large animal hernias = displacement of an internal organ or · special types richter hernia...

Large animal hernias Large animal hernias

Dr. Izing SimonDr. Izing SimonDr. Gábor Bodó Dr. Gábor Bodó Ph.D habil.Ph.D habil.

Szent István Szent István University, Faculty of Veterinary ScienceUniversity, Faculty of Veterinary Science,,Large Animal Clinic ÜllőLarge Animal Clinic Üllő

Definitions Definitions

�� = displacement of an internal organ or = displacement of an internal organ or

part of organ through a natural or aquired part of organ through a natural or aquired

space without contacting the outside space without contacting the outside

worldworld

�� Prolapse = displacement of an internal Prolapse = displacement of an internal

organ or part of organ through aquired organ or part of organ through aquired

space to the outside worldspace to the outside world

Division of hernias Division of hernias

♦♦ Outside and inside herniasOutside and inside hernias

♦♦ Indirect and direct herniasIndirect and direct hernias

♦♦ Reducible and nonreducible Reducible and nonreducible

♦♦ LocationLocation

♦ Abdominal (outside)

♦ Inguinal hernias

♦ Internal hernias

Parts of herniasParts of hernias

��Hernial ring Hernial ring

��Hernial sac Hernial sac

��Hernial contentHernial content

��Hernial wallHernial wall

prestenoticprestenotic

Poststenotic intestinePoststenotic intestine

1.1. Abdominal herniasAbdominal hernias1.1. Umbilical herniasUmbilical hernias2.2. TraumaticTraumatic3.3. PostoperativePostoperative4.4. Prepubic tendon rupturePrepubic tendon rupture

2.2. Inguinal herniasInguinal hernias1.1. Congenital (scrotal)Congenital (scrotal)2.2. AquiredAquired

1.1. IndirectIndirect

2.2. DirectDirect

3.3. Internal herniasInternal hernias1. Diaphragmatic, mesenteric, omental,

2. Nephrosplenic, epiploic,

3. Discus hernia, intracranial hernias

1. Abdominal hernias1.1. Umbilical herniasUmbilical hernias

2.2. TraumaticTraumatic

3.3. PostoperativePostoperative

4.4. Prepubic tendon rupturePrepubic tendon rupture

2.2. Inguinal herniasInguinal hernias1.1. Congenital (scrotal)Congenital (scrotal)

2.2. AquiredAquired1.1. IndirectIndirect

2.2. DirectDirect

3.3. Internal herniasInternal hernias

Special typesSpecial types�� Richter herniaRichter hernia

�� Adhesion, or even incarcerationAdhesion, or even incarceration

�� But just one side of the wallBut just one side of the wall

�� Littre herniaLittre hernia

�� Meckel divertikulum incarceratedMeckel divertikulum incarcerated�� = embrionic remnant of the = embrionic remnant of the

omphalomesenteric duct.omphalomesenteric duct.

i.walli.wall

Body wallBody wall

peritoneumperitoneum

Abdominal hernias 1. Umbilical hernias in large animals

Abdominal hernias 1. Umbilical hernias in large animals

♦♦ Occurence frequencyOccurence frequency

♦♦ dog>cat>pig>horse>cattledog>cat>pig>horse>cattle

♦♦ Congenital Congenital (or aquired: seldom: umbilical injury at (or aquired: seldom: umbilical injury at

birth, excessive straining etc.)}birth, excessive straining etc.)}

♦♦ filly>coltfilly>colt

♦♦ Hernial sac: Hernial sac: peritoneum+skin = real (indirect) herniaperitoneum+skin = real (indirect) hernia

♦♦ Hernial content: Hernial content: omentum, small intestine, (caecum, omentum, small intestine, (caecum,

colon, su: abscess!)colon, su: abscess!)

