Author

Stephen J. Birchard DVM, MS, Diplomate ACVS

Wednesday, April 12, 2017

Acute Traumatic Abdominal Hernia in Dogs and Cats: Key Point: Always do a complete abdominal exploratory!

Case Report

Cass is a 2 year old spayed female who presented to the emergency service after been bitten by another dog. She had no pertinent history of other health problems. On physical examination Cass had a palpable soft tissue subcutaneous swelling on the left lateral abdomen. A defect in the abdominal wall was palpable deep to the swelling and viscera were thought to be in the subcutaneous space. 

Plain radiographs of the abdomen confirmed a left lateral abdominal hernia. (Fig. 1) No other radiographic abnormalities were found. 
Fig. 1; Ventrodorsal radiograph of Cass showing the hernia of the left lateral abdomen (arrows).
Cass was initially treated with supportive care consisting of intravenous fluids with a balanced electrolyte solution, analgesics, and antibiotics. Preoperative CBC and serum chemistry profile were within normal limits. Cass was placed under general anesthesia and the ventral abdomen was clipped and prepared for aseptic surgery. (Fig. 2) 
Fig. 2: Cass in dorsal recumbency after clipping and prepping for  abdominal surgery.
Note the bulge on the left lateral abdomen at the site of the hernia.
A ventral midline abdominal approach was made. On thorough exploratory of all abdominal structures herniation of a portion of jejunum was found in a left sided abdominal wall defect.(Fig. 3, 4) 
Fig. 3: Intraoperative view of the abdominal cavity on Cass. (Head is to the left.)
Note herniated bowel and omentum (arrow).
Fig. 4: Same intraoperative view as figure 3 after reduction of the hernia showing the muscular defect.
Gentle traction on the herniated bowel reduced the hernia and the bowel mesentery was bruised but all tissues were viable. The abdominal muscle defect was closed from within the abdominal cavity with 2-0 PDS simple continuous pattern.(Fig. 5) 
Fig. 5: Same intraoperative view as figures 3 and 4 showing closure of the hernia.
The ventral abdominal incision was closed routinely. 

Postoperatively supportive care (IV fluids, analgesics, and antibiotics) was continued. Cass made an uneventful recovery and was discharged the day after surgery. At suture removal 10 days postoperatively Cass was doing well.

Discussion

In animals with severe abdominal trauma, hernias can be missed on initial physical examination. Serial, thorough physical examinations and careful analysis of abdominal imaging is recommended to fully assess trauma patients. Intestine and omentum were the 2 most commonly herniated structures in the study previously mentioned. (1)

Bite wounds were the most common cause of traumatic abdominal hernias in one study, with vehicular trauma being the next most common cause. (1) This is in contrast to an older study that found blunt trauma to be the primary cause of traumatic hernias.(2) Additional injuries, such as bowel perforation, are common complications of abdominal hernias. 

Key Point: Dogs and cats with acute traumatic abdominal hernias should have a complete abdominal exploratory via routine ventral approach. The hernias can be repaired from within the peritoneal cavity by closing the affected interior muscle layers. (3)


References
1. Shaw, Scott P; Rozanski, Elizabeth A; Rush, John E. Traumatic body wall herniation in 36 dogs and cats. JAAHA 39:35-45 2003.
2. Waldron DR, Hedlung CS, Pechman R. Abdominal hernias in dogs and cats: a review of 24 cases. JAAHA, 22:817-822,1986 
3. Smeak, DD. Abdominal wall reconstruction and hernias. In: Veterinary Surgery Small Animal, eds. Tobias KM, Johnston, SA. Elsevier, St. Louis, pg. 1368.