FA GI Topics

Hemorrhagic Bowel Syndrome

Hemorrhagic bowel syndrome (HBS or jejunal hemorrhage syndrome) is caused by intraluminal and intramural intestinal hemorrhage and necrosis with subsequent clot formation and intestinal obstruction.  Although the full extent of the SI can be affected, lesions are predominately found in the jejunum (hence the alternative name of jejunal hemorrhage syndrome).  The exact etiology is still under debate but is primarily thought to be due to Clostridium perfringens Type A or a fungal infection.  The prognosis for these cattle is poor as 77% of cattle do not survive and those that do survive may have a recurrence of HBS.

Identified risk factors

  • Dairy cows > beef cows
  • Early lactation
  • High milk producers, fed silage or total mixed ration
  • Free choice feeding
  • Breed: Holsteins and Brown Swiss

Clinical Evaluation

Cows with HBE may be found suddenly dead in the field or present with severe colic, apparent depression, recumbency and lethargy.  Given the severity of the disease, they will have significant dehydration and hypovolemic shock.  Depending on location and duration, you may palpate distended loops of small intestine in conjunction with melena or scant feces containing blood clots.  Ultrasound findings include distended, amotile loops of small intestine.


Presumptive diagnosis is based on clinical findings or confirmed via abdominal exploratory by identifying a movable, spongy, friable obstruction. Cows can ping if the blood clot obstructs the lumen (common) and often have blood in the feces. Differentials include coccidia (hemorrhagic diarrhea) and other SI lesions.

focal necrohemorrhagic enteritis of the distal SI
large blood clot occluding the jejunum


Given the poor prognosis, euthanasia is typically recommended.  For producers or owners that want to pursue treatment, three surgical option have been described: manual clot dissolution with massage, clot removal via enterotomy, or resection and anastomosis of affected intestines. One report found improved survival of surgical cases that utilized manual clot dissolution.  A few successful cases of medical management with or without surgical dissolution have been reported using penicillin and multimodel analgesics/sedation (flunixin, butorphanol, xylazine and lidocaine CRI).


Medical Management HBS in Beef Cow Case Rep Vet Med. 2019

Hemorrhagic bowel syndrome in 22 dairy cows  JAVMA 221(5):686-9



Icon for the Creative Commons Attribution-NonCommercial 4.0 International License

Large Animal Surgery - Supplemental Notes Copyright © by Erin Malone, DVM, PhD is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, except where otherwise noted.