A hernia is the protrusion of an organ or tissue through an opening.

The opening may be one

caused by a tear in the abdominal wall or diaphragm or it may be a natural opening like the
inguinal canal or femoral canal.
A hernia is different from a prolapse. In a
INTRODUCTION prolapse the protruded tissue is exposed outside
whereas in a hernia it is covered the skin.

(1) Imperfect closure of an embryonic defect, e.g. Imperfect closure of umbilicus predisposing
to an umbilical hernia, imperfect formation of the diaphragm predisposing to a
diaphragmatic hernia.
Predisposing Causes:
(2) Weakness of the abdominal wall due to contusions, local inflammation, etc.

Etiology (1) Increase in the intraabdominal pressure due to straining from constipation, diarrhoea,
during parturition, violent coughing, gastric or intestinal tympany.
Exciting Causes:
The hernia is reduced by local manipulation and bandage is applied around the abdomen to (2) Direct violence due to falling on a blunt object.
prevent its return. An "elastoplast" bandage is better to avoid interference with breathing. The
bandage is retained for two to three weeks. This method of treatment is effective in some
cases of 'umbilical hernia 1. Reduction and retention by bandage:

2. Application of blisters or injection of irritant solutions close to the hernial ring after
reducing the hernia causes inflammatory swelling which is sometimes sufficient to prevent
recurrence of a small hernia and to facilitate closure of the hernial orifice. The solutions
commonly employed for the purpose are Sodium chloride 5% to 15%, Zinc chloride 5% to
10%.

3. A ligature or a hernia clamp or a set of through and through mattress sutures may be
applied at the base of the hernial sac after reducing the hernia to facilitate sloughing of the
sac and simultaneous closure of the hernial ring. This method also may not be effective in
General Principles of Treatment of
some cases.

The hernial sac is incised and the hernial contents are returned through the hernial ring. The
Hernia
hernial sac is ligatured at its neck, amputated and its stump is pushed through hernial ring.
The borders of the hernial ring are then freshened and sutured together and closed Suturing of
the hernial ring is called herniorrhaphy. If the hernial ring is very large suturing its edges is not
possible. In such cases hernioplasty is performed by covering the gap with facia lata or
stainless steel wire mesh and suturing it to the borders. After closing the hernial ring the skin
edges are' also sutured, after removing any excess skin. 4. Radical operation for hernia:

Adhesion may take place between the sac and contents, making reduction difficult or
impossible. The fibrous tissue proliferation close to the hernial ring may cause constriction
due to cicatrical contractions. 1. Adhesion: A typical hernia has a hernial ring, through which the contents have migrated and the hernial
sac. The hernial sac encloses the hernial contents and consists of the neck, body and fundus.
Collection of fluid within the sac (hydrocele) is caused by exudations from the hernial Parts of Hernia The neck is that portion of the hernial sac close to the hernial ring, the fundus is the lowest
contents. A constricted hernial ring favours such exudations. 2. Hydrocele of the sac: part and the body is the portion between the fundus and neck. The hernial sac is formed by
the parietal peritoneum. Portions of visceral organs (e.g., intestines, omentum, liver, spleen,
An incarcerated hernia is a hernia wherein the hernial contents have become very voluminous bladder, uterus) usually form the hernial contents. The sac may sometimes be empty.
so that they can not be reduced. For example an enterocele may become incarcerated either
due to more and more of intestinal segments entering into the hernial sac or as a result of
accumulation of intestinal contents (food materials) within the lumen of the herniated
segment. The accumulating food materials become hard masses as water gets absorbed from Classified according to its location, Functional alteration, content and cause.
them and these hard masses make reduction of hernia very difficult. They may also cause
(i) External hernia:- Consists of hernia ring, hernia sac and contents of sac ex- Ventral hernia, umbilical hernia.
partial or complete obstruction of the bowel segment and thus favour further accumulation Location:
of food materials. 3. Incarceration: (ii) Internal hernia Which lacks of hernia sac, eg. DH, gut tie.
Torsion or twisting of the hernial contents within the hernial sac interferes with the blood Possible Changes in Hernia (i) Reducible hernia: Contents of hernia sac can be returned into original position through hernia opening
supply to the tissue and may lead on to gangrene, toxaemia etc. 4. Torsion:
Functional Alteration:
Contents of hernia sac can not be returned to the original position through the hernial
Compression caused by the hernial ring causing interference with the blood supply to the (ii) Irreducible hernia: opening.
hernial contents is called strangulation of a hernia. When a hernia is strangulated soon after
the time of its occurrence it is spoken of as an acute hernia, e.g., strangulated inguinal hernia (i) Hernia with adhesions:- -adhesions between sac and its contents prevent reduction.
in race horses.
HERNIA - GENERAL SURGERY It could be of three types
(ii) Incarcerated hernia:- Hernial content become too voluminous to be replaced through a narrow hernial ring.
A hernia gets strangulated due to constriction of the hernial ring which may also be due to
additional contents being pushed into the hernial sac. In a strangulated hernia the constriction When blood vessels supplying the hernial contents are affected to cause complication like
at the hernial ring interferes with blood supply to the hernial contents (and if it is an Classification (iii) strangulated hernia:- necrosis and extensive adhesions.
enterocele retention of bowel contents). The vascular compression at the hernial ring
5. Strangulation: Enterocele- (intestine)
interferes with the blood supply and venous drainage and causes congestion and oedema.
The oedematous portion of bowel has a deep blue colour due to venous congestion. Blood
epiplocele (omentum)
and mucous escape into the lumen and blood stained effusions take place from the peritoneal
surface. Gangrene sets in gradually and the hernial contents appear black and the peritoneum enteroepiplocele (intestine plus omentum)
loses its shining luster. Pathogenic organism from the gut pass through the intestinal wall and Contents of sac:-
death happens from toxaemia/septicaemia/peritonitis. reticulocele (reticulum)

