UNIT THREE
HERNIAS
Definition:
Hernia is the protrusion of organs or part of an organ
through a defect in the wall of the anatomical cavity in
which it lies.
Constituents of hernia
Hernial ring
Hernial sac
Hernial content
By Zerihun M.(DVM, MVSc, Assist. Prof.) 05/04/2025 1
A) Hernial ring: may be a natural (umbilical or inguinal)
Acquired (rupture of abdominal wall e.g. ventral hernias).
B) Hernial sac: is composed of skin, subcutaneous tissue and
with/out peritoneum.
C) Hernial content: these consists either omentum, loop of
intestine or a stomach or gravid uterus but urinary bladder is rare
based on location.
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Classification:
o Hernia can be classified:
1) According to location
Umbilical hernia (Omphalocoele)
Inguinal hernia (Bonocoele)
Scrotal hernia (Oscheocoele)
Ventral hernia- ventral abdomen
Perineal hernia- perineum
Diaphragmatic hernia- diaphragm
2) Nature of content
Omentum- epiplocoele
Stomach- gastrocoele
Uterus- metrocoele
Urinary bladder- vesicocoele
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Prof.) 05/04/2025 3
3) According to nature of reduction:
Reducible hernia- when the content and size of the hernia is
reduced and becomes almost zero.
Irreducible hernia- the contents cannot be easily reduced; may
be due to the adhesion b/n the content and the peritoneum.
4) Based on the nature of content:
Incarcerated hernia: the content of the hernial sac are too
voluminous to pass through small hernial ring.
Strangulated hernia: the incarcerated hernia may get
strangulated; if the hernial ring evert pressure on the mesentery
and obstructing the blood vessels to the contents.
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Prof.) 05/04/2025 4
If the condition persists for more time:
There will be necrosis and gangrene of the content
The content will protruded to the peritoneal cavity and develops
acute peritonitis.
5) Based on etiology:
A. Congenital causes
o Failure of the umbilical opening to close after birth
B. Acquired causes
Trauma- horn thrust in the abdominal wall
Deep abscess in the abdominal wall-abscess will weaken the
abdominal wall
Exciting causes- are causes which will increase the abdominal
pressure. E.g., pregnancy, parturition, diarrhea or dysentery
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oPrognosis: favorable for most hernias but unfavorable if the hernial
ring large in size and necrotized. E.g., irreducible and strangulated
hernia.
oDDX: abscess, tumor, hematoma, cyst
COMMON HERNIAS
1)UMBILICAL HERNIA (Omphalocoele)
o Develops in umbilical region due to acquired or congenital.
o The contents usually consist of omentum and intestines.
o The condition is common in foals, pigs, calves and pups but rare
in lambs and kids.
o Umbilical hernia is comparatively more common in females than
in males. By Zerihun M.(DVM, MVSc, Assist.
Prof.) 05/04/2025 6
Clinical Signs
A discrete spherical swelling at umbilicus
Hernial contents are usually fat and omentum
Larger hernial sac contains loops of small intestine
A circular or oval hernial ring can be palpated.
Presence of adhesions/ umbilical abscess prevent reduction .
Diagnosis: Clinical signs and physical examination
Treatment
Conservative: Suitable only for a small reducible hernia
Respond favorably to abdominal pressure bandages or
clamps.
Use of metal or wooden clamps
Wound heals by 2nd intention.
Surgical methods: Herniorrhaphy
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2) VENTRAL HERNIA
Is the term used to describe a hernia through any part of the
abdominal wall other than a natural orifice.
Radical surgery :
o Herniorrhaphy: Large swelling
o Anesthesia: general anesthesia or sedation combined with
local anesthesia.
o Control: dorsal recumbence or lateral tilt
o Incision: an elliptical incision over the hernial swelling.
o Reduce contents and debride hernial ring
o Closure: double breasting or overlapping suture pattern with a
synthetic non absorbable suture.
o Hernioplasty: Large and weak hernial ring.
By Zerihun M.(DVM, MVSc, Assist.
Prof.) 05/04/2025 8
Etiology
Any trauma- horn thrust in cattle, violent contact with blunt
objects, weakening of the abdominal muscle.
Violent straining during parturition- common in sheep.
Ventral or lateral hernia is usually seen along costal arch, high or
low in flank and between the last few ribs in the ventral
abdominal wall near the midline.
Signs
Size varies and swelling is usually very prominent.
May be oedema or haematoma surrounding tissue at early
stages.
Nature of hernial contents depends on the site of herniation.
By Zerihun M.(DVM, MVSc, Assist. Prof.) 05/04/2025 9
Surgical Procedure
An elliptical or linear incision -> Reduce the hernial
content.
The peritoneal sac is ligated or sutured close to the
ring and amputated.
The hernial ring is debrided and sutured using
special tension sutures with a non-absorbable suture
material.
The skin incision may be sutured with a vertical
mattress sutures.
By Zerihun M.(DVM, MVSc, Assist. Prof.) 05/04/2025 10
If the hernia ring is too large, hernioplasty using prolene
mesh or nylon mesh.
