VSR 421: Regional Veterinary Surgery (2+1)

Hiatal hermia

HIATAL HERNIA

• This is a form of diaphragmatic hernia in which the caudal end of the oesophagus and cardiac area of the stomach pass through the oesophageal hiatus of the diaphragm.
• The  associated sign is the oesophagitis. Treatment consists of reducing the hernia and reconstructing the diaphragam.

Diaphragmatic hernia in bovines

• In cattle and buffaloes, reticulum is the common herniating organ, however the omasum, abomasum, loops of intestine, spleen or liver may also get involved.

Etiology

• Weakening of the diaphragm by lesions of traumatic reticulo peritonitis, congenital weak points of the diaphragm and physical force like increased intra abdominal pressure during pregnancy and parturition, violent fall etc.

Clinical signs and diagnosis

• Most affected animals develop recurrent tympany not responding to medical treatment. The tympany is mild if only a small portion of reticulum is herniated.
• As more and more of the organ is herniated, signs become severe due to development of adhesions between the reticulum and other structures like lungs, pericardium, thoracic wall and hernial ring.
• There will be complete or partial cessation of milk yield with passing of scanty, foul smelling pasty dung. Some cases show slight degree of melena, Regurgitation may lead to aspiration pneumonia.
• Brisket edema and jugular pulse along with abduction of fore limbs may be observed. In rare cases chronic cough may be present.
• On auscultation, cardiac sounds are muffled and reticular sounds may be heard anterior to the 6^th rib. In untreated cases, inanition, progressive emaciation, weakness and dehydration leading to death are observed. The diagnosis is confirmed by plain and contrast radiography.  Left flank exploratory laparotomy may be done.

Treatment

• Treatment is only surgical.
• The first step is to evacuate the contents of the rumen and reticulum by rumenotomy and cud transplantation. Then the animal is kept on I/v fluids for 48 hours and there after in the soft diets with fluids. Surgery to correct hernia may be delayed 3-4 days.
• The common approaches for diaphragmatic hernia are abdominal and thoracic. Irrespective of the approach, proper ruminal evacuation and assisted ventilation during herniorrhaphy are required for successful procedure.