wound healing, but none of the 3 patients after planned cytoreduction did. Of these 3 patients, 1 suddenly died on the 36th postoperative day, presumably of thromboembolism. None of the patients developed postoperatively a gastrointestinal morbidity; however, in 1 patient operated 21days after BT due to a vesicointestinal fistula the bladder reconstruction could not heal and developed a permanent fistula. Emergency surgery after BT due to bowel obstruction and/or fistulas seems to be associated with an impaired wound healing in advanced heavily pretreated platinum-resistant OC patients, while this does not appear the case in planned cytoreduction. Prospective evaluations are warranted to assess surgical safety after BT in this special patients' collective.

A hinged metalloplastic anastomotic device: a novel method for choledochoduodenostomy

In biliary obstruction, the creation of a large-diameter permanent fistula between the bile duct and the duodenum would be attractive. To invent, prototype, and test a new method of forming a biliary duodenal anastomosis. Survival and nonsurvival porcine model. An animal laboratory with general anesthesia. A novel hybrid metalloplastic 7F anastomosis device that consisted of a central ferrous metallic tube sandwiched between 2 tapered flexible plastic end pieces was used. The device was hinged on either side of the metal insert so that a magnetic force could form an anastomosis and then the plastic components of the device could deform to fall through the compression anastomosis. These devices were inserted into the bile duct of the pigs over a 0.035-inch guidewire with a pusher tube. Cylindrical-shaped magnets were then positioned over the intraduodenal bile duct so that they exerted compressive ischemic force on the duodenum and bile duct above the papilla. Choledochoduodenal anastomoses created were inspected at subsequent endoscopy and postmortem for patency and size. Seven anastomosis devices were placed in the bile duct of pigs (weight 22-54 kg). All 4 survival animals were well and eating as soon as they were awake. Anastomoses were successfully accomplished in all survival animals. The supra-ampullary opening into the bile duct ranged from 5 to 10 mm. The small number of animals. A new method for achieving larger-diameter biliary drainage was developed. Four animals were euthanized after 2 to 7 days. Our best anastomosis resulted from 2 magnets left in the animals for 4 days.

Anal Fistula Plug: A European Perspective

Impressed by the initial success rates (80%) of the Cook Surgisis AFP anal fistula plug for the closure of both cryptoglandular and Crohn's associated anorectal fistulas, the preliminary results from Europe showed healing rates of 41% and 61%, respectively. However, no impairment of continence was documented. Analyzing the current experiences of the plug procedure from a German perspective, a variety of issues are under debate including the role of bowel preparation, treatment of fistula tract, closure of the internal opening, postoperative management, and, finally, financial reimbursement. Furthermore, the ideal indication has to be defined. In general, the introduction of the plug has accelerated a new discussion on the optimal treatment of high anorectal fistulas. Further analysis is needed to explain the definite role of this innovative technique in comparison to traditional surgical techniques, particularly whether the plug can offer the biological properties required for permanent fistula healing. Consequently—as a European perspective—the randomized German multicenter study comparing the plug procedure vs. advancement flap repair for transsphincteric fistulas will hopefully elucidate the definite role of the plug.

Técnica de fistulação e canulação do rúmen em bovinos e ovinos

Foi desenvolvida e descrita uma técnica cirúrgica para fistulação e canulação do rúmen em animais utilizados nos estudos de nutrição animal. O método cirúrgico foi empregado para canulação de 25 vacas e oito cordeiros. A fistulação permanente foi realizada no centro da fossa paralombar esquerda em estágio operatório único. Uma cânula de borracha foi implantada na parede ruminal após o afastamento da musculatura da parede abdominal e a sutura do rúmen ao peritôneo e à pele. Não foram observadas complicações graves advindas da canulação ruminal, mas houve a ocorrência de discreto vazamento de conteúdo em alguns animais. As cânulas permaneceram funcionais por longo período e permitiram a obtenção de quantidades suficientes de amostra.

