TUGAS MATA KULIAH

ILMU BEDAH KHUSUS VETERINER

TEKNIK OPERASI HERNIA

Disusun oleh :

Putu Ayutia Areningrat (1509005105)

Reydanisa Noor Madania (1509005106)

Ni Luh Ayu Praharani P.D. (1509005107)

Yeyen Fami Gressia S. (1509005108)

I Nyoman Kusumajaya (1509005109)

I A Sri Devi Adnyaswari (1509005110)

Kelas : C

LABORATORIUM BEDAH VETERINER

FAKULTAS KEDOKTERAN HEWAN

UNIVERSITAS UDAYANA

TAHUN 2018

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 RINGKASAN
Hernia sejati memiliki kriteria adanya cincin hernia, kantung, dan berisi.
Hernia pada dinding abdomen merupakan hal yang umum pada semua spesies
domestik seperti hernia umbilikalis dan hernia inguinalis atau skrotum sebagai akibat
dari kelemahan muskular abdomen konginental atau dapatan. Hernia umumnya
muncul pada saat anjing berdiri atau menggonggong dan mengejan karena tekanan
perut yang berlebihan dan mendesak bagian perut masuk ke dalam bagian tersebut.
Pendekatan melalui garis tengah ventral digunakan untuk semua hernia inguinal yang
memungkinkan penggunaan cincin inguinal dan perbaikan hernia bilateral melalui
insisi tunggal. Pada hernia perineal, Jahitan tali purse ditempatkan di sekitar anus
untuk mencegah defekasi selama operasi. Perawatan pasca operasi, selama masa
perawatan pasien diberikan antibiotic, antipiretik, analgesik dan antiseptik guna
mempercepat kesembuhan dari pasien. Kemoterapi profilaksis rutin dianjurkan dan
diet residu rendah harus diberi untuk mencegah ketegangan yang berlebihan selama
buang air besar.
Kata kunci : Operasi hernia, anjing, hernia inguinal, hernia perineal

SUMMARY
The Hernia has the criteria for a hernia, sac, and filled ring. Hernias in the
abdominal wall are common in all domestic species such as umbilical hernias and
inguinal or scrotum hernias as a result of congenital or acquired muscular abdominal
weakness. Hernias generally appear when the dog is standing or barking and straining
because of excessive abdominal pressure and urging the abdomen into the part. The
approach through the ventral midline is used for all inguinal hernias that allow the use
of inguinal rings and repair of bilateral hernias through a single incision. In perineal
hernia, purse cord sutures are placed around the anus to prevent defecation during
surgery. Postoperative care, during the treatment period patients are given antibiotics,
antipyretics, analgesics and antiseptics to accelerate recovery from patients. Routine
prophylactic chemotherapy is recommended and a low residual diet must be given to
prevent excessive tension during bowel movements.
Keywords: Hernia surgery,dogs, inguinal hernia, perineal hernia.

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 KATA PENGANTAR
Puji syukur kami panjatkan kehadirat Tuhan Yang Maha Esa atas segala
rahmat dan hidayah-Nya sehingga karya tulis yang berjudul “Teknik Operasi Hernia”
ini dapat diselesaikan tepat pada waktunya.

Karya tulis ini dibuat dalam rangka menyelesaikan tugas yang akan dijadikan
landasan dalam pemberian nilai pada proses pembelajaran mata kuliah Bedah Khusus
Veteriner Fakultas Kedokteran Hewan Universitas Udayana. Tidak lupa penulis juga
mengucapkan terima kasih kepada semua pihak yang telah membantu dan
memberikan dukungan pada kami. Kami menyadari bahwa tulisan ini masih banyak
kekurangan baik dari segi materi, ilustrasi, dan contoh. Oleh karena itu, saran dan
kritik dari para pembaca yang bersifat membangun sangat kami harapkan. Semoga
karya tulis yang dibuat dapat membantu dan bermanfaat bagi semua kalangan.

Denpasar, 30 September 2018

Hormat kami,

Penulis

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 DAFTAR ISI
Halaman Judul ....................................................................................... i
Ringkasan ............................................................................................... ii
Summary ................................................................................................ iii
Kata Pengantar ....................................................................................... iv
Daftar Isi ................................................................................................. v
Daftar Gambar ....................................................................................... vi
Daftar Lampiran .................................................................................... vii
Bab I Pendahuluan
1.1 Latar Belakang .................................................................................... 1
1.2 Rumusan Masalah ............................................................................... 1
1.3 Tujuan Penulisan ................................................................................ 1
1.4 Manfaat Penulisan............................................................................... 2
Bab II Tinjauan Pustaka
2.1 Pre Operasi Hernia .............................................................................. 3
2.2 Teknik Operasi Hernia ........................................................................ 4
2.3 Pasca Operasi Hernia .......................................................................... 6
Bab III Pembahasan
3.1 Pengertian Hernia ............................................................................... 8
3.2 Teknik Operasi Hernia ........................................................................ 10
3.3 Penanganan Pasca Operasi dan Prognosis Hernia ................................ 12
Bab IV Simpulan dan Saran
4.1 Kesimpulan......................................................................................... 13
4.2 Saran .................................................................................................. 13
Daftar Pustaka ........................................................................................ 14
Lampiran Jurnal .................................................................................... 15

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 DAFTAR GAMBAR

Gambar 1. Penyayatan kulit dan lapisan subkutan ..................................... 4

Gambar 2. Cincin hernia ........................................................................... 5

Gambar 3. Penjahitan cincin hernia ........................................................... 5

Gambar 4. Penjahitan sederhana pada bagian kulit .................................... 6

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 DAFTAR LAMPIRAN

Lampiran 1. Jahromi ,Alireza Raayat et al.2009. Concurrent bilateral inguinal and

umbilical hernias in a bitch. School of Veterinary Medicine,
Shiraz University, Shiraz, Iran. VETERINARSKI ARHIV 79
(5), 517-522, 2009

Lampiran 2. Singh, Kiranjeet et al.2014. A Case of Concurrent Inguinal Hernia and

Vaginal Leiomyoma in a Bitch Successfully Treated
Surgically. Indian Veterinary Research Institute, Izatnagar.
Journal for Veterinary Practitioners. 2 (1): 1 – 4
http://dx.doi.org/10.14737/journal.rjvp/2014/2.1.1.4

Lampiran 3. TATLI,Z. BOZKAN et al.2015. Unilateral dorsal (lumbar) abdominal

hernia in a cat. , Adnan Menderes University, Turkey. Revue
Méd. Vét., 2015, 166, 11-12, 316-318

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 BAB I

PENDAHULUAN

1.1 Latar Belakang

Anjing merupakan hewan kesayangan yang sangat menggemaskan dan sangat

setia kepada pemiliknya, sehingga pemilik hewan kesayangan khususnya anjing sangat
ingin hewannya selalu sehat dan dalam kondisi terbaik. Hernia adalah penonjolan isi
suatu rongga melalui defek atau bagian lemah dari dinding rongga bersangkutan. Pada
hernia abdomen isi perut menonjol melalui defek atau bagian lemah dari lapisan dinding
perut. Hernia paling sering terjadi pada rongga abdomen sebagai akibat dari kelemahan
muskular abdomen konginental atau dapatan. Lubang itu dapat timbul karena lubang
embrional yang tidak menutup atau melebar, akibat tekanan rongga perut yang meninggi.
Hernia umumnya muncul pada saat anjing berdiri atau menggonggong dan mengejan
karena tekanan perut yang berlebihan dan mendesak bagian perut masuk ke dalam bagian
tersebut. Hernia dapat bersifat reduksi dan non reduksi. Reduksi artinya bagian hernia
bisa didorong kembali ke perut, sementara yang non reduksi tidak bisa didorong kembali
bahkan seolah mengalami obstruksi parsial atau adhesi organ ke lapisan yang mengalami
hernia. Hernia tidak akan menimbulkan ancaman kesehatan berarti, namun pada beberapa
kasus yang terjadi, jaringan yang masuk kelokasi hernia misalnya usus akan terjepit
sehingga pembuluh darah terputus dan menyebabkan kematian sel dan jaringan usus. Hal
inilah yang membutuhkan pembedahan sesegera mungkin.

