Herniorrhaphy (Proceedings)

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Herniorrhaphy (Proceedings)

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Oct 01, 2008

Post-Operative Care

Complication following repair includes peritonitis, evisceration and recurrence. Administration of an antibiotic is indicated to prevent infection; Evisceration is best prevented by good surgical technique and confining the patient to a cage or otherwise limiting its activity for the first post-operative week

Ventral Abdominal Hernias

A ventral abdominal hernia is one in which there is a prolapse of abdominal contents through the abdominal wall at any point other than the umbilicus or inguinal ring. This hernia is acquired when an animal is kicked or struck by a car. It has been described as a false hernia because it does not occur through a natural or potential body opening. Ventral herniation may result when small dogs are mauled by large animals and it is not unusual for the hernia to develop some weeks following the original injury.

The incidence of ventral hernia is low. Its most common location is in the flank near the pelvis. This has been attributed to the assumption that abdominal muscles have greater elasticity at their costral attachments at the linea alba and at the prepubic tendon.

Clinical Signs

The most obvious sign is asymmetry or swelling of the abdominal region. The consistency of the swelling depends on the contents and the presence or absence of infection. The size of the swelling may increase following sudden body movement or during coughing. Pain is often elicited upon palpation.

Diagnosis

If the muscle layer rupture is complete, it may be possible to identify loops of intestine, spleen or other abdominal viscera, In other cases, some of the muscle fibers are separated and swelling is obvious, but an unbroken muscle layer could prevent the viscera from migrating subcutaneously. The greatest swelling may not be at the site of ruptured muscles because viscera escaping through the abdominal muscles may migrate subcutaneously. It is often necessary to administer an anesthetic agent to facilitate a complete examination to determine the extent of the hernia and the planned surgical approach.

If the swelling is reducible, one may be able to tentatively identify intestine by its tendency to slip suddenly back into the abdominal cavity when palpated; omentum returns slowly. An incarcerated hernia feels turgid, and it is difficult to palpate the hernial opening. When adhesions are present, it may be possible to reduce the swelling, but the sac cannot be separated from its contents. An incarcerated hernia must be differentiated from an abscess, hematoma, cyst or neoplasm.

Radiographic Diagnosis

Radiographs may reveal gas filled loops of intestine located subcutaneously in the lateral or ventral abdominal wall. There may be subcutaneous emphysema if the intestinal wall or skin has been perforated.

Prognosis

In most cases, a hernia of long-standing is less serious than a recent one, The fact that it has been present for some time without causing difficulty is in itself reassuring. Any hernia is a potential hazard to the health of the animal because the hernial contents are more exposed and vulnerable to trauma than when protected by the body wall. A hernia that can't be reduced is more dangerous than one that can because it is more likely to become strangulated. Strangulation is more likely if the sac is large in relation to the size of the rings. The prognosis is poor if the strangulated tissues have become gangrenous.