ABDOMINAL HERNIA CASE IN CAT (Felis domestica)

Yasinta Kartono (operator)1), Novrianto Albertino (ass. operator)1), Ayu Herawati

(anest)1), Rr. Soesatyoratih 2)
1)
Veterinary Medical Profession Educational Program (PPDH)
2)
Surgery & Radiology section, Clinical, Reproduction & Pathology Department, Faculty of
Veterinary Medicine (FKH), Bogor Agricultural University (IPB)

ABSTRACT

Abdominal hernia is one of the type of hernia that occured in cat. Abdominal
hernia is caused by the weakness of abdominal muscle or presence of an opening
hole or ring in the muscle that leads to the protrusion of abdominal content.
Therefore, the contents of the abdomen may exit from the opening hole or ring due
to intraabdominal pressure which resemble a swelling under the skin. The purpoe
of abdominal hernia operation is to train the skills and ability of PPDH students in
the field of veterinary surgery by performing a good, righteous and ‘lege artis’ of
surgery.

Key words: Abdominal hernia, ASA

FOREWORD

Population of domestic wild cat in necessary to pay attention to animal medical

environment increase as day passed and this
leads an increasing number of illness cases.
Diseases that often suffered by the wild
domestic cats are usually scabies, fracture and
hernia. Hernia is a condition where the tissue
or particular organ exit to the body part where
it is not supposed to be because of muscle
structure weakness. Based on the location of
hernia, it is divided to abdominal hernia
(ventralis, paracostral, umbilical and inguinal
hernia), diaphragmatic hernia, perianal hernia
and scrotal hernia (Hines 2012). Hernia can
occured congenitally or hereditary. Hernia
cases always occured because of blunt object
traumatization. Other than that, it will caused
an sudden increase of abdominal cavity
pressure (Ramadhan and Abdin 2001). The
signs of hernia are the presence of hernia sac,
hernia ring and contents of the hernia.
Diagnose of hernia can be done by performing
inspection and palpation on the protrude area
to search for the hernia ring. Furthermore, it is
records through signalment, anamnesis and
clincal examination. Radiography and blood
test are the diagnose tests to support the
occurence of hernia.
Case
Anamnesis, the cat is found in the Perumdos
IPB area with the presence of potrusion in the
midline ventral part of abdomen. This may be
due to a breakdown of stitches at abdomen of
previous operation.
Signalement, a domestic breed male cat
named Kimi, aged ± 2 years old with a body
weight of 3.84 kg.
Status present, the condition of the cat is good
generally with the temperature of 38.1oC,
respiration rate of 32 times/minutes, and heart
rate 124 times/minutes. The health condition of
the cat is well and normal.
Diagnosis, the cat does not experienced of any
impaired body function and systemic disease.
It will be undergoing an abdominal hernia
operation.
Prognosis, very good
Diagnosis tests, examination of blood tests
and x-ray are done.
Therapy, operation of abdominal hernia was
begun with:
Pre-operation, animal that will be operated
should do a health status examination to
determine whether it is feasible to undergo
surgery. Examination is done to avoid the
possibility of the animal’s state getting worse
because there are certain requirements to be
fulfilled along with the operating procedure in
operation. Preparation of animal before
operation was begun with physical
examination which included monitoring of
temperature, respiratory rate (time/minute),
pulses (time/minute), body weight (kg),
mucous membrane, and diameter of pupil
(cm). It was done to facilitate the evaluation of
animal monitoring result during the operation.
Further examination needed to be done to find
out more the condition of the animal before the
operation procedure under performance.
Further examination can be done by using x-
ray, USG or hematologi method.
Animal was prepared first before
operation procedure under performance.
Animal was handled well to prevent additional
stress. Animal should weigh beforehand to
identify the body weight in order to calculate
the dosage of medicine. Administration of
atropin subcutaneously was done after the
body weight was identified, afterwards, wait
for 10 minutes. Injection of anesthetic
medicine using ketamine and xylazine were
done after administration of premedication
drug. Shave the area where incisions will be
made when the animal was in deep sleep.
When the shaving was done cleanly, continue
it by applying iodine tincture sufficiently, the
cat will then place it on the surgical table. Part
that was shaved will be covered with surgical
drape and fixate it by using towel clamp.
Operation, operational method for abdominal
hernia using incision on medline laparotomy.
Animal that was placed on the surgical table
was being covered by surgical drape and fixate
by using towel clamp so that orientated area is
fixated. Incision of skin is done along 3 – 6 cm.
Slow incision on skin, fascia continue to