1.2 Rumusan Masalah

1. Apa yang dimaksud dengan hernia ?
2. Bagaimana teknik operasi hernia ?
3. Bagaimana penanganan pasca operasi dan prognosis dari hernia ?

1.3 Tujuan Penulisan

1. Untuk mengetahui pengertian hernia
2. Untuk mengetahui teknik operasi hernia
3. Untuk mengetahui penanganan pasca operasi dan prognosis hernia

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1.4 Manfaat Penulisan

Setelah melakukan penulisan paper ini diharapkan mahasiswa dapat mengetahui

dan mengerti manfaat dan kegunaan dari teknik operasi hernia. Selain itu diharapkan
mahasiswa mengerti dan mengetahui bagaimana tata cara pelaksanaan operasi hernia.

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 BAB II

TINJAUAN PUSTAKA

2.1 Pre Operasi

Persiapan yang perlu dilakukan sebelum melakukan teknik operasi hernia adalah
sebagai berikut :

 Alat-alat

Pinset anatomis, pinset sirurgis, gunting bengkok, gunting jaringan, scalpel,

needle holder, allis forcep, tampon, kapas, kain kasa, plester, jarum bedah penampang
bulat dan penampang segitiga, benang vicryl 2/0, chromic catgut 3/0, silk 3/0, timbangan,
pencukur rambut, sarung tangan, masker, penutup kepala, dan baju bedah.

 Bahan-bahan

Bahan-bahan yang digunakan meliputi alcohol, iodine, atropin sulfat, ketamine,

xylazine, laktat ringer, NaCl fisiologis, oxytral dan novaldon.

 Pengecekan fisik

Sebelum masuk melakukan tindakan bedah perlu dilakukan pemeriksaan fisik

terhadap berbagai indikator penting untuk menunjang keberhasilan operasi. Pemeriksaan
meliputi pemeriksaan suhu tubuh, frekuensi respirasi, denyut jantung, pulsus, berat badan,
dan CRT. Pemeriksaan di atas bertujuan untuk memastikan bahwa kondisi fisik pasien
cukup stabil untuk dilakukan pembedahan serta penentuan dosis obat yang akan
digunakan.

Pasien dipuasakan selama ±12 jam sebelum pembedahan untuk pengosongan

saluran pencernaan dan perkemihan. Hal ini bertujuan untuk mengurangi kejadian
vomiting, defekasi dan urinasi saat pembedahan berlangsung yang dapat menjadi sumber
kontaminan.

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  Anastesi

Premedikasi menggunakan atropin sulfat disuntikkan secara subkutan. Setelah

pemberian atropin sulfat, pemasangan IV katater dipasang sekaligus pemasangan infus.
10 menit setelah pemberian atropin, anjing disuntikkan anastesi dengan ketamin dan
xylazin secara intravena melalui infus. Bila anjing sudah teranastesi maka dipasang
stomach tube untuk mengeluarkan isi lambung, kateter urin untuk mengeluarkan urin,
Endotracheal Tube untuk pengaturan nafas dan anastesi inhalasi bila diperlukan.

2.2 Teknik Operasi

a. Hewan diposisikan dorsal recumbency, dan bagian yang akan diinsisi dibersihkan
dengan alkohol dan iodine untuk mengurangi kontaminasi mikroorganisme saat
operasi. Kain drape diposisikan di area yang akan diinsisi dan dijepit menggunakan
towel clamp. Lakukan reposisi dengan menekan pada hernia untuk menentukan lokasi
cincin hernia sebagai acuan untuk melakukan insisi. Insisi dilakukan pada kulit dan
subkutan tepat di atas dari cincin hernia. Kulit diinsisi dengan hati-hati agar tidak
sampai melukai organ yang terdapat pada kantung hernia. Isi hernia seperti usus dijaga
agar tidak kering dengan dibasahi menggunakan NaCl fisiologis.

Gambar 1. Penyayatan kulit dan lapisan subkutan

b. Ekspolari pada bagian tempat hernia dilakukan untuk mencari lokasi cincin hernia.
Setelah cincin hernia ditemukan jepit menggunakan allis forceps. Reposisi isi hernia
dengan mendorong secara perlahan menggunakan jari ke rongga abdomen. Cincin

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 hernia yang sempit dapat dilebarkan dengan menggunakan gunting jaringan untuk
memudahkan reposisi isi hernia. Pelebaran cincin hernia harus dilakukan dengan hati-
hati agar tidak memotong arteri dan vena yang ada disekitarnya.

Gambar 2. Cincin hernia

c. Bila isi hernia telah direposisi, pada bagian tepi cincin hernia dibuat luka baru dengan
menggunakan scalpel atau gunting jaringan untuk memungkinkan terjadinya
penyatuan jaringan. Cincin hernia yang telah dibuat luka buatan dijahit menggunakan
benang vicryl 2/0 dengan pola terputus sederhana. Jahitan dilakukan sepanjang cincin
hernia kemudian pastikan tidak terdapat celah yang memungkinkan terjadi hernia
kembali.

Gambar 3. Penjahitan cincin hernia

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 d. Selanjutnya dilakukan penjahitan pada subkutan menggunakan benang chromic catgut
dengan pola jahitan menerus sederhana. Subkutikuler dijahit dengan benang chromic
catgut 3/0 dengan pola jahitan menerus sederhana. Kulit dijahit menggunakan benang
silk 3/0 dengan pola jahitan terputus sederhana.

Gambar 4. Penjahitan sederhana pada bagian kulit

e. Luka jahitan diberikan iodine untuk mencegah infeksi kemudian disuntikan antibiotic
untuk mencegah adanya infeksi.
f. Selama operasi, dilakukan monitoring terhadap kondisi pasien setiap 10 menit yang
meliputi monitoring suhu, frekuensi nafas, frekuensi jantung, frekuensi pulsus, dan
mukosa (CRT) (Sudisma et al., 2006).

