Ventral abdominal hernia• Other than natural

orifice(umblicus/ inguinal

• Described – false hernia- not through body openings)

• Ventral to stifle skinfold- ventral hernia/ rest lateral hernia

Causes/Usually aquired- trauma

• Common location – flank near pelvis

• If no peritoneum in sac- adhesions are more• Left flank- mostly rumen(harmless and surgery

not done)

• Signs: • Assymetry/ swelling• Systemic complication

Diagnosis

• Palpation• Radiography• Discontinuity of ‘flank stripe’ (disturbed

outline of flank)• Contrast radiography

Treatment

• If fresh traumatic injury – delay the repair- if inflammation present is too large

• Prolonged delay- complications• As in umblical H.• Linear incision- suture the layers as in

laparotomy wound

• From inside to outside1.Peritoneum2.Transverse abdominis(CC)3.Internal oblique(cranio ventral)4.External oblique(caudoventral)

Diaphragmatic hernia • Abdominal viscera –

thoracic cavity – through congenital/ aquired opening

• Contents – reticulum, omasum, abomasum, L.Animals

• S.animals- spleen, liver, stomach, intestines

Incidence

• Buffaloes, females- rt. Side- one or multiple rings• Dogs – equal on both sides

• Etiology: weak diaphragm• TRP/ FB• Increased intraabdominal pressure• Musculotendineous junction(less tone and thickness)

Weakest spots of rupture

• Hiatus post.aorta• Hiatus post. Vena cava• Hiatus osophagi

• Weak points1. Rt.of esophagus2. Anywhere in central border3. Close to post. Aorta4. Above post.vena cava

Diagnosis

• Signs: SA severe dyspnoea- abducted elbows• Depends on structures herniated and size of tear• Signs of obstruction, gastric dilatation, liver problems

(vomiting anorexia, jaundice, exercise intolerance)• Signs of pneumothorax, lung contusion

• Auscultation: intestinal sounds on thoracic cage is heard

• Muffled heart sound• History of recent parturition

• Large animals:

• Recurrent tympany (inresponsive to medical treatment)

• Signs are mild to severe (small reticular portion or includes reticuloomasal opening)

• Adhesions of reticulum with diaphragm and distortion of reticuloomasal opening- reduce reticular motility

• Less milk yield•

• scant defecation/diarhoea with foul smell• Aspiration pnemonia in advanced cases• Brisket edema• Jugular pulsation• Abduction of limbs• Coughing may be present

Auscultation • Muffled heart sounds• Reticular sounds cranial to 6th rib

• Radiography:• Lateral/DV• Plain/contrast• Plain:empty reticulum as air filled viscus in

thoracic cavity• Absence of normal diaphragmatic line

• Radiopaque organs- liver/spleen – displacing normal thoracic viscera

• If hydrothorax present- pleural effusions –drain the fluid and go for RG

Comparison

• Radiopaque organs- liver/spleen – displacing normal thoracic viscera

• If hydrothorax present- pleural effusions –drain the fluid and go for RG

• Presence of gas filled structures in thorax(stomach/ intestines)

• Contrast RGConfirmatory

- Barium meal- Cholecystography- aid

in diagnosis of liver herniation

Treatment

• Laprorumenotomy:• Evacuate rumen 3/4th or full• Replace with healthy liquor• Off feed 48 hrs after evacuation-fluid therapy• GA- 6% chloral hydrate(30-60mg/kg)-15/20 min.-

thiopental sodium till effect• 6% chloral hydrate(50-60mg/kg)-15/20 min.-

diazepam (0.3-0.5mg/kg)• IPPV after intubation

• Approaches:• Transabdominal • Transthoracic

• Transabdominal: picture• Rt. Cranial quadrant/rt.

Hypochondriac area is prepared for surgery

• 25-30 cm incision: 5 cm caudal to xiphoid cartilage: parallel to costal arch

• sever the adhesions of diaphragm and reticulum

• abdominal and thoracic organs

• close- ring- continuous lock-stitch suture – non- absorbable- close the abdominal incision

• M.and peritoneum by series of interrupted mattress

• Transthoracic• rt./ left lat.