Outcomes of Percutaneous Mechanical Thrombectomy of Arteriovenous Fistulas in Hemodialysis Patients

Thrombosis of arteriovenous fistulas is usually superimposed on underlying stenosis in the arterial anastomosis, draining vein, or central vein. Restoring the patency of thrombosed fistulas requires mechanical thrombectomy, in conjunction with angioplasty of the underlying lesion. We evaluated the success rate of percutaneous thrombectomy of fistulas at our medical center. We retrospectively queried a prospective, computerized vascular access database to identify 41 patients with thrombosed fistulas treated percutaneously. Technical success was defined as the ability to use the fistula for at least one dialysis session. Primary patency was defined as time to the next intervention, and secondary failure as the time to permanent fistula failure. Of the 41 thrombosed fistulas, 21 were in the forearm and 20 in the upper arm. Percutaneous thrombectomy was technically successful in 31 of 41 patients (76%). The technical success rate was similar for upper arm and forearm fistulas (85% vs. 66%, p = 0.43). An underlying stenotic lesion was present at the arterial anastomosis in 13 patients (31%), in the draining vein in 37 (90%), and in the central vein in 3 patients (7%). Twelve patients (29%) had concurrent stenoses at two locations. At 6 months, the primary patency was 20%, and the secondary patency was 54%. In conclusion, percutaneous treatment of thrombosed fistulas can restore fistula patency about three-fourths of patients. However, the primary fistula patency is fairly short-lived, and the fistulas require repeated interventions to achieve long-term survival.

Die Reimplantation eines künstlichen Hüftgelenkes bei septischer Girdlestone-Situation

Resection arthroplasty is an accepted surgical option to treat severe late periprosthetic infections. However, it is known that one has to consider that a persistence of infection is very often combined with a permanent fistula in approximately 10 % of the patients. In particular, the occurrence of a fistula and pain caused by the persistent infection is followed by a considerable reduction of the quality of life of these patients. We have analysed the effort and complications of treatment and the change of pain and function of these patients. In this study 11 patients (average age 68 years) with a Girdlestone situation and persistent infection with an average duration of 33 months were successfully treated by a multiple stage surgical therapy plan which included a radical surgical revision of the infection, stepwise leg lengthening and subsequent reimplantation. In all cases surgical revision of the infection was supported by both systemic and local (antibiotic-loaded cement spacer) antibiotic therapy. The choice of implants followed the general recommendations for revision hip arthroplasty. The mean follow-up after reimplantation was 16 months (min 4, max 24). We observed an average improvement of the Harris hip score from 27.7 points at the beginning of the therapy to 72.5 points at the end of the follow-up. None of the patients had suffered from a reinfection at the end of the follow-up. We observed no surgically related mortality. Surgical complications including spacer dislocations and implant dislocation were seen. The leg length discrepancy could be decreased from an average of 6.8 cm to 1 cm without the occurrence of a neurological deficit. The reimplantation of a hip prosthesis in cases of infected Girdlestone situations is complex, it can, however, offer the prospect of a marked increase in function and less pain for these patients.

Hinged Metallo-Plastic Anastomosis Device: A Novel Intraluminal Method for Choledochoduodenostomy