2.3 Pasca Operasi

Setelah prosedur operasi berlangsung, langkah selanjutnya adalah perawatan

pasca operasi, selama masa perawatan pasien diberikan antibiotic, antipiretik, analgesic
dan antiseptic guna mempercepat kesembuhan dari pasien. Antibiotik yang dapat
diberikan adalah amoxsan sirup secara oral 3 kali sehari selama 5 hari, sebagai antipiretik,
analgesik dan antiradang diberikan asam mefenamat dengan dosis ½ tablet secara oral 2
kali sehari serta penggunaan oxytetracyclin dan limoxin digunakan pada kulit luar. Luka
jahitan dioles dengan povidine iodine setiap hari dan ditutup kassa untuk mempercepat
kesembuhan pada pasien. Penggunaan Elizabeth collar juga diperlukan ± selama 10 hari
pasca operasi, agar luka yang belum kering tidak dijilat yang dapat memperlambat

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kesembuhan. Diperlukan juga pemberian diet rendah protein dan lemak agar kotoran
lembek dan untuk mengurangi kondisi stress pada lapisan perineum yang diperbaiki,
pengurangan aktifitas pelatihan (lari dan latihan fisik/beban) serta sanitasi kandang yang
baik mutlak adanya untuk mempercepat penyembuhan luka. Jahitan di kulit dapat dilepas
setelah 7 hari pasca operasi. Kesembuhan luka mulai terlihat dari hari ke-8 pasca operasi.

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 BAB III

PEMBAHASAN

3.1 Hernia

Hernia sejati memiliki kriteria adanya cincin hernia, kantung, dan berisi. Hernia
pada dinding abdomenmerupakan hal yang umum pada semua spesies domestik seperti
hernia umbilikalis dan hernia inguinalis atau skrotum. Hernia dapat langsung (melalui
sewa di dinding tubuh) atau tidak langsung (melalui cincin yang sudah ada, seperti cincin
inguinal atau cincin umbilikal). Hernia kongenital cenderung masuk ke tipe tidak
langsung, meskipun hernia traumatik langsung dapat terjadi selama distosia atau
manipulasi obstetris. Hernia umbilicalmemiliki variasi dalam ukuran dan mungkin hanya
mengandung lemak/omentum, atau pada kasus yang lebih berat, loops usus. Hal ini biasa
terjadi pada anjing trah Weimaraners, Peking, Basenji, dan Airedale Terrier. Dalam
banyak kasus, hernia umbilical biasa terjadi bersamaan pada anjing dengan kasus
cryptorchidism. Ada kemungkinan hal ini merupakan herditas tetapi belum ada bukti
pasti. Pada sapi, breed yang biasanya mengalami hal ini adalah jenis Friesian Holstein.
Diagnosis pada semua hewan dapat dilakukan dengan mengamati adanya kantung hernia
pada abdomen, palpasi, ultrasonografi, dan mungkin radiografi. Penutupan dengan
pembedahan pada dinding abdomen diindikasikan pada sebagian besar kasus untuk
mengurangi risiko inkarserasi usus di masa depan.

Hernia inguinalis atau skrotum sering terjadi pada babi, kuda (terutama draft
breed dan warmblood), dan banyak anjing dengan dugaan hereditas. Hernia inguinalis
dapat terjadi pada anjing betina dan mungkin melibatkan uterus. Tanda-tanda klinis
bervariasi dari pembengkakan inguinal atau skrotum nonpainful ke kolik akut pada kuda
atau muntah pada anjing, terutama jika usus kecil terjepit. Pada kuda, palpasi per rektum
dapat mendiagnosis loop usus pada cincin vagina, yang dapat diangkat dengan lembut
untuk memberikan bantuan sebelum diangkut ke fasilitas bedah. Usus yang terjatuh
direseksi melalui midline celiotomy. Pada kuda jantan, laparoskopipada cincin inguinal
dilakukan dengan posisi berdiri maupun berbaring telentang dan hasil didapat termasuk
baik. Pada anak kuda dan anak sapi, manajemen medis melalui pengurangan hernia dan

8
penempatan perban angka delapan telah berhasil dalam beberapa kasus. Hernia yang
tidak segera ditngani pada usia dini harus dikoreksi dengan jalan pembedahan untuk
mencegah komplikasi di kemudian hari.

Hernia antara rongga abdomen dan toraks yang melibatkan diafragma

merupakansalah satu tipe dan dapat berasal dari bawaan(hereditas) atau traumatis. Hernia
pleuroperitoneal kongenitalbiasa pada hewan kecil, kuda, dan sapi. Pada kuda, tipe
spesifik hernia, retrosternal atau hernia Morgani, merupakan keadaan kantung hernia
menjorok ke toraks di bagian kiri dorsal tendinous dari diafragma. Kantung ditandai
dengan lapisan pleura dan lapisan peritoneum. Dalam kasus-kasus yang digambarkan,
keluhan yang muncul adalah kolik, dan diagnosis dilakukan dengan cara eksplorasi
celiotomy. Cacat dapat diperbaiki melalui pembedahan menggunakan produk mesh untuk
mengurangi risiko kekambuhan. Kantung hernia biasanya dibiarkan di situ. Dalam kasus
herniasi langsung, tanda-tanda klinis termasuk dyspnea, intoleransi latihan, kelesuan, dan
penurunan berat badan. Pada sapi, herniasi reticulum ke dalam thorax telah dijelaskan,
dengan defek diafragma sisi kanan. Tanda-tanda klinis termasuk anoreksia, kotoran
kurang, tympani, dan penurunan atau tanpa perenungan. Diagnosis adalah dengan
radiografi atau ultrasonografi.

Hernia peritoneopericardial didefinisikan sebagai defek embriologis pada

kegagalan fusi transversum septum selama perkembangan diafragma,
memungkinkantidak adaya pembatas antara rongga perut dan kantung perikardial.
Weimaraners dan kucing berbulu panjang domestik merupakan objek penelitian. Tanda-
tanda klinis mencerminkan isi hernia, yang mungkin termasuk omentum, hati, kandung
empedu, atau loop usus kecil, dan termasuk tamponade jantung, dyspnea, tachypnea,
intoleransi latihan, batuk, muntah, dan obstruksi GI. Dalam banyak kasus, diagnosis
adalah temuan insidental selama pencitraan atau celiotomy karena alasan lain. Kelainan
kongenital lainnya ditemukan dalam banyak kasus, termasuk hernia umbilical,
cryptorchidism, celah langit-langit, pirau portosystemic, dan kelainan sternum atau
vertebral. Hewan dengan tanda klinis ditangani dengan herniorrhaphy, sedangkan hewan
tanpa tanda klinis cenderung dimonitor secara ketat. Hiatal hernia terjadi karena hiatus
esofagus dan diklasifikasikan menjadi empat jenis. Tipe I, hernia akibat pergeseran,

9
 adalah yang paling umum pada hewan kecil dan ditandai dengan pergeseran intermiten
dari sfingter esofagus bawah dan lambung fundus ke dalam rongga toraks. Tipe II kurang
umum dan hanya melibatkan perpindahan fundus lambung. Brachycephalic breeds adalah
overrepresent, dengan sifat turun temurun yang dicurigai di Shar-Pei. Tanda-tanda klinis
termasuk disfagia, regurgitasi, muntah, ptyalisme, dan esophagitis karena penurunan
fungsi sfingter esofagus bagian bawah. Diagnosis adalah dengan radiografi atau
fluoroskopi; Namun, sifat berselang dapat membuat diagnosis menjadi sulit. Perawatan
medis esofagitis diperlukan. Koreksi bedah adalah dengan kombinasi dari hiatus plikasi,
esofagopeksi, dan gastropeksi sisi kiri.

