Hernias 2: management of commonly-occurring hernias Flashcards
How are umbilical hernias diagnosed?
- Usually obvious on clinical examination
- Palpation of ring: easier with patient in dorsal recumbency
- Abdominal imaging if multiple defects, incarceration or strangulation present
Why may some umbilical hernias not require treatment?
<2-3mm hernias may close spontaneously up to 6mo old
Why should animals with an umbilical hernia be neutered?
They are inherited so don’t want them to breed
Describe how to surgically treat umbilical hernias
- Incise skin around base of hernia
- Dissect sac free
- Ligate and amputate if only contains fat
- Enlarge ring if required to aid reduction
- Release adhesions
- Resect / repair damaged contents, reduce, excise sac
- Debride ring and suture closed
How are inguinal hernias diagnosed?
Inguinal swelling
Place animal in dorsal recumbency
- Manually reduce hernia and palpate ring
- Check both sides as often bilateral
Imaging
How might the clinical signs indicate the type of inguinal hernia?
Vomiting / pain / depression = intestine
Vaginal discharge / bleeding = uterus
Describe the two approaches to treating inguinal hernias
- Uncomplicated hernias via incision over hernia parallel to flank fold
- Complicated hernias via midline incision +/- coeliotomy if required
List some possible complications of inguinal hernia surgical repair
- Infection
- Haematoma / seroma: prevent with dressings / drains
- Pain / reluctance to walk
- Compression of vessels / nerves
How are traumatic hernias diagnosed?
- Palpation: Reducible hernia contents, Ring, Herniated viscera under skin
- Imaging to distinguish incarcerated / ill- defined hernias from other masses
- Plain / contrast radiography or CT
- Ultrasonography
How are patients with traumatic hernias treated?
- Stabilise and deal with life threatening injuries
- Delay surgery if possible
- Support hernia with bandages
- Ventral midline coeliotomy for acute hernias
Why would you want to delay surgery of a traumatic hernia for a few days?
- Improve blood supply
- Reduce oedema
- Resolve haemorrhage
BUT excessive delay can risk adhesions / incarceration / fibrosis
List the possible complications post operatively for traumatic hernias
- Seroma / haematoma
- Infection
- Recurrence is uncommon
How are incisional hernias diagnosed
- Palpation of deep sutures to detect defects
- Imaging if in doubt
- Surgical exploration as a last resort
How are acute incisional hernias treated?
- Hospitalise animal and support wound with bandages
- Try to identify cause of herniation
- Reopen original incision for uncomplicated hernias, ventral midline coeliotomy for complicated
- Resuture whole wound if technical error suspected
- Debride devitalised fat / tissue between wound edges then close primarily
How are chronic incisional hernias treated?
- Less risk of evisceration
- Conservative management if asymptomatic, no incarceration, owner can closely monitor
- Surgical repair:
- Approach over original incision
- Identify ring & excise edge
- Close defect primarily / as for chronic traumatic hernias
Define evisceration
An abdominal evisceration occurs when organs are protruding out of a penetrating wound.
How is evisceration treated?
- Protect viscera: sterile dressing, Elizabethan collar
- Stabilise patient with fluids, antibacterials
- Once stable, repair surgically
How are peritoneopericardial diaphragmatic hernias diagnosed?
Other defects often present
Reduced amplitude / alternans on ECG
Thoracic radiography
How are peritoneopericardial diaphragmatic hernias treated?
- Conservative in asymptomatic patients
- Surgical repair via ventral midline coeliotomy
- Reduce viscera +/- extending defect
- Repair / resect as required
- Close with continuous monofilament absorbable suture
- Drain air from pericardial sac
How are peritoneopericardial diaphragmatic hernias treated?
- Conservative in asymptomatic patients
- Surgical repair via ventral midline coeliotomy
- Reduce viscera +/- extending defect
- Repair / resect as required
- Close with continuous monofilament absorbable suture
- Drain air from pericardial sac
How will a patient with a traumatic diaphragmatic hernia present on a clinical exam?
- Tucked up abdomen
- Reduced / abnormally-positioned heart sounds
- Borborygmi in thorax
- Displaced apex beat
How will a patient with a traumatic diaphragmatic hernia present on radiography?
- Loops of SI with gas in them
- Cant see cardiac silhouette
- Lungs compressed and pushed dorsally in the thorax
- Loss of contrast due to pleural effusion
How is a traumatic diaphragmatic hernia treated?
- Surgical repair as soon as patient stable
- Assess and repair abdominal trauma at same surgery
- Complex surgery & aftercare, consider referral
How are perineal hernias diagnosed?
- Rectal examination: feel defect in pelvic diaphragm
- Radiography
- Ultrasonography
- Colonic / rectal biopsy
How are perineal hernias treated?
Investigate for intercurrent disease
Internal obturator transposition
