VSR 421: Regional Veterinary Surgery (2+1)

UMBILICAL HERNIA

Synonyms:  Omphalocoele

•  This is the hernia that develops in the umbilical region. The contents usually consist of omentum and intestines. The condition is common in foals, pigs, calves and pups but rare in lambs and kids.
• Umbilical hernia is comparatively more common in females than in males. The disease can be congenital or acquired. Acquired hernia is noticed few weeks after birth. Umbilical hernia may primarily be hereditary in origin due to dominant genes with low penetrance and autosomal recessive genes or due to environmental factors.
• The umbilical opening in the foetus allows the passage of the urachus and umbilical blood vessels. At birth, these structures are disrupted and the opening closes around the cord.
• The wound heals by cicatrisation which represents umbilicus in the later life. Acquired hernial ring may be primarily due to trauma, resection of cord too close to abdominal wall and excessive straining due to diarrhoea/ constipation. Infection of the cord may also prevent natural closure of umbilicus.

Clinical signs 

• A discrete spherical swelling at umbilicus
  • Hernial contents are usually fat and omentum
  • Larger hernial sac contains loops of small intestine  Sac is formed by skin, fibrous tissue and peritoneum
  • A circular or oval hernial ring can be palpated.
  • Presence of adhesions/ umbilical abscess prevent reduction.
  • Rarely, the contents get strangulated with symptoms of pain and intestinal obstruction
• Diagnosis: Clinical signs and physical examination

Treatment

• Umbilical hernia may be treated by various conservative or surgical methods. Conservative treatments are suitable only for a small reducible hernia.
  • Reducible umbilical hernia containing only a small part of the omentum or a small loop of intestine may respond favourably to abdominal  pressure bandages or clamps.
  • Reduce the hernia and the hernial ring to close by cicatrisation.
  • Use of metal or wooden clamps: The main objective of the clamp application is to obliterate the hernial sac and to stimulate healing of the ring.
  • Control the animal in dorsal recumbency
  • Reduce hernial contents manually.
  • Open the jaws of clamps
  • Place it longitudinally and directly over the hernial ring
  • Push down the hernial sac through the jaws of the clamp . Tighten the nuts of clamp to keep the clamp snugly against the abdominal wall
  • The sac undergoes necrosis and sloughs down within 10-12 days.
  • The skin wound heals by second intention 

Radical surgery

• Operation is done at the age of three months. If the swelling is too big , treatment is attempted immediately.
• Anaesthesia : General anaethesia or sedation combined with local anaethesia.
• With the animal in dorsal recumbency an elliptical incision is made on the skin over the hernial swelling.
• The incision is extended over the sac. The contents are reduced and the hernial ring is debrided and sutured.
• Preferably a synthetic non absorbable suture material is used. The ring is closed in a double breasting or overlapping pattern. Excess skin if available is trimmed before suturing.
• Hernioplasty is indicated if the hernial ring is large and weak which, could not be apposed.