3.2 Surgical Correction pada Hernia

3.2.1 Hernia Ingualis

Pendekatan melalui garis tengah ventral digunakan untuk semua hernia inguinal
yang memungkinkan penggunaan cincin inguinal dan perbaikan hernia bilateral melalui
insisi tunggal. Selain itu, sayatan ini mungkin diperpanjang secara kranial tanpa
gangguan jaringan mamaria atau suplai darahnya. Sayatan dibuat dari brirn tengkorak
panggul dan dibawa cranial sampai eksposur kantung yang memadai tercapai. Merusak
jaringan mamaria dan retraksi lateral memungkinkan terpapar cincin ingninal dan
kantung. Diseksi tumpul membebaskan kantung dari jaringan subkutan. Kantung hernia
dibuka dan diperiksa. Adhesi antara kantung dan visera diangkat dan isi kantung
dikembalikan ke rongga perut.

Seringkali pembesaran cincin inguinal dilakukan untuk mengurangi reduksi hernial.

Jika kandung kemih dimasukkan, aspirasi menyederhanakan prosedur.Setelah penggantian
organ, kantung dipotong di pinggiran cincin inguinal dan cincin hernial dijahit dengan
stainless steel yang diinterupsi sederhana (2-0).Inspeksi terbuat dari cincin inguinal yang
berlawanan, proses vagina diangkat dan jahitan cincin inguinal tertutup. Jaringan mamary
diganti dan drain penrose dimasukkan. Dosis rutin kulit berikut.Perawatan pasca operasi
termasuk perban perut yang menghilangkan ruang mati dan membantu kenyamanan
pasien. Pengurasan dibuang 3 - 5 hari setelah operasi.

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3.2.1 Hernia Perineal

Jahitan tali purse ditempatkan di sekitar anus untuk mencegah defekasi selama
operasi. Posisi operasi yang terbaik adalah menempatkan pasien pada tulang dada dan
mengangkat bagian belakangnya. Ekor ditarik ke depan dan lateral untuk mengekspos
daerah perineum. Operasi ini dirancang untuk merekonstruksi diafragma panggul.
Rekonstruksi lengkap tidak mungkin terjadi karena robek atau atrofi otot, penutupan
corong hernial dan pemusnahan ruang mungkin semua yang bisa dilakukan.

Sebuah sayatan kulit setengah lingkaran dibuat di atas hernia dan diperpanjang
jarak yang cukup di atas dan di bawah hernia untuk memfasilitasi manipulasi jaringan.
Seringkali tidak akan ada bukti fasia dan jaringan berserat, dan otot-otot akan berhenti
berkembang dan bercampur dengan omentum-seperti, nekrotik, jaringan lemak, Untai
jaringan harus terganggu antara lapisan otot dan jaringan lemak diikat dan dihapus
seperlunya. Daerah ini kemungkinan akan menjadi hemoragik dan serum darah keluar
ketika kantung hernia masuk.

Organ herniated diganti ke rongga pelvis dengan manipulasi lembut dan

kemudian pandangan yang jelas dari corong diperoleh. Di sisi medial adalah rektum,
berakhir pada sfingter anus. Ini biasanya adalah satu-satunya struktur di sisi medial di
mana jahitan dapat dimasukkan. Struktur otot pada sisi lateral corong tidak mudah
dilihat tetapi dapat diidentifikasi dengan palpasi. The levator ani dan otot coccygeous
berada di permukaan dorsolateral corong, 2-0 kawat baja Stainless jahitan dimasukkan
melalui otot-otot dan ke bagian dorsal dari sfingter anal. Otot obturator internal juga
dijahit ke aspek ventrolateral dari rectom.

Segera di bawah jahitan ini, yang tambahan disisipkan antara sfingter anus dan
ligamen sakrotuberous. Ligamen ini adalah pita yang cukup lebar yang dapat
diidentifikasi dengan melewatkan jari di sepanjang dinding medial panggul dan
mengaitkan jari ke belakang. Ligamen mungkin keliru untuk tulang. Bagian bawah
pembukaan ditutup dengan memasukkan serangkaian jahitan melalui otot obturator
internal yang terletak di lantai panggul, dan permukaan ventral dari sfingter anus. Ini
sulit karena struktur terletak sangat dalam panggul dan manipulasi hati-hati diperlukan.

11
 Ketika memasukkan jahitan bawah antara kepala otot obturator internal dan
bagian ventral dari sphincter anal, perawatan harus diambil untuk menghindari melukai
suplai darah dan saraf ke anus, Otot-otot sfingter ani dipasok oleh cabang anal dari
saraf pudenda dan oleh arteri perineum dan vena satelit, struktur ini akan dijumpai
dalam sebuah band sepanjang aspek ventral dari rektum. Cedera pada saraf dapat
menyebabkan inkontinensia fecal.

Jahitan tidak harus diikat sampai semua telah dimasukkan, 'jika tidak,
peningkatan kesulitan akan dijumpai dalam menempatkan jahitan. Setelah penutupan
garis jahitan awal upaya dilakukan untuk menemukan fasia perineum utuh yang
mungkin telah ditarik ke lateral. Tepi fasia digenggam dengan forsep Allis dan flap
dibentuk dengan membedah permukaan luar fasia dari kulit atasnya, Flap fascia ditarik
ke medial dan dijahit ke bagian paling ujung dari sfingter anus. Serangkaian jahitan
lainnya dimasukkan ke dalam jaringan subkutan dan kulit yang berlebihan dipangkas
untuk memastikan penutupan yang cukup dan akurat.

Kemungkinan komplikasi setelah perbaikan hernia peritoneum termasuk

inkontinensia fecal dan uriner, infeksi luka dari kontaminasi tinja dan kepincangan
akibat kerusakan saraf sciatic selama operasi. Dalam kasus yang parah, nilon mesh
dapat digunakan untuk membentuk "diafragma" yang mencegah perpindahan ekor dari
visera.

3.3 Penanganan Pasca Operasi dan Prognosis

Kemoterapi profilaksis rutin dianjurkan dan diet residu rendah harus diberi untuk
mencegah ketegangan yang berlebihan selama buang air besar, Dalam banyak kasus,
kekambuhan tidak menjadi masalah. Kedua sisi hernia bilateral tidak boleh dioperasikan
pada saat yang sama karena ini akan terlalu banyak menekan pada sfingter anal eksternal.
Kelemahan 4 hingga 6 minggu harus terjadi antara operasi.

12
 BAB IV

PENUTUP

4.1 Kesimpulan

Hernia adalah penonjolan isi suatu rongga melalui defek atau bagian lemah dari
dinding rongga bersangkutan. Pada hernia abdomen isi perut menonjol melalui defek atau
bagian lemah dari lapisan dinding perut.Proseduroperasidilakukanuntukmenangani hernia.
Setelahproseduroperasiberlangsung, langkah selanjutnya adalah perawatan pasca operasi,
selama masa perawatan pasien diberikan antibiotic, antipiretik, analgesic dan antiseptic
guna mempercepat kesembuhan dari pasien.

