2. HERNIA
• Hernia is defined as the protrusion of the contents of a
body cavity through a normal (or) abnormal opening in the
wall of that cavity either to lie beneath the intact skin or to
occupy another adjacent body cavity.
• Congenital as well as acquired hernia is common in
domestic animals.
• A congenital due to anatomical variations, polygenic
inheritance, and infectious diseases.
• Acquired hernia is due to trauma, increased intra
abdominal pressure.
3. CONSTITUENTS OF HERNIA
1.Hernial ring
2.Hernial sac
3.Hernial contents
• Ring may be formed due to a rupture in the
abdominal wall, limiting wall or due to a
persistent prenatal opening.
4. • Hernia sac is made of tissues that encloses the
hernial content.
• The wall of the sac usually contains the skin,
muscular fibres, fibrous tissue and parietal
peritoneum.
• The hernial sac is absent in diaphragmatic hernia.
5. CLASSIFICATION OF HERNIA…
• Based on location:
a) External hernia
b) Internal hernia
• Based on functional alteration:
a) Reducible hernia
b)Irreducible hernia
• Based on the contents:
• Based on the cause:
a. Congenital b. Acquired
6. BASED ON LOCATION:
• EXTERNAL HERNIA:
Consists of hernial ring, hernial sac & contents of the
sac
E.g. : Ventral (or) lateral abdominal hernia, inguinal
hernia, umbilical hernia & perineal hernia.
• INTERNAL HERNIA:
Lacks the hernial sac
E.g. : Diaphragmatic hernia
7. BASED ON FUNCTIONAL ALTERATIONS
• REDUCIBLE HERNIA
Where the contents of the hernial sac can be
returned to the original position through the hernial
opening.
• IRREDUCIBLE HERNIA
Where the contents of the hernial sac can not be
returned to the original position through the hernial
opening. Eg: incarcerated hernia, strangulated hernia
8. HERNIA
Strangulated
Incarcerated
If the contents of the hernia are not able to be reduced, the hernia is considered
incarcerated.
A strangulated hernia occurs when the hernia contents are ischemic due to a
compromised blood supply.
9. BASED ON CONTENTS OF THE SAC
• Enterocele ( intestine )
• Epiplocele ( omentum )
• Enteroepiplocele ( intestine and omentum )
• Reticulocele (reticulam )
• Hysterocele ( uterus )
• Vesicocele ( urinary bladder )
• Omphalocele( Umbilical hernia)
Oscheocele (Scrotal hernia)
Bubonocele (Inguinal hernia)
Gut tie (Pelvic hernia or Peritoneal hernia – Intra-abdominal hernia)
Crural or Caudal Hernia (Femoral)
10. BASED ON THE CAUSES
• Congenital – Due to anatomical variations. eg.
Umbilical hernia
• Acquired – caused by trauma. Eg.
Hysterocele
15. Ventral (or) lateral abdominal hernia
• A hernia through any part of abdominal wall other than a natural
orifice
• Ventral abdominal hernia - If the hernia is ventral to the stifle skin fold
• Lateral abdominal hernia - If the hernia in flank region
• Commonly noticed in ruminants
• Mainly due to (1) violent contact with blunt objects (2) violent straining
during parturition
• Commonly seen along the costal arch, high or low in the flank
between the last few ribs or in the ventral abdominal wall near to the
midline
17. INGUINAL Vs SCROTAL HERNIA…
• Inguinal hernia – Protrusion of an abdominal organ
through the inguinal canal
• Scrotal hernia – Protrusion of an abdominal organ
through the tunica vaginalis
• Causes :
(1) Trauma
(2) Mounting of other animal
• May be unilateral (common in left side) or bilateral
22. UMBILICAL HERNIA
Synonyms – OMPHALOCOELE, EXOMPHALOS
Situated in umblical region
More frequently seen in bovine calves and foals
More common in females than in males
Congenital or acquired
Contents include omentum and fat, rarely intestines
The umbilical opening in the foetus allows the passage of the urachus and
umbilical blood vessels. At birth, these structures are disrupted and the
opening closes around the cord.