Put the mesh between the skin and muscle and suture it
with the muscle by simple interrupted suture pattern.
The skin may be closed with a vertical mattress sutures.
Post Operative Care
Amount of feed should be restricted.
Supportive bandage may be placed around the
abdomen.
Tear of scar tissue during parturition and recurrence of
hernia may occur in some cases.
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3) DIAPHRAGMATIC HERNIA
o DH is defined as the passage of abdominal viscera into the
thoracic cavity through a congenital or acquired opening.
Etiology
1) Lesions of foreign body on the diaphragm: E.g. TRP
2) Congenital weakness of the diaphragm
E. g: Buffalo has weak diaphragm than cattle.
3) Accidental falling from a height: when animals fall from
height, there will be sudden increase in intra-abdominal
pressure (rupture of the diaphragm at the weakest points).
By Zerihun M.(DVM, MVSc, Assist.
Prof.) 05/04/2025 12
Clinical Signs
In bovine:
o Chronic tympany not responding to medical
treatment
o Complete or partial cessation of milk yield
o Brisket edema and jugular pulse with abduction of
fore limbs
o cardiac sound are muffled
In dogs:
May not be noticed until the pup attains six months of age
Abdominal breathing.
Peculiar cough, tendency to tire easily, un thriftiness and
tucked up abdomen.
Tendency to vomit after feeding.
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Prof.) 05/04/2025 13
Treatment: only surgical
Repair of the diaphragm can be done
Trans-abdominal approach
Trans-thoracic approach
A) Trans-abdominal approach
First perform laparo-rumenotomy. Foreign bodies if present in
the rumen and reticulum should removed.
Locate DH, its ring and adhesion
Add fresh rumen fluid from health animals before closure
The animal is kept off feed for 48 hrs and keep hydrated IV
fluid
The Make herniorrhaphy after 3-4 days of laparo-rumenotomy.
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Prof.) 05/04/2025 14
Anesthesia: sedative and local infiltration with local anesthetic agents.
Control: right lateral recumbence in inclined position.
The abdomen is entered through an incision of 20-30 cm in length,
about 5 cm caudal to the costal arch(least Hemorrhage).
Severe adhesions between the reticulum or other abdominal organs and
diaphragmatic ring by blunt dissection.
The reticulum is then withdrawn in to the abdominal cavity and the
ring is closed with continuous lock stitch suture using non-absorbable
suture material.
The suture starts from the lower part of the ring
Finally, the abdominal wound is closed in two or three layers
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B) Trans-thoracic Approach
The thoracic cavity is entered through a 5th inter costal space.
Infiltration of local anesthetic agents on the fifth rib starting from
10 cm below the costo-chondral junction.
After the skin and muscles have been incised, a longitudinal
incision is made on the periosteum of the exposed rib.
The periosteum is stripped from the lateral surface and cranial
and caudal borders of the rib with help of a periosteal elevator .
A curved mosquito haemostat introduced between the periosteum
and medial surface of the rib is moved up and down to separate
the periosteum completely from the rib.
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Prof.) 05/04/2025 16
To expose the periosteal bed, the rib is resected with obstetrical
wire or saw at the proximal end.
The distal end is then disarticulated at the costochondral junction
A small incision made during expiration through the exposed
periosteum and plural allows air enter the thoracic cavity to
cause collapse of the lung.
After the pleura has been incised, the herniated reticulum comes
into view.
Adhesions of the reticulum with the lungs pericardium and
pleura are separated carefully by blunt dissection.
By Zerihun M.(DVM, MVSc, Assist.
Prof.) 05/04/2025 17
The reticulum is freed from the ring by breaking the adhesion with
a gentle blunt dissection .
The reticulum is the pushed into the abdominal cavity and the ring
is closed the same ways as in trans-abdominal approach.
Intra operative considerations: in all the approaches the animal
should be maintained under positive pressure ventilation.
Negative pressure in the thoracic cavity should be reestablished
by aspirating the air from the thoracic cavity before the final
closure.
By Zerihun M.(DVM, MVSc, Assist.
Prof.) 05/04/2025 18
Clinical sign
Difficulty and pain while walking down from a height.
Chronic stomach disorders.
Respiratory distress.
Gurgling sounds on auscultation of chest.
Absence of respiratory sound on affected side.
More pronounced respiratory distress immediately after feeding
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Diagnosis
o History and clinical signs on auscultation- cardiac sound are
muffled
o Plan/contrast radiography
Post-operative care:
Broad spectrum antibiotic for 5-7 days
Analgesics for 5-7 days
Adequate fluid therapy
By Zerihun M.(DVM, MVSc, Assist.
Prof.) 05/04/2025 20
4) INGUINAL HERNIA
Definition:
Protrusion of an abdominal organ through the
inguinal canal (Bubonocele).
If the hernial contents extend into the scrotum in
male animals the condition is called as scrotal hernia.
Incidence: bitches, horses, bulls and pigs.
The hernial contents may be the omentum, intestine
or both
Rarely, the urinary bladder may be involved.