4.2 Saran

Saran yang dapat penulis berikan tindakan operasi hernia tetap memiliki efek
komplikasi yang berbahaya sehingga prosedur tindakan operasi harus dilakukan dengan
baik dan benar sesuai SOP

13
 DAFTAR PUSTAKA

DACVS, M. (2018). Diaphragmatic, inguinal, & perinial hernia repair (Proceedings).

[online] dvm360.com. Available
at: http://veterinarycalendar.dvm360.com/diaphragmatic-inguinal-perinial-hernia-
repair-proceedings [Accessed 2 Nov. 2018].

Jahromi ,Alireza Raayat et al.2009. Concurrent bilateral inguinal and umbilical hernias in a bitch.
School of Veterinary Medicine, Shiraz University, Shiraz, Iran. VETERINARSKI
ARHIV 79 (5), 517-522, 2009

Singh, Kiranjeet et al.2014. A Case of Concurrent Inguinal Hernia and Vaginal Leiomyoma in a
Bitch Successfully Treated Surgically. Indian Veterinary Research Institute, Izatnagar.
Journal for Veterinary Practitioners. 2 (1): 1 – 4
http://dx.doi.org/10.14737/journal.rjvp/2014/2.1.1.4

Slater, D. H. 2003. Textbook of Small Animal Surgery, Volume 2. Elsevier Health Sciencz
Singh, Kiranjeet et al.2014.A Case of Concurrent Inguinal Hernia and Vaginal
Leiomyoma in a Bitch Successfully Treated Surgically. Indian Veterinary Research
Institute,India. Journal for Veterinary Practitioners. 2 (1): 1 – 4
http://dx.doi.org/10.14737/journal.rjvp/2014/2.1.1.4

Sudimartini, L. M., Gunawan, I. W. N. F., Wirata, I. W. 2016. PenangananKasus Hernia

InguinalispadaAnjing Mix Pomeranian. FakultasKedokteranHewan,
UniversitasUdayana. Denpasar.
Sudisma, I.G.N., I.G.A.G.P. Pemayun., A.A.G.J.Wardhita., I.W.Gorda. 2006. Ilmu Bedah
Veteriner dan Teknik Operasi Edisi I. Pelawa Sari. Denpasar

TATLI,Z. BOZKAN et al.2015. Unilateral dorsal (lumbar) abdominal hernia in a cat. , Adnan
Menderes University, Turkey. Revue Méd. Vét., 2015, 166, 11-12, 316-318

Veterinary Manual. (2018). Hernias - Digestive System - Veterinary Manual. [online] Available
at: https://www.msdvetmanual.com/digestive-system/congenital-and-inherited-
anomalies-of-the-digestive-system/hernias [Accessed 2 Nov. 2018].

14
LAMPIRAN

15
VETERINARSKI ARHIV 79 (5), 517-522, 2009

Concurrent bilateral inguinal and umbilical hernias in a bitch

- a case report

Alireza Raayat Jahromi1*, Seifollah Dehghani Nazhvani1,

Musa Javdani Gandmani1, and Samira Mehrshad2
1
Department of Surgery, School of Veterinary Medicine, Shiraz University, Shiraz, Iran
2
Student of Veterinary Medicine, School of Veterinary Medicine, Shiraz University, Shiraz, Iran

JAHROMI, A. R., S. D. NAZHVANI, M. J. GANDMANI, S. MEHRSHAD: MEHRSHAD

Concurrent bilateral inguinal and umbilical hernias in a bitch
bitch. Vet. arhiv 79, 517-
522, 2009.
ABSTRACT
A 3 year old Schianlu bitch with a bilateral swelling in the inguinal region and a small umbilical swelling
was referred to the Veterinary teaching hospital, School of Veterinary Medicine, Shiraz University. She had had
dystocia with her 3 puppies 7 months earlier. Soft, painless and reducible swellings were palpated in all 3 sites
on physical examination. Under general anesthesia all 3 sites were repaired surgically. The left inguinal hernia
sac contained the entire uterus along with the broad ligaments and in the right, the omentum was found in the
hernia sac. The hernia rings were sutured by simple interrupted suture pattern using Vicryl no. 1. The umbilical
hernia sac contained some omental fat with a small ring. The hernial sac was removed and the margin of the
abdominal ring was trimmed and the ring was sutured in a similar suture pattern. Fluid and antibiotics were
administrated immediately after surgery but antibiotics were continued until 5 days post operative. The follow
up study for four months revealed no complications.
Key words
words:: bilateral inguinal hernia, umbilical hernia, bitch

Introduction
Hernia is an abnormal protrusion of an organ or tissue through a normal body opening.
An inguinal ring defect allows the abdominal contents to enter the subcutaneous space.
Its exact etiopathogenesis in small animals is unknown (BOJRAB et al., 1998; PARKS,
1981). The Pekingese appears to be the best model to determine the method of genetic
transmission for both defects in the same animal, the Basenji dog for excessive occurrence
of both umbilical and inguinal hernia, the Airedale Terrier for excessive occurrence of

*Corresponding author:
Dr. Alireza Raayat Jahromi. Department of Surgery, School of Veterinary Medicine, Shiraz University, Shiraz, P.O. Box 71345-
1731, Fars Province, Iran, Phone: +987112286950; Fax: +987112286940; E-mail: Raayat@shirazu.ac.ir

ISSN 0372-5480
Printed in Croatia 517
 A. R. Jahromi et al.: Bilateral inguinal and umbilical hernia in a bitch

umbilical hernia, the West Highland White Terrier for excessive occurrence of inguinal
hernia, and mixed breed dogs for negligible inguinal hernia occurrence (HAYES, 1974).
The Pekingese also exhibits a greater incidence of concurrent umbilical hernia (HAYESs,
1974). Inguinal hernia in dogs has been classified as congenital or acquired (BOJRAB et al.,
1998). Clinical signs often reflect the size of the hernia and the hernia contents and range
from a painless inguinal mass to signs related to incarcerated or nonviable small intestine.
Diagnosis of inguinal hernia might be accomplished by radiography demonstrating a gas
loop filled with intestine or the appearance of an ossifying fetal skeleton after 43 to 45 days
of gestation (BOJRAB et al., 1998). An umbilical hernia is generally not a serious hernia
as it mainly consists of fatty tissue, which protrudes. Both male as well as female dogs
can have an umbilical hernia (PARKS, 1981). Pekingese, Airedale, and Basenji commonly
have umbilical hernias (HAYES, 1974). Although herniorrhaphy techniques have been
described, data from dogs with inguinal hernia that have undergone surgical repair are
limited to case reports and a very small series of dogs with limited follow-up. This report
describes a concurrent bilateral inguinal and umbilical hernia in a Schianlu bitch.
Case description
A three year old Schianlu bitch with a bilateral swelling in the inguinal region
(prominent in left side) (Fig. 1) and a small swelling in the umbilical region was referred
to the Veterinary teaching hospital of the School of Veterinary Medicine of the Shiraz
University. She had had dystocia with her 3 puppies 7 months earlier. Clinical examination
revealed: normal heart rate, respiratory rate and rectal temperature. General condition,
appetite, CRT (capillary refill time) and hydration status were also normal. A soft, non
painful and reducible swelling was palpated in all 3 sites on physical examination. The
dog was premedicated by Acepromazine (0.05 mg/kg). The anesthesia was induced by
Ketamine (5 mg/kg) and diazepam (0.05 mg/kg), then it was intubated and the anesthesia
maintained by halothane in oxygen. After preparation of the surgical sites, an incision
was made over each inguinal canal separately to allow exposure of the hernial sac. In left
side, the whole uterus along with the broad ligaments (Fig. 3) and in the right, omentum
was contained in the hernial sac (Fig. 4). Some adhesion between the uterus and the sac
was dissected free. All contents were returned to the abdominal cavity by twisting the
redundant sac. The sac was transligated and trimmed at the margin of the abdominal ring.
The hernial ring was sutured by a simple interrupted suture pattern using No. 0 Vicryl.
Enough room was left for crossing the external pudendal vessels and genitofemoral
nerve. The subcutaneous tissue was sutured in a simple continuous pattern using No. 0
Vicryl to eliminate dead space. Finally, the skin was closed by No. 0 silk in a subcuticular
pattern. A stent suture was placed on each site immediately after the procedure. The
umbilical swelling contained some omental fat with a small ring (Fig. 2). The omentum
was returned back and the ring was trimmed off from the abdominal wall, then it was
sutured by polyglycolic suture no.1 using a simple interrupted pattern. The fascia and the