Background: Stents are commonly placed in the bile duct to relieve biliary obstruction. The main limitations of plastic stents are their relatively narrow luminal size and occlusion rate. Expanding metal stents last longer but also occlude and are extremely expensive. Creating a permanent fistula of larger diameter between the bile duct and duodenum would be attractive and allow greater drainage of bile. Aim: To invent, prototype and test a new method of forming a biliary duodenal anastomosis. Methods: A novel hybrid metallo-plastic 7F anastomosis device was developed. It consisted of a central ferrous metallic tube sandwiched between 2 tapered flexible plastic end pieces. The stent was hinged on either side of the metal insert so that a magnetic force could form an anastomosis and then the plastic components of the device could deform to fall through the compression anastomosis leaving a fistula above the papilla. These devices were inserted into the bile duct in pigs over a 0.035 inch guidewire with a pusher tube. Chromium plated neodymium iron boron magnets of cylindrical shape with a central lumen were then positioned by passing closed forceps with weak magnetic attraction through the magnets which were held close to the endoscope tip over the intraduodenal portion of the distal bile duct and releasing them so that they exerted compressive ischemic force on the duodenum and bile duct above the papilla. It was possible to remove the magnets using forceps with strong magnetic attraction. Because of the proximal positioning of the biliary papilla in the duodenal bulb it was possible to insert these devices with forward viewing gastroscopes or even colonoscopes in larger pigs in these survival experiments. Results: In preliminary studies a method for stenting the bile duct in pigs was developed and at post-mortem we established that the metal stent and magnet combination exerted sufficient force to cause ischemia. The length of bile duct available for anastomosis by magnetic compression was approximately 3 cms. Seven anastomotic stents were placed in the bile duct of pigs (weight 22-54 Kg). All 4 survival animals were well and eating as soon as they were awake. Anastomoses were successfully accomplished in all survival animals. The supraampullary opening into the bile duct ranged from 5 to 10 mm. Conclusions: A new method for achieving larger diameter biliary drainage by forming a choledocho-duodenostomy above the ampulla. The method seems simple, safe, economical and was accomplished in survival studies without complicalions. Biliary cannulation and device placement was accomplished with both standard forward viewing and side-viewing endoscopes.

A study of in situ degradability: heterogeneity of variances and correlated errors

Degradation models exhibit a non-linear behavior and the selection of a model to describe the degradability depends on the coherence of the model with the involved biological events. The purpose of this study is to evaluate the behavior of the parameters of the degradation model proposed by Mertens &amp; Loften, adjusted to the results of an in situ degradability trial. The experiment evaluated the potential degradable residue of neutral detergent fiber (NDF) of coastcross grass (Cynodon dactylon × Cynodon nlemfuensis) submitted to two cutting ages (30 and 90 days), with three replicates. For each cutting age, the potentially degradable residue of NDF was studied using fifteen incubation times (0; 0,5; 1; 3; 6; 9; 12; 18; 34; 35; 48; 56; 72; 96 e 120 hours). The experimental unit comprised one non-lactating cow with a permanent ruminal fistula. Mean and individual adjustments were obtained for the animals in three different configurations: inverse variance weight without autoregressive errors; unweighted with autoregressive errors, and unweighted without autoregressive errors. Variances of parameter estimators were also obtained by means of the mean parameter covariance matrix, providing expressions for the estimation of the confidence age for the parameters of the model. A weighting of the model by the inverse variance resulted in estimates statistically equal to zero for the colonization time. The use of a structure of second order autoregressive errors improved the fit of the model of Mertens &amp; Loften, providing more precise estimates of the parameters.

Degradability study of neutral detergent fiber of coast cross (Cynodon dactylon x Cynodon nlemfunensis)

The objective of this work was to fit the degradation model proposed by Orskov &amp; McDonald (1979) to data of an in situ degradability trial. Neutral detergent fiber degradations (NDF) of coast cross grass (Cynodon dactylon x Cynodon nlemfunensis) were submitted to twelve cutting ages (30, 60, 90, 120, 150, 180, 210, 240, 270, 300, 330 and 360 days) in a complete block design. At each cutting age, NDF degradation was investigated using nine incubation times (0, 3, 6, 12, 24, 48, 72, 96 and 120 hours) in a split-plot design, taking cutting age as main plots and incubation time as subplots. Each plot comprised a non-lactating cow with a permanent ruminal fistula. Variances of the parameter estimates were also obtained, as well as expressions for the estimation of confidence intervals for parameters in the model. A good fit of the model to the data of neutral detergent fiber degradability in the most cutting ages was found. The cutting ages of the coast cross grass influenced the degradability of different fractions, benefiting early stages. In advanced cutting ages the parameters estimates were less precise.

