The material has been collected from the standard text books and published papers

1.  

2.  Hernia is defined as the protrusion of the content of a
body cavity through a normal and abnormal opening in
the wall of that cavity either to lie beneath the intact skin
or to occupy another adjacent body cavity.

3.  A hernia consists of-
o Ring
o Sac
o Content

4.  Ring may be formed due to
o Rupture in the abdominal wall(ventral hernia)
o Rupture of limiting wall(diaphragmatic hernia)
o Due to persistent prenatal opening(umbilical hernia)
 Sac
o The hernial sac made of tissue that enclose the hernial content
o Wall of sac usually contains skin, muscular fibre, fibrous tissue
and parietal peritoneum
o Absent in diaphragmatic hernia
 The content of hernia include
o Organs (a loop of bowel)
o Tissue (omentum)

5.  On the basis of location
o External hernia- It consist of hernial ring, sac and contents
o Internal hernias-which lacks the hernial sac e.g. diaphragmatic
hernia

6.  Passage of abdominal viscera into thoracic cavity
through a congenital or acquired opening in the
diaphragm
 Most commonly reticulum herniates but other organs like
omasum, abomasum, loops of intestine, liver, spleen
may get involved .

7.  Most frequently seen in she buffalo- right side with one
or multiple rings
 In buffaloes – DH occurs in right hemidiaphragm(90%)
and rarely in the left (7%)or in the center(3%)
 In dogs and cats – equal on both sides

8.  Weakening of diaphragm
o TRP/ FB
o Increased intraabdominal pressure –
• Advanced pregnancy
• Tympany
• Straining during parturition
• Violent fall
o Musculotendineous junction (less tone and thickness)
o In dogs and cats DH is caused by trauma, particularly
automobile accidents
 DH may also occur in animal with connective tissue

9.  Congenital hernia
o Pleuroperitoneal hernia Serous lining of
pleura and peritoneum---separated by
transverse septum—when weaken/ trauma in
fetuses—cause rupture of these and thus
hernia
o Peritoniopericardial hernia (congenital hole in
diaphragm and pericardium, also pericardium
is fused with dia.---entry of abdominal parts in
that hole)
 Acquired-secondary to trauma.
o Trauma is the most common cause of DH in
dogs and cats
o 77-85% cases from traumatic origin
o 5-10% cases from congenital origin
o Rest from unknown causes

10.  Common site for rupture –
o 12-15 cm ventral to hiatus
oesophagi
o 12 cm ventral to foramen
vena cavae close to central
musculotendinous junction
 Other sites
o Completely in the tendinous
part or in the ventral
musculature

12.  Recurrent tympany
 Reduced reticular motility
 Reduced milk yield
 Scant defecation or diarrhoea with foul smell
 Slight degree of melena
 In advanced cases regurgitation leads to aspiration
pneumonia
 Brisket oedema
 Jugular pulsation may or may not be present
 (The herniated reticulum may lie between the heart and
diaphragm)
 Pasty faeces

14. A-arching of back, B-abducted forelimbs, C-dullness, D-brisket oedema

15.  Abduction of limbs may be observed
 In rare cases chronic cough
 In untreated cases inanition, progressive emaciation,
weakness and dehydration and ultimately death
 dogs and cats-
o Severe dyspnoea
o Depend on the structures herniated and size of tear
o Signs of obstruction, gastric dilatation, liver problems (vomiting,
anorexia, jaundice, exercise intolerance)
o Signs of pneumothorax and lung contusion

16.  The herniated reticulum lies in the caudal mediastinum
5-10 cm caudal to xiphisternum between the heart and
diaphragm
 Fibrous bands frequently observed
 Diaphragmatic abscess may be present
 Dogs and cats –
o Pleuroperitoneal hernia- Incomplete development of
pleuroperitoneal canal during diaphragmatic development