518 Vet. arhiv 79 (5), 517-522, 2009

 A. R. Jahromi et al.: Bilateral inguinal and umbilical hernia in a bitch

skin were apposed routinely. Fluid (5% dextrose) was administered during surgery until
one hour after the operation. Penicillin (30,000 IU/kg) and streptomycin (10 mg/kg) were
administered for 5 days postoperative. The follow up study for four months revealed a
sound recovery with no complications.

Fig. 1. Bilateral inguinal hernia, larger left (a) Fig. 2. Umbilical hernia, umbilical hernial ring
and smaller right (b) sacs. (arrow), and omental fat (a).

Fig. 3. Contents of the left inguinal sac; uterine Fig. 4. Right inguinal hernial sac; omentum (a)
body (a), left horn (b), broad ligament (c) and and inguinal hernial ring (b).
inguinal hernial sac (d).

Discussion
Data from dogs with inguinal hernia that have undergone herniorrhaphy are limited
(WATERS et al., 1993). Concurrent bilateral inguinal and umbilical hernias have not been
reported in dogs. Inguinal hernia has been classified as congenital and acquired. These

Vet. arhiv 79 (5), 517-522, 2009 519

 A. R. Jahromi et al.: Bilateral inguinal and umbilical hernia in a bitch

hernias are often chronic and do not cause clinical signs until pregnancy or pyometra
develops (FOSSUM et al., 2002). WATERS et al. (1993) have identified two groups of dogs
with inguinal hernia: dogs with inguinal hernia surgically repaired when they are younger
than 4 months of age and those diagnosed when they are older than 4 months of age
(WATERS et al., 1993). It is likely that hernias in the first group are congenital. However it
is plausible that dogs in the second group include some dogs with congenital hernias that
were not identified earlier (WATERS et al., 1993). The dog in our report was 3 years old, and
the history of a dystocia with 3 puppies 7 months earlier suggests an acquired cause of her
hernias. It seems that the protrusion of the whole uterus, along with the broad ligaments in
left inguinal canal, concurrent with adhesions to the sac may be explained by the distinct
role of the pregnancy and parturition pressures worsening the hernias and development
of clinical signs too. The risk for nonviable small intestine in dogs with longstanding
inguinal hernia is relatively low (less than 5%). This may mean that small hernias go
unnoticed until pain or vomiting caused by mechanical or vascular obstruction of the
intestine occur. Longstanding hernias are more likely to be large and unnoticed; large
hernias are less likely to become incarcerated than small hernias. A role for estrogens in
the etiology of inguinal hernia has been postulated because spayed females with acquired
inguinal hernia have not been reported (HAYES, 1974). Experimental evidence suggests
that sex hormones may influence the development of inguinal hernia in mice. The role of
trauma in the development of inguinal hernia remains unclear. The contribution of other
factors, such as tensmus, vigorous physical activity, or obesity, has not been investigated.
Inguinal hernias are reportedly rare in male dogs. Congenital inguinal hernia in dogs is
more common in males than females (WATERS et al., 1993). The prevalence of perineal
hernia in male dogs with inguinal hernia has not been reported at a high rate which
suggests that dogs with inguinal hernia are at increased risk for hernias in other locations
(FOX, 1963; FOSSUM et al., 2002; HAYES, 1974; SMEAK, 1985). Due to the absence of
incarceration and intestinal perforation or leakage in this reported case, the prognosis was
evaluated to be good.
Unilateral hernias are much more common than bilateral hernias. Bilateral hernias seem
to occur more frequently in young dogs. Despite the low prevalence of bilateral hernias,
careful palpation of the contra lateral inguinal region for occult hernias is recommended.
Surgical management of inguinal hernia consists of identification of the hernia sac,
assessment of the viability of the hernia contents, surgical resection of nonviable tissue,
herniorrhaphy, and, in some instances, neutering. The surgical approach in this case was
through the inguinal region, although a midline approach in female dogs is common,
since it facilitates examination of both inguinal rings (WATERS et al., 1993). Intraoperative
pneumoperitoneography has been used as an alternative to surgical exploration in the
detection of occult contralateral hernias in children (HARRISON et al., 1990). This technique
has not yet been described in Veterinary literature. Herniorrhaphy by simple interrupted or

520 Vet. arhiv 79 (5), 517-522, 2009

 A. R. Jahromi et al.: Bilateral inguinal and umbilical hernia in a bitch

mattress sutures has been reported as effective. Use of multifilament sutures increased the
incidence of infection after inguinal herniorrhaphy in humans (PARKS, 1981). Omentum
is reportedly the most common organ present in canine inguinal hernia (BOJRAB et al.,
1998; FOSSUM et al., 2002; GRIER et al., 1971; WATERS et al., 1993); the omentum was also
the main content of the right inguinal sac in this case too. The presence of the omentum
may account for the asymptomatic nature and benign course of inguinal hernia in many
dogs. However, the omentum may occasionally become incarcerated, resulting in clinical
signs that include pain and depression (WATERS et al., 1993). The uterus within a hernia
may limit the movement of the small intestine into the hernia; such a hernia is likely
to be relatively large, and large hernias are associated with less risk for incarceration.
The whole uterus, along with the broad ligaments, was present in the left inguinal sac
in this case, without any signs of incarceration although there was some adhesion to the
sac. Small intestine viability is an important factor in determining whether herniorrhaphy
is an elective or an emergency procedure. Complications in dogs treated surgically for
inguinal hernia are incisional infection, wound dehiscence, hematoma, seroma, excessive
postoperative swelling, hernia recurrence, sepsis or peritonitis and death. The reported
case did not show any form of complications having been monitored for four months.