By Zerihun M.(DVM, MVSc, Assist.
Prof.) 05/04/2025 21
Anatomy
Inguinal canal is an oblique (slit like) canal between the
abdominal muscles connecting the external and internal
inguinal rings.
The inguinal canal, in both the male and female is lined by the
tunica vaginalis, which is an out pouching of the peritoneum
and thus the protruding viscous may be contained within the
sac of the tunica vaginalis.
The canal acts as a passage for structure like spermatic cord in
males and external pubic artery in females.
Internal inguinal ring is longer than external.
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Prof.) 05/04/2025 22
Causes
May be congenital or acquired – accidental slipping causes
stretching of the hind limbs outwards which may dilate
inguinal canal.
Mounting of other animals increases intra-abdominal pressure
which may facilitate passage of a loop of intestine in to
inguinal cannel.
Symptoms
In large animals swelling in the inguinal canal at the neck of
scrotum.
Unilaterally enlarged scrotum; affected bulls or stallions may be
reluctant to serve.
Refuse to move due to pain
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Prof.) 05/04/2025 23
Abduction of hind limbs
Systemic signs are evident only when the hernia gets
strangulated.
Diagnosis
Clinical signs
Radiography.
Hernial swelling close to or including the scrotum
Rectal palpation in large animals.
By Zerihun M.(DVM, MVSc, Assist.
Prof.) 05/04/2025 24
Treatment
In small animals: A paramedian incision is made close to the
inguinal swelling.
The contents are reduced by gentle pressure.
A kelotomy may be performed if the hernial ring is small. The
edges are debrided and closed using an absorbable suture
In large animals: after making the incision the hernia is reduced
and purse string suture is applied around the tunica vaginalis as far
high as possible.
A portion of the omentum that is difficult to reduce can be
amputated. Overlapping suture of the muscles and routine closure
of the skin is made.
By Zerihun M.(DVM, MVSc, Assist.
Prof.) 05/04/2025 25
5) PERINEAL HERNIA
Definition:
Is protrusion of the abdominal or pelvic viscera through the pelvic
diaphragm which supports the rectal wall.
Anatomy
o The perineum is a part of the body wall that covers the pelvic
cavity outlet while surrounding the anal and urogenital canals.
o The pelvic diaphragm, a principal structure of the perineum, is
formed by coccygeus and levator ani muscles besides perineal
fascia.
o The ischiorectal fossa formed by the external anal sphincter,
the levator ani and the coccygeus muscles medially, the
internal obturator muscle ventrally and the superficial gluteal
muscle laterally, is very important from surgery point of view.
By Zerihun M.(DVM, MVSc, Assist.
Prof.) 05/04/2025 26
Etiology:
Hernation occurs due to slacking or tearing of the
pelvic diaphragm muscles.
The herniated structures occupying the
ischiorectal fossa appears as a reducible
swelling alongside the anus.
The hernia swelling is present along side the
vulva lips or the anus.
It is most predominantly seen in old un
castrated male dogs. Though the condition is
reported in bitches and cats, incidence is rare.
By Zerihun M.(DVM, MVSc, Assist.
Prof.) 05/04/2025 27
Symptoms
Fluctuating/hard swelling ventral and lateral to the
anus (in the ischiorectal fossa)
Swelling may be unilateral or bilateral
The hernial contents are usually rectum, bladder,
enlarged prostate and retroperitoneal fat.
Retroflexion of the bladder is not uncommon.
Incarceration of bladder in the perineal hernia
should be considered as an emergency.
Hard swelling should be differentiated from perianal
neoplasm.
By Zerihun M.(DVM, MVSc, Assist.
Prof.) 05/04/2025 28
Diagnosis
Based on clinical signs.
Contrast radiography with barium enema will help to
differentiate rectal deviation from rectal diverticulum.
Ultra sound scan will be useful to identify retroflexed bladder.
Surgical Management
o Following sedation and epidural block, the animal is controlled
either in dorsal or lateral recumbent position.
o A purse string suture is placed the anus after placing a gauze
plug in the anal opening.
o An incision slightly curved and starting from the lateral side of
the anus is extended upward over the ischiorectal fossa.
By Zerihun M.(DVM, MVSc, Assist.
Prof.) 05/04/2025 29
o Subcutaneous tissue is then separated by blunt dissection to
expose the herniated mass.
o The hernial contents are replaced and the defect in the pelvic
diaphragm is repaired by placing sutures in two layers.
o In the first layer, the cranial margin of the external anal
sphincter muscle is sutured to the lateral sacrococcygeal
muscle dorsolaterally, to the ventromedially, using non-
absorbable suture materials.
o The second layer unit’s perineal fascia to the caudal margin
of the external anal sphincter.
o The skin is closed with interrupted sutures.
o The purse string suture is removed and the plug is taken out
from the anal opening.
By Zerihun M.(DVM, MVSc, Assist.
Prof.) 05/04/2025 30
THANKS!!!!!!
By Zerihun M.(DVM, MVSc, Assist.
Prof.) 05/04/2025 31
