bilateral inguinal hernia with distinct hysterocele and ... - Jivaonline.net

CLINICAL REPORT
BILATERAL INGUINAL HERNIA WITH DISTINCT HYSTEROCELE
AND OMENTOCELE IN A DACHSHUND BITCH
1 2 3
John Martin K. D. , Susannah Bijee Philip , Sherin B. Sarangom
4
and Ashay P. Kankonkar
College of Veterinary and Animal Sciences, Mannuthy, Thrissur, Kerala 680651
INTRODUCTION
Inguinal hernias may be congenital or acquired
of which the former in dogs occur as a result of a
defect in the inguinal ring through which the
abdominal contents protrudes into the subcutaneous
space (Pratschke, 2002). Inguinal hernias may be
congenital or acquired. The former are rare in dogs
and may co-exist with the umbilical hernias (Fossum,
2007), while the latter are often seen in middle aged
intact bitches (Waters et al., 1993). The potential
factors involved in the development of inguinal
hernias might be anatomical, hormonal and
metabolic in nature. However, the exact etiopathogenesis
is still unknown (Smeak, 2003).
Polygenic inheritance of inguinal hernia had been
described in Cocker Spaniels and Dachshunds by
Roberts (1986). The usual contents of inguinal hernia
may include omentum, fat, ovary, uterus, small
intestine, colon, bladder and spleen, with omentum
being the commonest. (Bellenger, 1996). Herniation
of gravid uterus and pyometra uterus through the
inguinal ring are also report (Munro and Stead, 1993;
Byers, 2007). The present paper reports bilateral
inguinal hernia in a dachshund bitch and its surgical
management.
CASE HISTORY AND OBSERVATIONS
A five year old nulliparous dachshund bitch was
presented to the Kerala Veterinary and Animal
Sciences University Hospital, Kokkalai with a
bilateral swelling in the inguinal region. The swelling
was noticed since one month, which increased in size
over the last two weeks. The animal was in estrus one
month back and had no previous history of any
1 2,3&4
Associate Professor, M.V.Sc. Scholar
Department of Veterinary Surgery and Radiology
trauma. The animal was bright, active and alert. All
the physiological parameters were within the normal
range. On palpation, the swellings were non-painful,
soft and doughy in consistency. The left inguinal
swelling was bigger in size compared to the right
one. The contents of both the swelling were nonreducible,
even on application of moderate pressure.
The bladder was catheterized, urine was relieved and
thus the possibility of vesicocele was ruled out.
Ultrasonographic examination of the left inguinal
mass could revealed strands of hypoechoic region
with areas of normal echogenicity and the right
inguinal mass with moderate echogenicity. Based on
history, physical inspection and ultrasonographic
examination, the condition was diagnosed as an
acquired bilateral inguinal hernia. The reduction of
the hernial contents and herniorrhaphy under general
anaesthesia were resorted to.
SURGICAL INTERVENTION
AND TREATMENT
The dog was premedicated with atropine
a
sulphate at the rate of 0.045 mg/kg body weight
b
followed by xylazine hydrochloride at the rate of 1.5
mg/kg body weight, both given intramuscularly. The
the surgical site ware shaved, scrubbed and painted
with Tr Iodine for aseptic surgery. General
anaesthesia was induced with ketamine
c
hydrochloride at the rate of 5 mg/kg body weight
intramuscularly and was maintained by incremental
intravenous injection of a combination of xylazine
hydrochloride and ketamine hydrochloride, equal
d
quantity by volume and diazepam given 'to effect'.
The dog was positioned on dorsal recumbency. The
site was painted with Tincture iodine and the patient
JIVA Vol. 10 Issue 1 April 2012
45

CLINICAL REPORT
J. Ind. Vet. Assoc., Kerala. 10 (1)
was draped. A four centimeter long cutaneous
incision was made over the lateral aspect of the left
inguinal swelling parallel to the flank fold. The
incision was deepened through the subcutaneous
tissue to expose hernial sac by blunt dissection. The
hernial sac was opened and the contents were found
to be non-gravid uterine horns with the broad
ligaments (Fig.1). The kelotomy was performed by
incising the inguinal ring in a cranio-medial direction
to reduce whole non- gravid uterus with the broad
ligaments into the abdominal cavity. The hernial sac
was ligated as close to the internal inguinal ring as
possible and was sectioned distal to it. Both internal
and external inguinal rings and the kelotomy wound
were closed in separate layers by simple continuous
sutures followed by a layer of subcutaneous sutures
e
using 3.5 metric polyglactin 910 . The skin wound
was apposed with horizontal mattress sutures using
3.0 metric nylon. A similar procedure was repeated
on the right inguinal ring to reduce omentum. (Fig.
2). A sterile gauze stent was sutured over both skin
wounds and Tr. benzoin was applied.
f
Postoperatively, ceftriaxone was administered at the
rate of 25 mg/kg body weight intravenously. Oral
antibiotic therapy was continued for six more days.
The animal had an uneventful recovery except for a
seroma on the right side. The skin sutures were
th
removed on the 9 post-operative day (Fig. 3) and the
seroma subsided subsequently. Ovariohysterectomy
at another date was recommended to avoid
complication is future.2.
46
Fig. 1: The exposed contents of the left hernial sac,
the uterus and the broad ligament
Fig. 2: The exposed content of the right
hernial sac, the omentum
Fig. 3: Healed skin wound after bilateral hernial
repair with a seroma on right side
RESULT AND DISCUSSION
Acquired inguinal hernias are relatively common
in dogs and may often met with middle aged intact
bitches. Although certain toy breeds are over
represented, no breed predilection has been
documented (Waters et al., 1993). According to
Munro and Stead (1993), the potential for
development of inguinal hernia is more in females
because of the normal extension of the vaginal
process through the inguinal canal. Furthermore,
accumulation of fat around the round ligament may
dilate the vaginal process and inguinal canal
allowing herniation. The contents of the hernial sac