17. o Congenital pleuroperitoneal hernias seldom diagnosed in small
animals because many affected animal die at birth or shortly
thereafter.
o Located in dorsolatral part of diaphragm
o Intermediate part of left lumbar muscle of the crus may be absent
o 1-2 cm in diameter
o Animal die because of respiratory insufficiency
o Peritoniopericardial hernia – faulty development or prenatal injury
of the septum transversum- teratogen, genetic defect, or prenatal
injury
o In this type of hernia organ herniated into pericardial sac

18. o Organs like liver, falciform ligament, omentum, spleen, Small
intestine and very rarely stomach
o This leads to strangulation of viscera which leads to less venous
drainage from liver
o Effusions
o Herniated stomach produce cardiac temponade
o Traumatic diaphragmatic hernia – costal muscle are more
often ruptured then the central tendons
o Parietal surface of liver covers most of diaphragm so liver is the
organ most herniated

19. o Incarceration, strangulation and obstruction are the chief effect
on the abdominal viscera
o Flow obstruction of stomach leads to tympany
o In liver hepatic venous stasis may develop
o Hydrothorax and ascites may develops
o Pleural effusion may be seen

20.  History- history of recent parturition
 Clinical signs
 Auscultation –
o Intestinal sound on thoracic cage is heard
o Muffled heart sound
o Reticular sound cranial to 6th rib

21.  Position-
o Right Lateral and supine and lateral projections are taken
 Plain and contrast radiography can be performed
 Plain radiograph –
o An empty reticulum appears as a air filled viscus in the thoracic
cavity
 Contrast radiograph- for confirm diagnosis
o Barium meal is used as contrast material

26.  Exploratory laparotomy can also be performed where x-
ray facility of large animal is not available

27.  Laparorumenotomy
 Evacuate rumen 3/4th or full
 Replace the healthy liquor
 Off feed the animal for 48 hours after evacuation and
fluid therapy should be maintained
 GA- Induced with thiopental sodium 5% solution @ 5
mg/kg b.wt
 Maintained with isoflurane
 IPPV after intubation

28.  Sedation (xylazine @0.1 mg/kg) i/v
 Local anaesthesia (lignocaine HCl 2%) was given at
surgical site
 Approaches
o Transabdominal
o Transthoracic

29.  Right cranial quadrent
/right hypochondric area
is prepared for the
surgery
 25-30 cm incision : 5 cm
caudal to xiphoid
cartilage :parallel to
costal arch
 Severe the adhesions of
diaphragm and reticulum
 Abdominal and thoracic
organs

30.  Close the ring with
continuous suture or lock
stitch or vest over Pants
by using non absorbable
suture materials(no 2)
 Close the abdominal
incision using absorbable
suture material with
simple continuous suture
in muscle and peritoneum
 Close the skin incision

33.  Right or left lateral
thoracotomy
 Midway on 7th rib
to downward
toward
costochondral
junction
 Overlaying
thoracic muscles
incised

34.  Rib resesection –
o Periosteum incised by scalpel
o Periosteum retracted cranially and caudally with periosteal
elevator

35.  Gigli wire is used
 Transect
 Rib wide and thin
 Disarticulate rib at costochondral Jn.

36.  Incise pleura-
herniated reticulum
seen
 Separate the
adhesions with lungs
and pleura
 Push in abdominal
cavity

37.  Close the diaphragmatic rent
 Resect indurated diaphragmatic tissue along with
reticulum if adhesions are extensive
 If small gap then close by few suture
 If large gap then use grafts
 Similarly, adhesions with pulmonary lobe requires
partial/complete lobectomy
 It may recur, if animal is pregnant at the time of surgery
after parturition so postpone surgery till parturition

40.  Medicinal treatment
o If the animal is dyspnoeic, oxygen should be provided by face
mask, nasal insufflation, or an oxygen cage.
o Positioning the animal in sternal recumbency with the forelimb
elevated may help in ventilation.
o If moderate to severe pleural effusion is present, thoraco-
centesis Should be performed.
o Fluid therapy and antibiotics should be given if animal in the
shock.

