A 7-year-old spayed female mixed breed dog named Lola presented with acute vomiting and rapid enlargement of a mass over her umbilicus.(Fig.1)
|Fig. 1: Lola, a 7 year old female spayed dog|
Plain film abdominal radiographs were obtained and confirmed an umbilical hernia with loops of intestine in the hernia sac. (Fig.2) The remainder of the abdomen was radiographically within normal limits.
|Fig. 2: Lateral abdominal radiograph in Lola showing |
an umbilical hernia with incarcerated bowel (arrow)
|Fig. 3: Appearance of the hernia in Lola after clipping for surgical repair|
|Fig. 4: Intraoperative photo of Lola during abdominal exploratory showing the|
strangulated portion of jejunum after it was reduced.
|Fig. 5: Lateral abdominal radiograph of Lola 1 day after repair of the umbilical hernia.|
Lola is an example of a dog with an incarcerated (non-reducible), and strangulated (loss of blood supply of the hernia contents) umbilical hernia. Umbilical hernias are common in dogs and cats but rarely do they contain intestine or other abdominal organs.(1) More commonly umbilical hernias are small and contain a portion of the falciform ligament or greater omentum.
Plain film radiographs were diagnostic for the hernia in Lola. Ultrasonography can also be useful to determine if a hernia is present and if organs are located in the hernia sac.
The clinical signs of acute vomiting and pain on palpation were suggestive of intestinal obstruction, and possibly strangulation. Vomiting was predictive of non-viable intestine in inguinal hernias in dogs in one study.(2) Emergency surgery is indicated when this type of hernia is suspected.
In Lola the hernia repair was straightforward since adequate local tissues, i.e. rectus muscle fascia, was available for closure without tension across the suture line. Larger defects may require a muscle flap or mesh implant, such as polypropylene mesh, for effective repair. Mesh is well tolerated in dogs and provides a strong and stable closure for abdominal wall defects with minimal complications.(3)
Complications of hernia repair include pain, seroma, infection, reoccurrence and mesh rejection requiring removal. However, complications are rare and the prognosis for successful repair of congenital and traumatic hernias is generally good.
This is the first in a series of Veterinary Key Points blogs addressing congenital and acquired hernias in dogs and cats. Watch for future articles on other hernia types and their treatment.
1. Ruble RP, Hird DW. Congenital abnormalities in immature dogs from a pet store: 253 cases (1987-1988). J Am Vet Med Assoc. 202(4) 633-636, 1993
2. Water DJ, Roy RG , Stone EA. A retrospective study of inguinal hernia in 35 dogs. Vet Surg 22:44, 1993
3. Bowman K, Birchard SJ, Bright RM. Complications associated with implantation of polypropylene mesh in dogs and cats: A retrospective study of 21 cases (1984-1996). J Am An Hosp Assoc 34:225-233, 1998