CLINICAL REPORT
in bitches most often consist of broad ligament and
uterine horns (Formston, 1990).
In the present case, the history and the clinical
signs were similar to the reportes of Jahromi et al.
(2009). Byers et al. (2007) had reported a case of
inguinal hernia in a dog with signs of oestrus
approximately three to four weeks before
presentation and substantial increase in size of
inguinal swelling two to three weeks prior to
presentation. The condition has to be differentially
diagnosed from mammary tumours, cysts, lipomas,
enlarged lymph nodes, abscesses and hematomas.
The chances of traumatic inguinal hernia were also
ruled out as the dog was in normal body condition
and had no history of trauma. Though a diagnosis of
bilateral inguinal herniation could be diagnosed
before surgery, the hernial contents could be
confirmed only through surgical correction. Instead
of a midline approach for bilateral inguinal hernia
repair in bitches, the conventional approach was
selected as it could facilitate better visualisation of
both inguinal rings (Waters et al., 1993). The
contents of the left and right hernial sacs were almost
the same as in the report of Jahromi et al. (2009).
Ovariohysterectomy was also recommended
considering (Fossum, 2007) the probable heritable
nature of this disease (Roberts, 1986). The most
common post-operative complications observed in
dogs undergone surgical repair of inguinal hernia
included hematoma or seroma formation, incisional
infection, wound dehiscence, hernia recurrence,
peritonitis, sepsis and death (Pratschke, 2002).
However, the follow up study did not reveal any
potential post-operative complications and the
animal had an uneventful recovery.
utrine horn and omentum in a beagle dog. J.
Vet. Emerg. Crit. Care. 17:86-92
Fossum, T. W. 2007. Surgery of the abdominal cavity.
In: Small animal surgery (ed. Fossum, T. W.).
rd
3 Ed. Mosby Elsevier, Philadelphia, pp: 317-
338
Hayes, H. M. 1974. Congenital umbilical and
inguinal hernias in cattle, horse, swine, dogs,
and cats: Risk by breed and sex among
hospital patients. Am. J. Vet. Res. 35: 839-842.
Jahromi, A. R., Nazhvani, S. D., Gandmani M. J. and
Mehrshad, S. 2009. Concurrent bilateral
inguinal and umbilical hernias in a bitch-a case
report. Vet. Arhiv. 79: 517-522.
Munro, E. and Stead, C. 1993. Ultrasonographic
diagnosis of uterine entrapment in an inguinal
hernia. J. Small Anim. Pract. 34: 139-141.
Pratschke, K. 2002. Management of hernias and
ruptures in small animals. In Pract. 24: 570-
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Roberts, S. J. 1986. Veterinary Obstetrics and genital
rd
diseases (Theriogenology), 3 Ed. Woodstock,
VT. 981p
Smeak, D. D. 2003. Abdominal hernias. In: Text book
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of small animal surgery (ed. Slatter, D.). 3 Ed.
W. B. Saunders, Philadelphia, pp: 449-470
Waters, D. J., Roy, R. G. and Stone, E. A. 1993. A
retrospective study of inguinal hernia in 35
dogs. Vet. Surg. 22: 44-49
a
Atropine Sulphate 1ml amp, Morvel
b
Xylaxin 10 ml vial, Indian Immunologicals
REFERENCES
Bellenger, C. R. 1996. Inguinal and scrotal
herniation in 61 dogs. Aust. Vet. Practitioner.
26: 58-59
Byers, C. G., Williams, J. E. and Saylor, D. K. 2007.
Pyometra with inguinal herniation of the left
c
Aneket 10 ml vial, Neon Laboratories Ltd.
d
Calmpose 2 ml ampoule, Ranbaxy
e
Vicryl 90 cm, Ethicon
f
Intacef 500 mg vial, Intas Pharmaceuticals
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