Inguinal & Umbilical Hernias

Question 1

On which side do we more commonly see inguinal hernias in bulls?

Answer 1

Left

Question 2

An indirect inguinal hernia:

• Involves bowel passing through the internal longitudinal ring
• Involves bowel passing through a rent in the body wall adjacent to the internal inguinal ring
• Can occur only in mares and geldings
• Rarely produces testicular compromise in the adult stallion

Answer 2

involves bowel passing through the internal longitudinal ring

Question 3

If there is an umbilical vein infection extending to and involving the ________, the vein should be marsupialized to the ventral body wall

Answer 3

liver​

• If there is an umbilical vein infection extending to and involving the liver, the vein should be marsupialized to the ventral body wall.*
• After surgery, the marsupialized tract is irrigated with iodine until closure by second intention*

Question 4

T/F: Inguinal hernias in adult horses are usually acquired and non-reducible

Answer 4

True

• Inguinal hernias in the adult horses are usually acquired and non reducible
• Congenital inguinal hernias in foals are reducible

Question 5

What is the difference between a direct and an indirect inguinal hernia?

Answer 5

• Direct goes through a defect in the abdominal wall
• Indirect goes through a hole that already exists
  
  • ​Indirect is more common

Question 6

This healthy 2-­month old calf is presented to your clinic. What is the most likely diagnosis?

Answer 6

simple umbilical hernia

Question 7

Umbilical hernias are most commonly seen in ________ calves

Answer 7

Holstein

Question 8

As part of the castration technique for inguinal hernias, a transfixation ligature is placed through the __________ muscle

Answer 8

cremaster

Question 9

When is a mesh implant indicated for repair of umbilical hernia?

Answer 9

Hernia >15 cm and hernia unsuccessfully repaired previously

Polypropylene or plastic mesh are more commonly used in large animal

Question 10

What portions of the intestine are most commonly found in an inguinal hernia?

Answer 10

jejunum and ileum

Question 11

Equine patients with acquired inguinal hernias have a reported survival rate of ~___%

Answer 11

75%

Question 12

What is the best method to examine the contents of an inguinal hernia?

Answer 12

Ultrasound

Question 13

T/F: Any hernia with evidence of pathology should be surgically repaired with an open herniorrhaphy

Answer 13

True

Question 14

In adult equine patients, are inguinal hernias usually congenital or acquired? Reducible or non-reducible?

Answer 14

Acquired, non-reducible

Question 15

What are the benefits of an open herniorrhaphy for repair of an umbilical hernia?

Answer 15

• Takes less time
• Less traumatic
• Allows inspection of the viscera
• Permits removal of the umbilical remnants

Question 16

Are inguinal hernias more commonly seen in males or females?

Answer 16

Males

Way more common in males

Question 17

What is your diagnosis in this pig?

Answer 17

left inguinal (scrotal) hernia

Question 18

T/F: Direct inguinal hernias are more common than indirect inguinal hernias

Answer 18

False

Direct inguinal hernias are very rare.

Question 19

T/F: Bulls can maintain reproductive function following unilateral castration

Answer 19

True

• ~75% of sperm production remains*
• Unilateral castration can be used for inguinal hernia, orchitis, testicular torsion, testicular hematoma, and testicular tumor*

Question 20

T/F: Calves have a higher prevalence of umbilical infection compared to foals

Answer 20

True

Question 21

T/F: Scrotal hernias may damage thermoregulation leading to primary and secondary defects

Answer 21

True

Question 22

__________ is the second most common type of hernia observed in large animals

Answer 22

inguinal hernia

• Congenital or acquired, unilateral or bilateral
• Congenital hernias more common in colts
• Appear in the first days of life

Question 23

What is the “Vest Over Pants” suture?

Answer 23

overlapping interrupted mattress suture pattern

• “Vest Over Pants” is also known as mayo mattress, overlapping pattern, or vertical mayo pattern, but we all know “Vest Over Pants” is way more fun.
• It is an overlapping interrupted mattress suture pattern and is useful in repair of abdominal hernia defects and cleft palate
• How is it done?
  
  • The suture is begun by passing the needle from the outside to the inside of the incision on one side
  • The needle is then similarly inserted on the opposite side on the same transverse plane in the same inward direction
  • It is advanced 0.7 to 1.5cm and is passed from within to the outside on the second sutured side
  • Finally, it is returned to the original side and is passed from within to the exterior in the same transverse plane
  • As the knot is tied, the first area of tissue sutured will overlap the second
  • A surgeon’s knot may be required to overcome distracting forces
  • Sufficient sutures are placed to close the incision or defect

Question 24

What equine breeds are most predisposed to developing inguinal hernia?

Answer 24

• Standardbred
• Draft breeds
• Morgan

Question 25

T/F: The umbilical vein is the most commonly infected umbilical remnant

Answer 25

False

The urachus is the most commonly infected umbilical remnant. It is rare to see infection in the umbilical vein

Question 26

Infection of the umbilical arteries is termed:

Answer 26

omphaloarteritis

Question 27

When is conservative treatment of umbilical hernias appropriate?

Answer 27

If reducible (less than 3 fingers and less than 1 year of age)

Question 28

What would be your treatment in this case of inguinal hernia?

Answer 28

• Keep vaginal tunic intact
• Twist the testicle to return the intestine back into the abdomen
• Place a transfixation ligature (through the cremaster muscle) just distal to the inguinal ring
• Ligate spermatic cord

Question 29

__________ is the most common type of hernia observed in large animals

Answer 29

umbilical hernia

• Most commonly affect females
• Quarter horses and Holstein cattle predisposed
• Contains intestine, omentum, or abomasum

Question 30

What are the selection criteria for the castration technique using injectable anesthesia for inguinal hernias?

Answer 30

• Hernia is manually reducible
• No edema or erythema
• No colic

Question 31

You observe this presentation in a bull and you diagnose inguinal hernia. What procedure would you recommend to the owner?

Answer 31

inguinal herniorrhaphy

Question 32

T/F: Congenital inguinal hernias in foals may resolve if manually reduced twice daily

Answer 32

True

Question 33

The “Vest Over Pants” suture pattern is useful for repairing umbilical hernias and __________

Answer 33

cleft palate

• “Vest Over Pants” is also known as mayo mattress, overlapping pattern, or vertical mayo pattern, but we all know “Vest Over Pants” is way more fun.
  
  • It is an overlapping interrupted mattress suture pattern and is useful in repair of abdominal hernia defects in all domestic mammals

Question 34

Identify this piece of equipment:

Answer 34

hernia clamp

Question 35

Is infection of umbilical remnant more common in foals or calves?

Answer 35

more common in calves

• In a calf, it is more common to do an open herniorrhapy because inflammation of the umbilical remnant is more common, so peritoneum must be opened to get in there all nice and deep like and get it cleaned out*
• In a foal, closed herniorrhapy is more common*

Question 36

T/F: Visual evaluation is one of the most useful tools in distinguishing umbilical abscess from umbilical hernia

Answer 36

False

Visual evaluation is probably one of the worst tools for distinguishing umbilical abscess from umbilical hernia

Question 37

T/F: Calves have a lower prevalence of umbilical infection compared to foals

Answer 37

False

Calves have a higher prevalence of umbilical infection compared to foals

Question 38

T/F: Inguinal hernias are more common in females. Umbilical hernias are more common in males.

Answer 38

False

Inguinal hernias are more common in males. Umbilical hernias are more common in females.