SymptomsSymptoms

�� ReponableReponable

�� softly elasticsoftly elastic

�� compressable, reducablecompressable, reducable

�� IrreponableIrreponable

�� Adhesions (Adhesions (~~ accreta)accreta)

��~~ Incarcerata Incarcerata elastica(in foals 2elastica(in foals 2--10% of umbilical hernias 10% of umbilical hernias ––predisposing: small predisposing: small

ring, large sacring, large sac

�� Incarceratio elastica Incarceratio elastica

�� Incarceratio stercoralisIncarceratio stercoralis

DiagnosisDiagnosis

�� AnamnesisAnamnesis�� Visual examination, Visual examination, �� palpationpalpation

IncarceratioIncarceratio

�� Irreducible, firm swelling, painful,Irreducible, firm swelling, painful,

�� Inflammation of the surrounding tissuesInflammation of the surrounding tissues

�� Colic symptomsColic symptoms

�� UltrasoundUltrasound

IncarceratioIncarceratio Therapy 1. reducible umbilical hernia: conservative treatment

Therapy 1. reducible umbilical hernia: conservative treatment

♦♦ < 5cm =sponteneous closure, if not after 6 months surg.< 5cm =sponteneous closure, if not after 6 months surg.

♦♦ > 5> 5--10 cm = surgery10 cm = surgery

Conservative treatment: Conservative treatment: Frequent reposition of the content, bandage (more Frequent reposition of the content, bandage (more effective in calfes)effective in calfes)

hernia clamps at 4hernia clamps at 4--6 months (<5cm)6 months (<5cm)

General anaesthesia, dorsal recumbency General anaesthesia, dorsal recumbency

♦♦ Anblock excision of hernial sac Anblock excision of hernial sac –– opened techniqeopened techniqe

♦♦ Closed techniqe: Closed techniqe:

♦♦ Extraction of the inner tube, closure of the h. ringExtraction of the inner tube, closure of the h. ring

♦♦ Biological plugging of the hernial ringBiological plugging of the hernial ring

Therapy 2. reducible umbilical hernia: surgical treatment

Therapy 2. reducible umbilical hernia: surgical treatment

�� Immediate surgery!Immediate surgery!

Predisposition: small ring large sacPredisposition: small ring large sac

�� Course of surgery:Course of surgery:

�� 1. Open the hernial sac1. Open the hernial sac

�� 2. Resection of the sac2. Resection of the sac

�� 3. Reposition or resection of the content3. Reposition or resection of the content

�� 3. Closure of the hernial ring and surg. wound3. Closure of the hernial ring and surg. wound

Therapy 3. Incaracerated umbilical hernia

Therapy 3. Incaracerated umbilical hernia

Incaracerated umbilical herniaIncaracerated umbilical hernia







2.2. DirectDirect


Abdominal hernias 2. traumatic origin

Abdominal hernias 2. traumatic origin

Clinical signsClinical signs

Large hernial ring:

Not susceptible to incarceration, but do susc. to adhesionsNot susceptible to incarceration, but do susc. to adhesions

Small hernial ring:

Susceptible to incarcerationSusceptible to incarceration–– ileusileus

Most common location:

Aponeurosis Aponeurosis of the int. and transv. abd. orof the int. and transv. abd. or

ext. and transv. abdom. muscleext. and transv. abdom. muscle







2.2. DirectDirect


Abdominal hernias 3.Postop abdominal hernia

Abdominal hernias 3.Postop abdominal hernia

�� Following abdominal (colic) surgery at the Following abdominal (colic) surgery at the

previous surgical siteprevious surgical site

�� Possible causes:Possible causes:

�� Surgical technical error, failure of surture materialSurgical technical error, failure of surture material

�� Wound infectionWound infection

�� Extra abdominal pressure, foal under the mareExtra abdominal pressure, foal under the mare

�� Too early trainingToo early training

�� Predisposing factors:Predisposing factors:

�� „Belly horse”, large wound, long operating time, „Belly horse”, large wound, long operating time,

�� Peritonitis at the time of surgeryPeritonitis at the time of surgery

Postop. abdominal herina: treatmentPostop. abdominal herina: treatment

�� Abdominal bandage, Abdominal bandage,

�� Reconstruction:Reconstruction:

�� 44--6 months post surgery6 months post surgery







2.2. DirectDirect


Prepubic tendon rupturePrepubic tendon rupture

�� Associated with:Associated with: hydroallantois, twins, trauma,

� Excessive edema of the ventral abdom. wall

�� Clinical signs:Clinical signs: sudden onset

progressive enlargement, edema

mild to moderate discomfort

stiff gait, prefer not to lie down, reluctant to move

DiagnosisDiagnosis: :

� anamnesis, visual exam., palpation,

� rect. exam. US exam.