Influence of aFusarium culmorum inoculation of wheat onin sacco dry matter degradation of wheat straw and wheat chaff

The aim of this study was to investigate the effect of aFusarium culmorum inoculation of wheat on thein sacco dry matter degradation (DG) of wheat straw and wheat chaff in dairy cows. The ruminal disappearance of dry matter was measured with thein situ nylon bag technique. Samples of wheat straw and wheat chaff from non-inoculated andFusarium-inoculated wheat were used to examine the ruminal dry matter degradability. Samples were subjected to ruminal incubation in two dairy cous fitted with a permanent rumen fistula and incubated for 4, 8, 16, 24, 48, 72, 96 and 120 h. To describe the degradation kinetics, the equation by Ørskov and McDonald (1979) was used. DG rates obtained for contaminates straw and chaff were higher compared to the corresponding rates of the non-contaminated samples, which is assumed to be due to the activity of fungal enzymes. It can be concluded that an infection of wheat withF. culmorum may have an influence on the dry matter degradation of straw and chaff.

Penis Strangulation by Metallic Rings

Penile strangulation (“penile tourniquet syndrome”) is a rare serious injury that occurs mostly amoung children and may be accidental or intentional. In adults usually it is volontary as a consequence of sexual drive arousing manouvres. The severity of the strangulation depends on different elements such as: length of the lesions, materials used and degree of strangulation. In this report, we describe a psicopathic man with penis and two hand's fingers strangulation caused by the use of metallic rings placed 2 days before that caused a permanent urethrocutaneous fistula.

Steal Syndrome of the Hemodialysis Vascular Access: Diagnosis and Treatment

Steal syndrome is an uncommon but serious condition of arterial insufficiency distal to a permanent hemodialysis fistula. The management of the condition is a great challenge to the surgeon because of the conflicting goals of preserving the fistula and treat the ischemia. In this review the purpose was to analyze the clinical problem and treatment possibilities. Medline and Embase databases were searched for studies relevant to diagnosis and management of steal syndrome of the hemodialysis vascular access. The diagnosis of steal syndrome is largely based on clinical features and non-invasive studies. In same cases angiography may be necessary to find out the real causes of the steal syndrome. The cause is usually high fistula flow but other causes as steal phenomenon, inflow, outflow or anastomotic stenosis have to be considered and even combination of causes. The main treatment options are some form of flow reducing procedure or the distal revascularization interval ligation method. In some cases simple distal arterial ligation is the method of choice. Furthermore, in some patients a stenosis has to be treated as the first treatment option. For an appropriate treatment of a steal syndrome a careful analysis of the cause is important.

A simple surgical technique for tracheoesophageal fistula closure.

Placement of a voice device in a tracheoesophageal fistula provides successful speech rehabilitation after total laryngectomy. However, in the long term, removal of the voice device and permanent closure of the fistula is sometimes necessary. This paper presents and evaluates a simple surgical technique for primary closure of tracheo-esophageal fistulae. We retrospectively review 12 laryngectomees who received this technique of primary closure from 1997 to 2000. In 58% of the patients, permanent fistula closure could be obtained. Six patients (50%) healed primarily; in one patient (8%) the residual fistula opening healed secondarily. Four patients (33%) needed a second surgical procedure, and in one patient (8%) inserting a new speech prosthesis obliterated the residual fistula. Radiotherapy seems to compromise wound healing and therefore may be considered as a contraindication. Complications such as tracheal stenosis, tissue necrosis and pneumonia, etc., did not occur.

Ash Split Cath® in Geriatric Dialyzed Patients

Vascular access is the essential step in performing hemodialysis in uremic patients. In the absence of a permanent and utilizable native arterio-venous fistula, the use of a tunnelled catheter makes dialysis therapy possible. The Ash Split Cath, a recently introduced chronic hemodialysis catheter, was inserted in five patients (7.1% of our prevalent dialysis population) because of repeated venous thrombosis in three patients and a poor venous tree in two. The mean age of patients was 78 years +/- 7. The average blood flow rate was 250+/-50 ml/minute and the mean venous pressure 140mm Hg +/- 35. Recirculation determined by low flux technique was less than 2%. KT/V calculated 3 months after the catheter placement was 1.2+/-0.02. During the follow-up we did not document any infection of the exit site or related to the catheter. This device is simple to place, gives adequate dialysis treatment and is useful in geriatric dialyzed patients in whom the arterio-venous fistula can no longer be used.