Thoracotomy• midway on 7th rib-

25cm- downwards towards costochondral junction

• rib resection• incise pleura- herniated

reticulum seen• separate the adhesions

with lungs and pleura• push in abd. Cavity

• close the d. rent• resect indurated diaphragmatic tissue along

with reticulum- adhesions are extensive• if small gap- close by few sutures• if large – use grafts

• Similarly, adhesions with pulmonary lobe requires partial/complete lobectomy

• It may recur, if animal is pregnant at the time of surgery- after parturition – so postpone surgery till after parturition- rumen fistula – partial relief

• dogs: • ventral abdominal approach is preferred since

access to both sides of diaphragm – ventral midline behind the xiphoid cartilage

• if necessary prolong the cranial abdomen incision by splitting the sternum cranially

• lateral thoracotomy if a long standing hernia involving parenchymatous organ

• handle liver carefully as it may bleed/ rupture the liver peritoneum

• if on ventral aspect of dia. And in contact with pericardium – median sternotomy

• edge of tear is not scarified – even if longstanding- suture the rent – simple interrupted / horizontal mattress suture / 0/ 2-0 silk / chromic catgut

• prognosis is good in small animals• hiatal hernia – caudal end of esophagus and

cardia area of stomach passes through hiatus esophagi of diaphragm

Inguinal and scrotal hernia• Inguinal h. : protrusion of an organ through

the inguinal canal (bubonocele)

• If upto the scrotum (oscheocele/ scrotal h.)

Congenital / Aquired

• Inguinal/ Scrotal : congenital: • Rare in cattle and rams : • Common in pigs (cryptorchid) and • Horses(next to pigs)

• Common in bitches esp. the preg. ones (inguinal hysterocele)-obesity

• increased intraabdominal pressure (rough mounting of animals)

• contents are omentum , intestine or both and rarely the UB

• inguinal canal: 2 rings • deep inguinal ring • superficial inguinal ring• bet. These two rings – inguinal canal

• vaginal ring : near the deep inguinal ring above that or dorsal to deep inguinal ring – vaginal ring(males)

• VR is nothing but opening of the lumen of the vaginal tunic into the abdominal cavity.

• Vaginal ring is ring of the peritoneum formed by vaginal tunic as it passes through internal inguinal ring

• It is not circular- slit like

• Deep inguinal ring Medial wall – internal oblique and lateral wall is made by inguinal ligament

• Superficial inguinal ring- opening in - pelvic tendon of external oblique m.

• deep inguinal ring: • bounded ventrocranially

by caudal edge of the internal oblique abdominal muscle and dorsocaudally by the inguinal ligament

superficial inguinal ring : slit like opening in the external oblique

abdominal tendon

• males this canal acts as a passage for structures like spermatic cord within the common vaginal tunic

• in male, passes caudally on each side to the scrotum ending with the testis

• In females vaginal tunics extend upto the vulva and there is no vaginal ring

• In horses : the 2 inguinal rings do not overlie each other. In pig both rings overlie each other and canal is virtually non existent

• Ruminants – canal is shorter than in horses

Confusions

• The vaginal ring should not be confused with deep inguinal ring(inguinal rings are present in both males and females but vaginal ring is present only in males)

• Using of term inguinal canal as though it is same as spermatic sac where as the canal is occupied more than the spermatic sac

• Area bet. the superficial inguinal ring and neck of scrotum is sometimes spoken of as being part of inguinal canal but the external limit of inguinal canal is the superficial ring

• There is lot of gap anatomically present between the neck of scrotum and superficial inguinal ring.

• So it is difficult to describe the hernia- bet. Superficial ring and neck of the scrotum

• Decided to name the h. on the basis of neck of hernia

• If neck is inguinal ring- inguinal• If neck is inguinal ring+neck of scrotum-

scrotal hernia