Surgical management of pseudo enterocele in a lamb.
Hernia is protrusion of an organ or tissue through a natural or unnatural opening (Jettennavar et al., 2010) and acquired due to mostly trauma (Krishna murthy, 2006). Abdominal hernias alter body conformation, physiological functions and distort the cosmetic appearance of animal (Ramadan and Abdin-Bey, 2001). In sheep and goat hernial contents may be intestines, mesentery, bladder or uterus (Abdin-Bey and Ramadan, 2001).
Ventral abdominal hernia is a common acquired condition in ruminants and herniation of intestines is called enterocele. Hernias generally are created either by accidental trauma to abdomen (traumatic hernia) or develop after breakdown of surgical entry into the abdomen (incisional hernia). False hernias do occur in small animals however viscera will not be covered by complete peritoneal sac (Smeak, 1993). This paper reports a case of false hernia (pseudo enterocele) in Nellore brown ram lamb and its successful surgical management.
History and Clinical observations
An 8 month old Nellore brown ram lamb of about 10 kg b.wt. was presented with history of soft, fluctuating swelling (Fig. 1) at right inguinal region since last 5 days. It was reported to have met with a gore injury by an adult ram, 1 week back and since then it started swelling gradually. The lamb was off fed since last 2 days, straining while defecation and faeces were hard in consistency.
The lamb was unable to walk properly due to swelling in right inguinal region. On palpation, swelling was soft, fluctuating and painless with oedematous fluid in sac. Hernial ring could not be palpated due to presence of voluminous hernial contents and oedema.
The lamb was fasted for 8 hrs. 150 ml of RL and inj. Meloxicam (a) 0.2mg/kg b.wt. administered intravenously to rehydrate and pre-emptive analgesia respectively. Animal restrained in dorsal recumbancy with hind limbs stretched out and pulled apart. The right hind limb held in vertical position as and when needed. It was anaesthetised with Xylaxine hydrochloride (b) and Ketamine hydrochloride (c) @0.1 mg/kg b.wt. and 5 mg/kg b.wt. respectively. The right inguinal area was aseptically prepared. Linear infiltration was done with Lignocaine hydrochloride (d) following a 10 cm linear skin incision, small and large intestine including caecum were found in the sac. Site of herniation could not be found in the inguinal or ventro-lateral abdominal region. But careful and through examination revealed the linear hernial ring for enterocele found near the high right para lumbar fossa at the level of 4th and 5th lumbar vertebra. Since the herniorrhaphy and repositioning of viscera was difficult at this site it was decided to incise at para lumbar fossa closing the present incision routinely. The hernial ring was like a linear slit between psoas major and transversus abdominis muscle below 4th and 5th lumbar vertebrae. The viscera were cleaned with normal saline and repositioned in the abdominal cavity. Oxytetracycline (e) liquid was poured in the cavity to prevent infection and adhesions. The abdominal vent was closed by overlapping suture pattern using chromic catgut No. 1. The sub cutis and skin were closed in a routine manner (Fig. 2). The sites were padded with sterile gauze after applying Zinc oxide plus Tincture Benzoin paste. Inj. Anistamin (a) 1.5ml, Inj: Tribivet (a) 1.5ml, inj. Intacefa 500mg and RL 150ml I/V were given post operatively and repeated for next 5 days. Mild oedema was observed near suture line which subsided in next 3 days. Sutures were removed 9th post-operative day. Animal showed uneventful recovery.
Paracostal, high or low flank hernias are usually caused by violent force such as from the impact of blunt objects but may result from overstretching of abdominal muscles (Tigari, 1979). In the present case, hernia resulted from gore injury by a ram. The incidence of abdominal hernia was marginally high in goats (71.43%) compared to sheep (68.2%) and females were more affected than males (Sobayil and Ahmed, 2007). The incidence of abdominal hernia is more in sheep and goats as the abdominal wall is relatively thin.
Acquired hernias may be worsened by exciting causes like intra abdominal pressure caused by constipation (Krishna murthy, 2006). Size of hernial ring varies in diameter from 1-40 cm (Abdin-Bey and Ramadan, 2001) and shape which may be circular, linear or oblong. In present case it was linear and measured 8cm. It was difficult to palpate, the hernial ring during initial stages due to oedema or haematoma in surrounding tissues (Tyagi and Singh 2006). Normal hernial contents in inguinal hernia are omentum, intestines or both and rarely urinary bladder (Tyagi and Singh, 2006).In the present case small and large intestines along with caecum were the hernial contents and were not covered by peritoneum. The hernial ring was closed by overlapping suture pattern. The larger hernial rings also may be closed using prosthetic meshes (Youssef et al., 1994, Abdin-Bey and Ramadan, 2001). The slight swelling post operatively might be due to accumulation of fluid in dead space and this disappeared spontaneously within 3 days as was also reported by Sobayil and Ahmed (2007). Antibiotic inj. Intacef was administered to combat any infection. Meloxicam administered pre-emptively alleviated surgical pain.
This case was presented since it was rare to find hernial ring and its contents at different places making the diagnosis and treatment difficult. However, careful examination and timely surgical intervention ensured successful treatment.
A rare case of dorso-lateral pseudo enterocele in a Nellore brown ram lamb and its successful surgical management was reported.
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G. Kamalakar (1), R. Mahesh (2), and V. Devi Prasad (3)
Department of Veterinary Surgery and Radiology College of Veterinary Science Sri Venkateswara Veterinary University (SVVU) Proddatur Dist. Y.S.R. Kadapa--516360 (Andhra Pradesh)
(1.) Assistant Professor and Corresponding author. E-mail: firstname.lastname@example.org
(2.) Assistant Professor
(3.) Associate Professor
(a)--Brand of Intas Animal Health, Ahmedabad
(b)--Brand of Indian Immunologicals Ltd., Hyderabad
(c)--Brand of Themis Medicare Ltd., Haridwar
(d)--Brand of Astra Zeneca Ltd., Bengaluru
(e)--Brand of Zoetis Animal Health, Mumbai
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|Title Annotation:||Short Communication|
|Author:||Kamalakar, G.; Mahesh, R.; Prasad, V. Devi|
|Date:||Jan 1, 2015|
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