References
BOJRAB, M. J., G. W. ELLISON, B. SLOCUM (1998): Current Techniques in Small Animal
Surgery. 4th ed. Williams & Wilkins. pp. 552-554.
FOX, M. W. (1963): Inherited inguinal hernia and midline defects in the dog. J. Am. Vet. Med.
Assoc. 143, 602-604.
FOSSUM, T. W., S. H. CHOYL, A. H. DOLAND, L. J. ANN, B. S. HOWARD, D. W. MICHAEL
(2002): Small Animal Surgery. 2nd Ed., Mosby Inc Missouri. pp. 261-267.
GRIER, R. L., J. D. HOSKINS, J. D. WAHLSTROM (1971): Inguinal hernia and Richter ’s hernia
in a dog. J. Am. Vet. Med. Assoc. 159, 181-183.
HARRISON, C. B., G. W. KAPLAN, H. C. SCHERZ, M. G. PACKER (1990): Diagnostic
pneumoperitoneum for the detection of the clinically occult contralateral hernia in children. J.
Urol. 144, 510-511.
HAYES, H. M. Jr. (1974): Congenital umbilical and inguinal hernias in cattle, horse, swine, dogs,
and cats: risk by breed and sex among hospital patients. Am. J. Vet. Res. 35, 839-842.
PARKS, J. (1981): Herniation. In: Pathophysiology in Small Animal Surgery. (Bojrab MJ, ed.).
Philadelphia: Lea & Febiger. pp. 420-424.
SMEAK, D. D. (1985): Caudal Abdominal Hernias. In: Textbook of Small Animal Surgery. (Slatter
DS, ed.). Philadelphia: WB Saunders. pp. 862-869.
WATERS, D. J., R. G. ROY, E. A. STONE (1993): Retrospective study of inguinal hernia in 35
dogs. Vet. Surgery 22, 44-49.

Vet. arhiv 79 (5), 517-522, 2009 521

 A. R. Jahromi et al.: Bilateral inguinal and umbilical hernia in a bitch

Received: 10 April 2008

Accepted: 2 September 2009

JAHROMI, A. R., S. D. NAZHVANI, M. J. GANDMANI, S. MEHRSHAD:MEHRSHAD Istodobna

bilateralna ingvinalna i pupčana kila u kuje. Vet. arhiv 79, 517-522, 2009.
SAŽETAK
Kuja pasmine Schianlu u dobi od tri godine s bilateralnom oteklinom u ingvinalnom području i slabom
oteklinom u pupčanom području dovedena je na pregled na kliniku Veterinarske škole Sveučilišta Shiraz u Iranu.
Sedam mjeseci ranije s poteškoćama je oštenila tri šteneta. Blaga, bezbolna i reponibilna oteklina palpirala se
na sva tri spomenuta područja. Sva tri područja podvrgnuta su operativnom zahvatu pod općom anestezijom.
U lijevoj ingvinalnoj hernijalnoj vreći nalazila se cijela maternica zajedno sa širokim ligamentima, a u desnoj
omentum. Hernijalni prsteni bili su sašiveni jednostavnim prekinutim šavom uporabom vikrila br. 1. Pupčana
hernijalna vreća sadržavala je nešto masti omentuma, a imala je mali prsten. Hernijalna vreća bila je uklonjena,
a rubovi trbušnog prstena resecirani i sašiveni jednostavnim šavom. Tekućina i antibiotici bili su primijenjeni
netom nakon kirurške obradbe s tim da su antibiotici bili davani tijekom pet dana nakon operacije. U kuje nisu
bile ustanovljene komplikacije tijekom šest mjeseci postoperativnog promatranja.
Ključne riječi: obostrana ingvinalna kila, pupčana kila, kuja

522 Vet. arhiv 79 (5), 517-522, 2009

Research Journal for Veterinary Practitioners. 2 (1): 1 – 4
http://dx.doi.org/10.14737/journal.rjvp/2014/2.1.1.4

Case Report
A Case of Concurrent Inguinal Hernia and Vaginal Leiomyoma in a Bitch
Successfully Treated Surgically
Kiranjeet Singh*, Deepti Bodh, Aswathy Gopinathan, Mohsina Abdul Muthalavi, Sangeetha Palakkara
Division of Surgery, Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttar Pradesh–243122, India.
*Corresponding author: ksuppli@yahoo.co.in Phone no +918410757265

ARTICLE HISTORY ABSTRACT

Received: 2013–10–23 An 11–year–old intact Pomerian bitch was presented to the Referral Veterinary Polyclinics, Indian
Revised: 2013–11–18 Veterinary Research Institute, with a history of non–painful, non–reducible pendulous swelling
Accepted: 2013–11–23 (left side) on the caudal abdomen and a small perennial mass protruding through the vulva with no
signs of discomfort. Abdominal radiography revealed protrusion of intestinal loops into the
inguinal swelling confirming inguinal hernia Diagnosis of vaginal leiomyoma was confirmed by
Key Words: Inguinal hernia, histopathology. Herniorrhaphy of the inguinal defect and surgical resection of the vaginal
Leiomyoma, Surgically, Bitch leiomyoma was performed under diazepam–ketamine anesthesia. No post–operative complications
and reoccurrence of hernia and vaginal mass was reported up to one month after surgery.
All copyrights reserved to Nexus® academic publishers
ARTICLE CITATION: Singh K, Bodh D, Gopinathan A, Mohsina A and Sangeetha P (2014). A case of concurrent inguinal hernia and
vaginal leiomyoma in a bitch successfully treated surgically. Res. j. vet. pract. 2 (1): 1 – 4.

An inguinal hernia is a protrusion of an organ or part of an swelling involving abdominal mammary gland of left side was
organ, fat or tissue through the inguinal ring, i.e. the region in observed on physical examination near the inguinal region.
the groin where the abdominal musculature meets the back In the same bitch, another small mass was observed
legs. Factors potentially involved in the development of inguinal protruding through the vulva along with mild perineal swelling
hernias may be anatomical, hormonal, and/or metabolic in (Figure 1). The mass was present since 15–20 days but the bitch
nature; however the causes of inguinal herniation in small faced no difficulty in urination and defecation. Vaginal
animals are poorly understood (Byers et al., 2007). Contents of examination revealed an oval, smooth, firm mass arising from
inguinal hernia may include omentum, fat, ovary, uterus, small the region of ventral vaginal wall and extending into the vulvar
intestine, colon, bladder and spleen. These hernias are often opening. The skin and tissue overlying the mass was intact and
chronic and do not cause clinical signs until pregnancy or appeared normal. However, the extent of attachment of mass to
pyometra develops (Fossum et al., 2002). Leiomyoma is a the vaginal wall could not be fully evaluated during
benign tumour originating from smooth muscle cells arising examination due to the intact vaginal mucosa overlying the
from any organ containing smooth muscle cells but the uterus mass.
and gastrointestinal tract are the most common sites (Yilmaz et
al., 2009). Leiomyomas accounting for 85–90% of all canine
uterine tumors, are the most common tumors of the tubular
genitalia in dog and may be single or multiple, intraluminal or
extraluminal and, in some unknown manner, endocrine
dependent (Karagiannis et al., 2011). About 85% of leiomyomas
occurring in the reproductive tract of a bitch arise from the
vagina, vestibule and vulva (Bojrab MJ, 1975). The present case
report describes the successful surgical management of
concurrent inguinal hernia and vaginal leiomyoma in an elderly
Pomerian bitch.