muscle. Exploration was done and reposition
of the exposed hernia organ back in abdominal
cavity. Observe well if there is attachment
between organ such as intestine to the
abdominal wall. Skin was fixate to the lateral
direction after incision was done to facilitate
the exploration in abdominal cavity. Clean it if
there is any attachment. Reposition the
exposed hernia organ into abdominal cavity
and ensure there will no change position before
reposition. Antibiotic was given after
reposition and continue with the sequence of
stitches from hernia ring, muscle to skin.
Fusion of cat gut 3/0 amd silk gut 3/0 were
used to stitch hernia ring and muscle. The
stitches wound was applied with iodium
tincture afterwards. Stitches area was cover by
gauze and bandaged. Patient was being
monitored for every 15 minutes included
temperature, respiratory rate, heart rate and
mucous membrane.
Post operation, post operation treatment was
given with Ringer Lactate infusion, vitamin B
complex, ad libitum food, cefadroxil as
antibiotic, vitamin K, antiinflammation agent
dexamethasone. Antibiotic cefadroxil was
given 3 ml per oral for 5 days continously.
Removal of stitches was done after 7 days.
During postoperative care,
observation of temperature, pulsus, respiration,
urine, mucous membrane and defecation and
wound after removal of stitches were cleaned
with rivanol twice a day and change of bandage
to enhance to healing process and to prevent
the possibility of hernia recur.
DISCUSSION
The cat was experienced with abdominal
hernia because it was suspected that stitches
breakdown of the previous operation leads
omentum to fill the empty cavity. This cat was
suspected of having tumor, abses, hematoma
and cyst before the diagnose was confirmed
with series of tests. It was suspected as a tumor
because the position of the protrusion is under
the skin. According to Berata et al. (2011) skin
tumor is a tumor cell that spread to skin tissue
or soft tissue below skin until it leads to
uncontrolled growth. Skin tumor normally is
followed by other abnormalities such as
pustule, itchiness, hematoma, cyst, blister,
abcess, lick granulomas and skin tags.
However, there were no such abnormalities
after examination. Furthermore, this cat was
suspected with abcess because soft protrusion.
Next, general examination was done to
understand the health condition of the cat.
Palpation was done at the protrusion area and
it found to be a cavity. It was suspected to be a
hernia ring. To support the confirmation of the
diagnose, x-ray was performed. Results from
radiography for ventrodorsal and laterolateral
view showed there was an enlargement at
abdomen containing omentum. Results from
radiography showed there was a protrusion,
this support the presence of abnormality at the
abdominal area, likely hernia. The purpose of
examination by using x-ray was to assist in
diagnose of location and content of hernia
therefore, to facilitate in reposition of hernia.
Hematology test was done before
operation was performed. Volume of 3 ml
blood sample was sent to Mandapa
Laboratorium Clinic for hematology test.
Purpose of hematology test is to examine the
blood condition of the patient and to
understand the history of the patient. From the
result of blood test, this can help in anticipation
if the blood test result is abnormal and affects
patient during and after surgery. This test was
done to as one of the supporting decision to
perform surgery. Blood test result can be seen
on Table 1. Other diagnostic tests such as
radiography and ultrasonography (USG) was
not perform because it was very clear that the
hernia ring was palpated at the abdominal area.
Tabel 1 Results of blood tests
Type of tests Results Normal
Value
Total RBC (106/µl) 6.69 5.8-10.7
Total WBC (103/µl) 29.95 5.5-19.5
Hematocrit (%) 20.90 30-47
Hemoglobin (g/DL) 9.8 9-15
Dif. Leukosit (%)
- Neutrophil 69 35-37
- Lymphocyte 27 20-55
- Monocyte
2 1-4
- Eosinophil
2 2-12
Results of blood tests showed that value
of RBC, and hemoglobin was still in the
normal range. This indicated the patient does
not undergo of any dehydration by showing
good skin turgor. According to Cowell et al
(2006) dehydrated condition can resulted from
high RBC, WBC, total protein, hematocrit and
hemoglobin. WBC value was above the normal
range. It was suspected the patient was infected
by other sick cats during the boarding period in
RSHP. Kimmi was suspected to experienced
inflammation due to disease spreading by other
cats. In the other hand, stress condition can
increase the value of WBC as well. Results
from blood tests showed the patient was in a
good health condition and was approve to be
operated. According to laboratorium tests by
American Society of Anesthesiologist (ASA)
in Jeff et al. (2013), patient was categorized in
ASA 1, in which the patient still in a good
health condition that need to be operated.
Next, premedication drugs such as
atropin was administered to the patient to
prevent vomiting from anesthesia effect.