4672 Endoscopic siphon drainage of massive traumatic biliary and pancreatic fistulas.

Background: Massive hepato-pancreatic injury resulting in large fistulas have traditionally been managed by early surgical intervention.We report five cases of traumatic hepatic laceration or pancreatic transection who were successfully treated with endoscopic siphon drainage using a 7 French nasobiliary tube (NBT). Methods: All patients were managed by the following protocol: (1) ERCP to identify sites of ductal disruption (2) endoscopic sphincterotomy and site selective NBT placement (3) positioning of the NBT drainage bag at floor level (i.e. siphon drainage) (4) prior to removal, elevation of the NBT system to patient level once percutaneous drains demonstrated an absence of fistula output (5) clamping of the NBT and reinjection to confirm closure and (6) removal of the NBT under fluoroscopy. Results: Permanent fistula closure occurred in 100% of cases; mean length of time closure was 18 days (range 9-35 days). Siphon drainage with NBT was used after drainage by Cotton-Leung stents failed in 2 cases. The need for surgical ductal repair was avoided in all 5 cases. Discussion: This case series reinforces the role of endoscopic decompression as an adjunct to surgical and/or radiologic percutaneous drainage in the management of massive traumatic biliary or pancreatic fistulas. The advantages of NBT drainage include the ability to monitor closure of the fistula with repeat contrast injection, the achievement of maximum decompression by siphon drainage, and the removal of NBTs without the need for a second endoscopic procedure. No cases in our series were complicated by infected NBTs or electrolyte disturbances. Case Series: December 1997 to October 1999 Type of Injury Interventions Surgery ± NBT Age Etiology Organ drains IR Duration 23 y.o.W MVA Liver Hepatectomy Yes 35 days 37 y.o. M MVA Pancreas Pancreatectomy No 20 days 19 y.o. M GSW Liver Pancreatectomy No 11 days 40 y.o.W MVA Liver No No 16 days 19 y.o.W 20' Fall Liver No Yes 9 days IR: Interventional Radiology Percutaneous Drains

The effect of the plasma glucose level on the abomasal function in dairy cows.

We have studied the effect of plasma glucose level on the abomasal outflow rate of fluid using a hyperinsulinemic glucose clamp technique in dairy cows. Four nonpregnant, nonlactating cows were subjected to one of the following treatments: hyperinsulinemic normoglycemic clamp; hyperinsulinemic hypoglycemic clamp; hyperinsulinemic hyperglycemic clamp; or, as a control, an intravenous infusion of .9% sodium chloride in a Latin square design. The cows were previously fitted with a permanent fistula in the abomasum and the outflow rate of abomasal fluid was determined using Co-EDTA as a marker assuming that the outflow followed first-order kinetics. The abomasal pH was also registered. Insulin was infused continuously through a jugular catheter at a rate of 4.8 mU. kg(-1)min(-1) for 2.5 h in the three clamp treatments. A glucose solution was infused through the catheter at a variable rate to achieve a circulating concentration, near the preinfusion glucose level (approximately 4.1 mmol/L), 2 mmol/L below the preinfusion level, and 2 mmol/L above the preinfusion level for the three hyperinsulinemic treatments, respectively. There was a significant effect of treatment on the rate of abomasal outflow (P < .001). The rate of abomasal outflow was highest for the control treatment (7.8%/min). The slowest outflow was observed in the hyperglycemic cows (3.40%/min). The hypoglycemic and normoglycemic cows showed intermediate rates (6.0%/min and 5.2%/min, respectively). The rate of outflow for the hyperglycemic cows was significantly lower than for all the other treatments (P < .01). Abomasal pH was affected by treatment (P < .05). The highest pH was observed in the hyperglycemic cows (pH 2.3). The values for the other three treatments ranged from pH 1.9 to 2.0. These results show that hyperglycemia reduced the rate of outflow and increased the pH of abomasal fluid in dairy cows. An elevated plasma glucose level thus can be considered as a potential risk factor in the pathogenesis of left-displaced abomasum.