23. Clinical signs :
Spherical swelling at umbilicus
Palpable circular or oval hernial ring
Treatment includes :
Belly bandages / clamps( metal or wooden)
Radical surgery – overlapping mattress sutures
Herniorrhaphy
Hernioplasty
24. KELOTOMY
• A kelotomy (extension of the hernial ring) may be performed if the
hernial ring is small.
25. TREATMENT
• Herniorrhaphy - Hernia repair surgery or
herniorrhaphy involves returning the displaced
tissues to their proper position and suturing the
hernial ring.
• Hernioplasty - Hernioplasty is a type of hernia
repair surgery where a mesh patch is sewn over
the weakened region of tissue.
26. HERNIOPLASTY…
•To avoid recurrence of hernia due to a
weak spot following Herniorrhaphy
•To bridge the gap especially when the
hernial ring is large
•To reinforce absence or weakness of the
tissues at the hernial ring
28. Perineal Hernia
A perineal hernia is a condition that occurs in both
dogs and cats in which there is an abnormal
displacement of pelvic and/or abdominal organs (small
intestine, rectum, prostate, bladder, or fat) into the region
around the anus called the perineum.
It is a protrusion of the abdominal or pelvic viscera
through the pelvic diaphragm which supports the rectal
wall.
(OR)
29. • Common in old uncastrated male dogs.
• This condition uncommon in ruminants.
• Lack of herniation in female dog, because the
levator ani muscle is stronger and more adherent to
the rectal wall.
• Peak incidence occurring at 7 to 9 years.
• Herniation may be unilateral or bilateral.
30. Etiology
• Congenital predisposition to weakness of pelvic
diaphragm
• Hormonal imbalances
• Prostatic disease.
• Chronic constipation.
• Muscle atropy and concurrent rectal disease.
33. Cont…
SURGICAL TREATMENT
Herniorrhaphy
Two method;
1. Traditional herniorrhaphy.
2. Internal obturator transposition.
*Castration is always performed at the same time as
the perineal hernia surgery so that the prostate will
shrink, thus minimize straining during bowel
movements.
34.
35. Clinical signs
• Reducible perineal swelling
• Constipation, obstipation, tenesmus,
dyschezia
• Straining to urinate
• Leaking stool or urine with blood
• Vomiting
• flatulence
36. Diagnosis
• Based on the history, clinical signs , physical
examination, radiography, USG.
• HISTORY: Difficulty in defecating.
• RADIOGRAPHY
• USG
.
37. Synonym – Crural or Caudal Hernia
Herniation of abdominal viscera through femoral canal
Very rare in animals
Seen as swelling on inner aspect of thigh between
sartorius and gracilis mus.
Interference with normal gait of the animal
Recurrence prevented by suturing Poupart’s ligament
(Inguinal ligament) to sartorius muscle
FEMORAL HERNIA
38.
39. Synonym– pelvic or peritoneal hernia.
Passage of portion of intestine through a tear in the serous
membrane suspending the spermatic cord or hernial ring
like opening between spermatic cord and lateral abdominal
wall due to adhesion.
Seen in bullocks
GUT- TIE
40. Due to castration and occurs on right side
If strangulation – intestinal obstruction and colic
Diagnosis – per rectum, pain(rt flank)
Treatment – Right Flank Laparotomy
41. • Protrusion of the abdominal viscera into the thoracic
cavity through a congenital opening in the diaphragm
• Commonly reticulum herniates into the thorax. And also
omasum, abomasum, loop of intestine, spleen &liver
• Commonly occur in buffaloes
• Passage of abdominal viscera into thoracic cavity
• Herniation at musculo-tendinous junction of diaphragm and
mostly right Hemidiaphragm
DIAPHRAGMATIC HERNIA
42. • Weakening of the diaphragm by lesions of TRP, congenital
weak points of the diaphragm and increased intra
abdominal pressure during pregnancy and parturition,
violent fall etc.