DifferentialDifferential--diagnosis:diagnosis:

� haematome, abscess, tumor







2.2. DirectDirect


Inguinal herniascongenital

Inguinal herniascongenital

Definition:Definition:

Inguinal hernia: abdominal organ slips into the inguinal

channel

Scrotal hernia: hernial content in the vaginal tunic

(In general: inguinal hernia)

Occurence: large an. small an.

boar, colt,ram (seldom: bull, male dog)

Cause: congenital predisposing factor

SymptomsSymptoms

♦♦ Congenital indirect form (foals)Congenital indirect form (foals)♦♦ Usually no colic symptomsUsually no colic symptoms

♦♦ Palpable intestines in the scrotum, soft fluctuend Palpable intestines in the scrotum, soft fluctuend

swelling swelling

♦♦ NoNott painfulpainful

TreatmentTreatment

��Congenital inguinal hernias in foalsCongenital inguinal hernias in foals (without colic (without colic

signs!)signs!)

�� Continuous controlContinuous control

�� Can grow out of the problem until 3Can grow out of the problem until 3--6 months6 months

�� Immediate surgery if colic signs are also presentImmediate surgery if colic signs are also present

�� If direct: surgical treatment necessary!If direct: surgical treatment necessary!







2.2. DirectDirect


♦ Hard, painful palpational finding, good visible, enlargement is not remarkable, not palpable!!!

♦ Early stage: rectal palpation of the involved structures is

painful, indolent stage: not painful palpation finding

(suspicion: necrosis)

Clinical symptomsAquired indirect form (stallions)

Clinical symptomsAquired indirect form (stallions)

DiagnosisDiagnosis�� Anamnesis, clinical signsAnamnesis, clinical signs

�� Visual exam., palpationVisual exam., palpation

�� Rectal exam., (adults)Rectal exam., (adults)

Differential diagnosisDifferential diagnosis

�� Twisted testicle (rare)Twisted testicle (rare)

�� Thrombosis of the testicular artery (rare)Thrombosis of the testicular artery (rare)

�� Seroma (hydrokele), hematoma (hematokele)Seroma (hydrokele), hematoma (hematokele)

�� Pyokele (pus in the vaginal tunic)Pyokele (pus in the vaginal tunic)

�� OrchitisOrchitis

�� Teratomas of the testicle or scrotum)Teratomas of the testicle or scrotum)

Treatment of acquired incarcerated

inguinal hernias in stallions

Peracute stage: pull out rectally continue with castration

Surgery: gen. anesth. dors. rec.

• herniotomy, gut resection if needed

• decompress prestenotic intestines

• castration, closure of the ext. ing. ring,

• Collateral castration? – ask owner

• Laparoscopy?







2.2. DirectDirect


Aquired scrotal, direct herniasAquired scrotal, direct hernias

••Clinical signsClinical signs

••MildMild-- to moderate colicto moderate colic!!

••Adhesions and or Adhesions and or

inflammation of intestinesinflammation of intestines

••PrognosisPrognosis

••Guarded to goodGuarded to good

••TreatmentTreatment

••Do not wait long!Do not wait long!••Closure of hernial ringClosure of hernial ring







2.2. DirectDirect


Internal hernias(see colic surg. lecture)

Internal hernias(see colic surg. lecture)

Displacement of an abdominal organ trough a Displacement of an abdominal organ trough a physiological or abnormally originating space physiological or abnormally originating space

��Diaphragmatic herniaDiaphragmatic hernia

��For. epiploicum WinslowiFor. epiploicum Winslowi

��Rent in the mesenterium or omentumRent in the mesenterium or omentum

��Nephrosplenic spaceNephrosplenic space

��adhesions, wholes made by fibrous growthadhesions, wholes made by fibrous growth

�� Some interesting examples for thinkingSome interesting examples for thinking

large animal hernias = displacement of an internal organ or · special types richter hernia...

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