41.  Depends upon-
 The extent of initial cardiopulmonary dysfunction.
 The presence and absence of organ entrapment
 The degree of compromised pulmonary function
 Whether or not animals condition is improving , stable, or
detoriarating.
 Diaphragmatic herniorrhaphy may require immediate
surgery if aggressive supportive care can not stabilize
respiratory function

42.  Acute dilatation of a herniated stomach or strangulated
bowel are examples of situations where emergency
surgery may be indicated.

43.  Prophylactic antibiotics in animals with hepatic
herniation.
 Massive release of toxins into the circulation may occur
with hepatic strangulation or vascular compromise.
premedication such patients with steroids may be
beneficial.
 An ECG should be performed on all trauma patients
before surgery.

44.  Supplementing oxygen before induction improves
myocardial oxygenation
 Drugs with minimal respiratory depressant effect.
 Injectable anaesthetics allowing rapid intubation are
preferred.
 Inhalation anaesthetics should be used for maintenance
of anaesthesia

45.  Intermittent positive pressure ventilation should be
performed and high inspiratory pressure should be
avoided to help to prevent re expansion pulmonary
oedema.
 Methyleprednisolone may be beneficial to prevent
reeexpansion pulmonary oedema

46.  Midline abdominal celiotomy is the easiest and most
versatile approach
 Position the animal head towards the top of the table and
tilting the table at a 30-40 ̊ angle will facilitate gravitation
of abdominal viscera out of the thorax.
 Rarely is it necessary to extend the incision into the
thorax via a median sternotomy .

47.  Incision is made from xiphoid to point caudal to
umbilicus.
 Open the peritoneal cavity, diaphragm is exposed now.
 Herniated content are replaced in their proper position
and inspected for damage.
 If adhesions exist, they should be broken down using
blunt dissection
 Using large sponges or laparotomy pads moistened with
warm saline, the liver and bowel are retracted caudally.

48.  All thoracic fluids should be aspirated
 The lung should be expanded to remove atelectasis and
to inspect and persistent tear of collapse
 Edges of the tear should be debrided
 Recommended to suture the hernia from dorsal to
ventral
 Hernia is closed with single layer, simple continuous
pattern using synthetic absorbable suture material
(dexon is preferred, vicryl) (3-0 to 1 )or non absorbable

49.  If the diaphragm is avulsed from the ribs, incorporate a
rib in the continuous suture for added strength

50.  Median sternotomy-
o Sternotomy of caudal 2-3 sternebrae
o Rarely performed alone
o May be necessary in irreducible hernia
 Lateral thoracotomy-
o 9th intercostal approach
o It allows inspection of convex part of diaphragm
 Transsternal thoracotomy- 7th-8th rib provide good
exposure

51.  Antibiotics should be given for 5-7 days
 Fluid therapy should be given
 Analgesics should be given

52.  Causes of diaphragmatic hernia in horses
 Congenital
o This may occur as a secondary condition to pulmonary
hypoplasia.
o In incomplete hernias, such as diaphragmatic diverticulum, the
abdominal contents enter the thorax, however, are covered by a
thin membrane
 Acquired diaphragmatic hernia (ADH)
o trauma
o Internal pressure like in advanced pregnancy

53.  The most common symptom seen is signs of severe
abdominal pain.
 Respiratory distress such as difficulty with breathing
 Rapid breathing
 Blue mucous membranes
 Signs due to complications such as pneumothorax (fluid in the
thoracic cavity)
 Muffled heart and lung sounds

54.  History
 Clinical signs
 Ultrasonography
 Radiography

56.  This will be done under general anesthesia
 Xylazine – 1.1 mg/kg b. wt. i/v
 Diazepam – 0.05 mg /kg b.wt i/v
 Ketamine -2.2 mg /kg
 Anesthesia maintained with either isoflurane or
sevoflurane via an endotracheal tube

57.  Ventral abdominal midline approach
 Carefully reduce the incarcerated intestine into the
abdominal cavity.
 Repair the herniated rent with the non absorbable suture
(no 2)
 If rent is large then polypropylene mash is used to close
it
 Close the incision

58.  Rib resection approach

59.  https://www.youtube.com/watch?v=zRfc6mTZJko