• Congenital or acquired
• Reticulum, omasum, stomach, intestine etc
• Seen in dogs and she buffaloes
43. ANATOMY
Broad and large dome shaped
Unpaired muscle
Forms partition between thoracic and abdominal cavities
Three foramina
1.Hiatus aorticus - aorta
2.Hiatus esophagi – vagus , esophagus
3.Foramen venacava – posterior vena cava
Composed of centre tendinous portion and outer muscular
portion
45. CLINICAL SIGNS:
Dogs – unthriftinesss, coughing, abdominal breathing,
tucked abdomen etc.
Buffaloes – recurrent bloat, abrupt fall in milk yield, scant
faeces / diarrhoea, melena, brisket edema, abduction of
limbs, regurgitation,chronic cough
Death – progressive emaciation and dehydration
46. • Based on history of recent parturition or clinical signs.
• Radiography: (plain or contrast)
- Based on the position of diaphragm & its relationship with
pericardium & reticulum; presence of foreign body , its shape &
size, location of hernia can be recorded
• Contrast radiograph of reticulum – confirmatory
• Ultrasonography
DIAGNOSIS
48. RADIOGRAPH
• Radiograph of reticulum
showing clearly
demarcable
diaphragmatic line and
presence of potential
and non-potential
metallic densities
cranial to diaphragm.
51. • First step of treatment
• Performed under paravertebral block or local infiltration.
• Before opening the rumen, manual exploration is carried out for
assesing the herniation
• Almost 3/4th of rumen content is evacuated
• If foul smelling complete evacuation is done.
• If foreign body present, it is removed
• Before closure of rumen, fresh rumen fluid from healthy animal
should be transplanted.
LAPARO - RUMENOTOMY
52. Procedure :
• After laparo – rumenotomy, the animal is kept off
feed for 48 hrs following ruminal evacuation
• During fasting period, the animal is hydrated with
i/v fluid Half an hour before herniorrhaphy,
prednisolone ( 1.5 – 3mg/kg )is given in i/m
route.
HERNIORRHAPHY
53. • Animal is shifted to supine position and the right cranial quadrant
of abdomen is prepared for surgery
• Skin incision of 25-35cm is made from midline about 5cm below the
xiphoid
cartilage running parallel to costal arch to enter in abdomen
• Incision is made through the muscle and peritoneum for entering in
to the abdominal cavity.
TRANS - ABDOMINAL APPROACH
54. • While exploring the hernial ring, the adhesion b/w reticulum and
Diaphragm are severed by blunt dissection.
• Adhension b/w herniated part of reticulum and thoracic organs is
seperated.
• Reticulum is then retracted into abdominal cavity & hernial ring is
sutured in a continuous lock stitch pattern with no.4 braided silk
(non-absorbable suture material).
• The suture starts from the lower part of the ring.
• Finally, abdominal wound is closed in three layers with braided silk
no.3.
55. • Animal is casted & right or left lateral wall of thorax is prepared for
surgery as per location of the hernia.
• Cutaneous incision of about 25cm in length is made midway on 7th
rib & extended ventrally to costochondral junction.
• The thoracic cavity is entered through rib resection technique.
• After, incising longissimus costarum & serratus ventralis muscle, the
peritoneum over the rib is incised , separated all over the rib &
about 20cm of rib is removed with wire saw.
TRANSTHORACIC APPROACH
56. • The herniated reticular is identified after entering into thoracic
cavity and adhesions with lungs, pericardium and pleura are
carefully separated by blunt dissection.
• Reticulum is then freed from the hernial ring by breaking the
adhesions with gentle blunt dissection.
• Reticulum then pushed into the abdominal cavity and ring is closed
by simple continuous suture with non-absorbable suture material.
57. Form of diaphragmatic hernia - caudal end of the
oesophagus and cardiac area of the stomach pass through
the oesophageal hiatus of the diaphragm.
Reticulum, omasum, abomasum, loops of intestine, spleen
or liver.
Clinical sign - oesophagitis
TREATMENT- Reducing the hernia and reconstructing the
diaphragam
HIATAL HERNIA
59. Farm animal surgery – Susan L.Fubini,
Norm G. Ducharme
Ruminant surgery – R.P.S Tyagi.Jit singh
Essentials of veterinary surgery –
A.Venugopalan
REFERENCES