Hysterocele (uterus)

1. Umbilical hernia: In foals, pigs, calves, and pups. vesiculocele (urinary bladder)

2. Ventral hernia. Horses and cattle. (i) Traumatic hernia Which occurs due to injury e.g. ventral hernia
Cause-
3. Inguinal hernia: Bitches, horses, bulls, and male and female pigs. (ii) Infectious hernia which occurs following destruction of abdominal wall due to infections

4. Diaphragmatic Hernia: Pups, adult dogs, and horses.

5. Perineal hernia: Uncastrated, old, male dogs. a has an external swelling. The swelling varies in shape and size and differentiated from other
Hernias encountered in Animals -External hernia swellings. Such as abscess, cellulitis, haematoma, cyst and neoplasm.
6. Pelvic hernia (Gut tie): Bullocks (steers).
the ring can be easily palpated. Incarcerated hernia ring is not felt easily because it is
7. Femoral hernia (Crural hernia): Not common in animals. In cattle umbilical hernia and In reducible hernia, impossible to reduce the contents.
ventral ESSENTIALS OF VETERINARY SURGERY EIGHTH EDITION A. VENUGOPALAN 124 hernia
are more common. Inguinal hernia and gut tie in bullocks are met with only occasionally. symtoms like abdominal pain, fever and evidence of bowel obstruction may coincide with the
Other hernias are very rare. Similarly, the frequency of occurrence in other species are: In strangulated hernia swelling

Radiography may be helpful to identify the contents of irreducible hernia in small ruminants and calves.
Diagnosis:-
Horses- Umbilical hernia, Inguinal hernia and Ventral hernia. Exploratory puncture may also helpful to know the contents of swelling

Dogs- Umbilical hernia in pups, Perineal hernia in male dogs, and Diaphragmatic hernia. in reducible hernias. In the case of umbilical hernia, the hernial ring can be easily felt if the
ANIMALS By palpating the hernial ring animal is placed in dorsal recumbency and palpated.
Pigs- Umbilical hernia and Inguinal hernia.
Auscultation will reveal gurgling or bubonic sound in an enterocele. On palpation the
By the nature of its contents contents feel doughy in epiplocele while enterocele will have an elastic consistency.

differentiated from abscess, tumour, haematoma and cyst. Abscess, tumour, and cyst develop slowly whereas a hernia is of sudden occurrence.

In a developing abscess there are symptoms of local inflammation and it does not fluctuate
under the skin. An abscess has a tendency to point. In cold abscess the contents may crepitate
ABSCESS when the pus is inspissated.

haematoma the collection of blood may feel like free fluid or may give a slight crepitating
HEMATOMA sound on palpation.
Differential Diagnosis
A cyst fluctuates uniformly and has no tendency to point and pain and functional symptoms
CYST are absent

HERNIA The presence of a hernial ring confirms a hernia.

OTHER METHODS Exploratory puncture and/or radiography may also be done for confirmation.

Guarded

Favourable in many cases when properly treated.

Prognosis
Congenital hernias like umbilical and inguinal hernias may disappear spontaneously within
one year after birth