Atropin was administered subcutaneously and
wait for 10 minutes. Atropin is one of an
antimuscarinic agent which work to decrease
the contraction of smooth muscle, so, it is
always used as a premedication drug to prevent
or decrease the mucous secretion of respiratory
tract and vomit effect. The patient was induced
using the combination of xylazine and
ketamine after 10 minutes. The combination of
anesthetic medicine that frequently used was
ketamine and xylazine.
Ketamine is one of the strong anesthetic
agent. Ketamine has long sedative effect
between 20 to 30 minutes. Ketamine is one of
the anesthethic type of medicine that is able for
all types of animals. However, without
intensive observation, ketamine can cause
death. Ketamine can cause dangerous adverse
effect such as tachycardia, hypersalivation,
increase the muscle stiffness, sore at injection
site and extreme overdose can cause slow
d
recovery and even dangerous. The use of
xylazine can reduce secretion of saliva and
increase the blood pressure that caused by
ketamine. Xylazine is one of the muscle
relaxant that caused the muscle to become
more relax. Xylazine often combinated with
ketamine which works to support each other
function. The use of combination of ketamine
and xylazine as general anesthesia has a lot of
advantages such as, easy to administer, e f
economy, fast induction and recovery, good
relaxant and less likely to cause clinical
complication (Jones et al. 1997).
Surgery is one of treatment to overcome
the hernia problem in cats. Surgery was
performed using laparotomy technique,
incision was done from the side of hernia ring.
If the hernia is progress for long period, it will
attach strongly to the abdominal muscle.
Exploration of abdominal cavity through g h
hernia ring was done after incision, seperate
the fat and omentum which attached to the
abdominal muscle. Make sure there were no
attachment between intestine before
reposition. Penicilin was given and suture
using cat gut 3/0.
Suture was begun by closing the muscle
from hernia ring using simple interrupted
Diagram 1 Operation procedure (a) Preparation, (b)
pattern. Afterwards suture skin and fascia Incision, (c) Searching for hernia ring (d)
using silk gut 3/0. There was small size of Insertion of organ, (e) Make sure of no
second hernia ring appear after the suture of the other hernia ring,, (f) Subcutan suture, (g,
first hernia ring. Same suture pattern was done (h), (i) Skin suture
on second hernia ring. Iodine tincture was
applied on the suture skin area after the hernia Heart rate of the cat after being induced
ring was covered. From all series of operations, by ketamine was still in normal range which
applied operation technique was based on was 120 time/minute. Heart rate was decreased
American Society of Anesthesiologist (ASA), to 104 time/minute and lower during the first
and categorized as ASA II, where the animal 15 minutes of operation while increase again to
experienced abnormalities or light systemic 112 time/minute at 60 minutes of operation.
infection. Operation procedure can be seen in Anesthethic agent that used was ketamine
diagram 1. while muscle relaxant that used was xylazine.
According to Plumb (2005), the effect of
ketamine lead to overstimulation of CNS that
a b caused to cataleptic stage where happened the
increase of emotional respond, muscle tone
and heart rate. Ketamine is not advisable for
use in single in major operation because caused
increase in muscle tone. Therefore, ketamine is
always combine with transquilizer such as
xylazine. Xylazine will stimulate the α2
receptor in neuron that release norepinephrine

c
as a result cause depression and decrease the Lumb WV, Jones EW. 1996. Veterinary
ability of stimulus respond. Decrease in Anesthesia. Ed ke-3. Philadelphia: Lea
temperature caused by the administration of and Febiger.
ketamine. Administration of ketamine can Plumb DC. 2005. Veterinary Drug Handbook
decrease at the average temperature of 1.06° C. Ed-5.Iowa: Blackwelll Pr.
Selection of anesthesia is done based on the Ramadhan RO, Abdin MR. Abdominal and
hematology result of the cat where the result is inguinal hernias in camel (Camelus
still in normal range and in absence of systemic dromedaries) in Saudi Arabia. 2001. J
diseases. Agric Sci, 13: 57-61.
Monitoring of post operation was done
for 7 days by checking the pulse, respiration,
temperature, appetite and ability to drink,
defecation, urination and side of suture.
Condition of the patient improved as day
passed. This is because operated cats was
infuse with ringer lactate during operation.
Appetite of Kimi was getting better and better,
good stool condition. Antiobiotic was given 2
ml orally once a day during recovery period.

CONCLUSION

Treatment of hernia can only done by

operation. Prognosis is based on the width of
hernia ring, condition of organ that exited from
the hernia ring and with or without attachment.

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