When Is Umbilical Hernia in Dogs An Emergency Operation? Here's a Great Example

Case Report

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

The owners reported that she had a hernia there since birth but it just recently got much larger. The mass was soft, painful on palpation, and not reducible. An umbilical hernia containing abdominal viscera was suspected.

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)

Complete blood count and serum chemistry profile were unremarkable. An intravenous catheter was placed and a balanced electrolyte solution administered to correct dehydration. Under general anesthesia the ventral abdomen was clipped and prepared for aseptic surgery. (Fig.3) 

Fig. 3: Appearance of the hernia in Lola after clipping for surgical repair

A ventral abdominal approach was performed with care taken to not injure structures within the hernia. A strangulated loop of jejunum was found in the hernia. (Fig.4) The remainder of the abdomen was normal. 

Fig. 4: Intraoperative photo of Lola during abdominal exploratory showing the
strangulated portion of jejunum after it was reduced.

The affected segment of intestine was resected and an end to end anastomosis performed (see http://drstephenbirchard.blogspot.com/2013/10/intestinal-anastomosis-made-simple.html for details on technique for intestinal anastomosis).  Debridement of the tissue edges of the hernia was not necessary and it was repaired as part of the routine linea alba closure with 2-0 PDS, simple continuous pattern. The remainder of the abdominal incision was closed routinely. Postoperative abdominal radiographs confirmed satisfactory closure of the hernia. (Fig. 5) 

Fig. 5: Lateral abdominal radiograph of Lola 1 day after repair of the umbilical hernia.

Lola recovered well from surgery and was released from the hospital 2 days postoperatively.

Discussion

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.

References

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