hernia
TRANSCRIPT
Hernia Dr. Rekha Pathak, Senior scientist, IVRI
• Def:• Protrusion of body
cavity contents• Into normal / Abnormal
opening in the wall of that cavity
• To lie beneath the intact skin or to occupy another body cavity
Constituent of herniaRing, Sac and Contents
• H. Ring:• Rupture of abdominal
wall- Ventral hernia• Diaphragm is the
limiting wall: DH• Normal opening/
Passage: Inguinal ring / canal
Sac
• In external hernia-• Skin• M.fibres• Fibrous tissue• Parietal peritoneum
Contents
• Intestine• Omentum• Liver• Spleen• Bladder• uterus
Classification of hernia
• 1. OCCURRENCE • Congenital • Aquired
• 2. LOCATION:External : has ring , sac and contentsEg: ventral, lateral , inguinal (bubonocele), scrotal
umblical(exomphalos, omphalocele) , perineal
Internal: no sacEG. DH, gut- tie (occasional)
Interstitial : between the abdominal muscles
Classification of hernia
• 3. According to contents• Enterocele• Epiplocele• Enteroepiplocele• Gastrocele• Reticulocele• Vesicocele• Hysterocele
Classification of hernia
• 4. Depending on cause:• Traumatic H.• Infectious H.
• 5.Based on functional alteration
• Reducible- contents returned through ring into original position
• Irreducible – adhesions(sac and contents)
• Incarcerated- voluminous contents due to venous congestion
• Strangulated- necrosis and extensive adhesions
Diagnosis
• Symptoms:• 1. Physical :
• Swelling – variable in size
• (abscess, hematoma , cyst, neoplasm )- aseptic exploration
• Palpation of ring• Consistency of sac: enterocele(elastic), epiplocele
(doughy)
Diagnosis
• Functional symptom• Absent in reducible and
non- complicated hernia• Colic in incarcerated
hernia• Severe pain, temp.etc
Radiography
Complications of hernia
• Adhesions• Hydrocele of sac• Incarceration-absorption of water in enterocele-
making reduction difficult• Torsion• Strangulation-called as acute hernia
Umblical hernia
• Common in dogs and bovine calves
• Rare in lambs & kids• No gender
predisposition, among ruminants- common in females
• Congenital/ aquired • Congenial – hypoplastic
rectus muscles and aponeurosis of oblique muscle(wide thin linea alba from xiphoid to pubis )- DH
• Aquired: cord cut close to abdomen
• Bitch chews • Rough handling• Excessive
straining(diarhoea/ constipation)
• Infection of cord• Congenital/ aquired –
primarily hereditary – size- H.ring- recessive genes(2 or more)
Clinical signs
• Swelling • Ring • Contents – omentum / fat/ intestinal loop• More voluminous content/ adhesions- ring not
felt- RG diagnosis
Treatment
• Conservative: belly bandages/ wooden or metal clamps
• Reducible- small content• Dorsal recumbency- reduce manually the
contents- clamp the empty sac- jaw of clamp and tighten the nuts
• Aim : to obliterate hernial sac – stimulate healing of the ring
• Sac – necrosis- sloughs down – 10- 12 days• Skin wound- heals by 2nd intention• Inject irritants – HCL/ H2so4- around ring-
stimulate fibrous tissue formation
Radical surgery
• 12-24 hrs fasting• Local infiltration/GA• Dorsal recumbency
• Midline/ extended past craniocaudal limits on the ring
• In large hernia- elliptical incision – removal of isolated skin
• Open the sac • More
content and small ring- go for kelotomy
• Reducible – invert the contents
• if large and adhesions: remove
1. Bet. Sac(inner wall) and contents
2. Bet. Sac with skin/muscles
Edge of ring – debrided
If sac is big- remove the sac
• Series of simple interrupted / horizontal mattress
• Chromic catgut/ silk / monofilament/ steel/ nylon
• Overlapping mattress- non – absorbable- tighten from centre to periphery
• Wide wall disruption- tension on apposition of edges
• To relieve- external laminae of rectus sheath- incised on each side of incision – relieve tensionand achieve apposition of sutured H. ring
• Alternatively, Hernioplasty
Hernioplasty(Hernial Prosthesis)
• Large h. ring• Weak spot(scar) present• Large loss of tissue on edges
• Allow approximation without tension
• Bridge the gap• Avoid reccurrence of hernia
Living (fresh and preserved)
• Skin- full thickness, autologous whole skin graft (DH)
• Duramatter• Muscle• Fascia lata- lumbar
area- no tissue reaction
Non – living
• Metallic : stainless steel
• Synthetic: Nylon, teflon, Marseline, Marlex, dacron, etc
• Mesh/sheets
• Mesh – prefferred1. More flexibility2. Permits infiltrative fibrosis-
scaffold – ingrowth- fibrous CT3. Minimal tissue reaction and
adequate strength 4. 15x30 cm
Techique • Remove sharp ends and
corner• Close muscle defect• Edge of mesh – sutured-
surrounding fascia with non- absorbable material in a horizontal mattress pattern
• Close the skin