An 11 year old intact Pomerian bitch weighing 10 kg with a

unilateral swelling in the inguinal region (prominent on left
side) and a small mass protruding from vulva was presented to
the Referral Veterinary Polyclinics of Indian Veterinary
Research Institute. History revealed a long standing duration of
swelling (approximately two years) in the inguinal region
without any pain and discomfort to the bitch. Figure 1: Animal with Inguinal hernia and vaginal leiomyoma
Clinical examination revealed normal heart rate,
respiratory rate, rectal temperature and a general body Lateral radiograph of caudal abdomen revealed two
condition. The bitch had whelped thrice with the last pup circumscribed swellings having soft tissue opacity in the
delivered two years back. A gradual increase in size of inguinal inguinal and perenial region, respectively. The larger swelling in
swelling had been observed since last estrus about 5–7 months the inguinal region consisted of loops of intestine and gas
back. A large, roughly orange sized, non–painful, non–reducible pockets suggestive of inguinal herniation of intestine

1
Singh et al (2014). Concurrent Inguinal Hernia and Vaginal Leiomyoma in a Bitch
ISSN 2308–2798
Research Journal for Veterinary Practitioners. 2 (1): 1 – 4
http://dx.doi.org/10.14737/journal.rjvp/2014/2.1.1.4

A B
Figure 2: Visible hernia sac (A) and hernia contents (B) after skin incision

A B C

Figure 3: Suturing of the hernia ring (A, B, C)

(Figure 6A). From the history, physical examination and
diagnostic test results, inguinal herniation of intestine was
confirmed and vagina leiomyoma was suspected.
The bitch was premedicated by atropine (0.04 mg/kg IV)
and five minutes later induced by diazepam (0.5 mg/kg IV) and
ketamine (5 mg/kg IV), followed by endotracheal intubation.
Anesthesia was maintained with diazepam–ketamine
combination (1:1) administered intravenously. After preparation
of the surgical site a skin incision was made directly over the
swelling in the inguinal region just lateral to the groin fold. The
subcutaneous tissue was undermined to allow exposure of the
hernial ring and hernial sac, thereafter, an incision was made
over the hernial sac and hernial contents comprising of
omentum and small intestines were returned back into the
abdominal cavity (Figure 2). The base of hernial sac was
resected and the hernial ring was closed with No. 1–0 Vicryl in a
simple interrupted suture pattern (Figure 3). The subcutaneous
tissue was sutured in a simple continuous pattern using No. 0
Catgut to eliminate dead space and the skin incision was closed
using No. 1–0 nylon in a cross mattress pattern.
The mass in the perineal region was found to be smooth,
oval, submucosal growth measuring approximately 6 cm in
diameter (Figure 4). The mass was firm to touch and had a well
defined stalk (3cm by 1 cm base) attached to the ventral vaginal
wall. As the urethral orifice was very close to the pedicle of the
mass, a size no.7 urinary catheter was placed in the urethra to
help in defining and avoiding trauma to this structure (Figure
4C). The pedicle of the mass was then transected from base
close to the urethra. After incision of the mass portions of it was
sent for histopathological and cytological examination. The
excision site was closed by approximating the mucosa of
vaginal floor and submucosal dead space was occluded by
simple interrupted suture pattern using No. 1–0 Chromic
Catgut. Postoperative treatment consisted of Injection
Ceftriaxone and Tablet Serratiopeptidase for five days, Injection
Meloxicam and Tablet Rabeprazole for three days. Daily
antiseptic dressing with Betadine (5% povidone iodine) and
pressure bandaging on alternate days was advised. Sutures were
removed on the 12th post operative day. The bitch made an
uneventful recovery from anaesthesia with no postoperative
complications.
Inguinal hernia occurs more often in middle aged intact bitches
and may be caused by stretching of the abdominal muscles
during pregnancy or atrophy of the abdominal wall due to old
age (Waters et al, 1993). The clinical signs range from a painless
inguinal mass to signs related to incarcerated or nonviable small
intestine (Jahromi et al., 2009). As inguinal hernias typically
appear during estrus or in pregnant bitches, estrogen is believed
to play a major role in the development of these types of hernias
(Fossum et al., 2002; Byers et al., 2007). Sex hormones may
change the strength and character of the connective tissue,
thereby weakening and enlarging the inguinal rings (Smeak et
al., 2003). Unilateral inguinal hernias are more common than

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ISSN 2308–2798
Research Journal for Veterinary Practitioners. 2 (1): 1 – 4
http://dx.doi.org/10.14737/journal.rjvp/2014/2.1.1.4

bilateral (Jahromi et al., 2009). Unilateral inguinal hernia was
reported in this case without any involvement of contra lateral
inguinal ring. Inguinal hernia can be diagnosed using
radiography and ultrasonography (Abdin and Ramadan, 2001)
as in the present case plain radiography revealed radiolucent
intestinal loops protruding into the hernial sac. For the
management of inguinal hernia in dogs three surgical
approaches have been described and they include: midline
approach (Smeak, 1993a), incision over the inguinal ring
(Waters et al., 1993) and incision on the lateral aspect of hernia
parallel to flank fold (Smeak, 1993a).
.

A B C D
Figure 4: Surgical removal of vaginal leiomyoma (A, B, C, D)

A B
Figure 5: Photographs of the animal taken after surgery (A and B)

A B

Figure 6: Preoperative (A) and Post operative (B) radiographs of the same animal

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Singh et al (2014). Concurrent Inguinal Hernia and Vaginal Leiomyoma in a Bitch
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Research Journal for Veterinary Practitioners. 2 (1): 1 – 4
http://dx.doi.org/10.14737/journal.rjvp/2014/2.1.1.4
The surgical approach in this case involved an incision made on
the lateral aspect of hernia parallel to the flank fold. As
herniorrhaphy with simple interrupted or mattress suture has
been found to be effective (Jahromi et al., 2009), same
procedure was followed in this case. The hernial contents
included omentum and intestine in the present case. Omentum
is reported to be the most common organ present in canine
inguinal hernias (Waters et al., 1993). Since inguinal hernia is
mostly inherited, dogs that have had hernia or a surgical repair
of hernia should not be used for breeding
The most common types of tumors found in the genital
tract of bitches include benign, smooth muscle tumors of the
vagina and vulva. These tumors are variably referred to as
leiomyomas, fibroleiomyomas, fibromas and polyps depending
on the amount of connective tissue present (MacLachlan and
Kennedy, 2002). The diagnosis of vaginal leiomyomas can be
done histopathologically. In animals aetiology of leiomyomas is
not fully understood but some studies suggest that hormones
have an influence on their tumorigenesis (Miller et al., 2003).
Vaginal leiomyomas are best treated surgically (Klein 2001) but
the condition can recur due to hormonal influence (Miettinen
and Fetsch, 2006). Therefore, ovariohysterectomy is advised at
an early age to prevent occurrence of leiomyomas in female
dogs.
Complications can occur after surgical repair of inguinal
hernias as well as after resection of vaginal leiomyomas.
Incisional infection, wound dehiscence, seroma, excessive
postoperative swelling and peritonitis are some of the
complications seen after surgical treatment for inguinal hernia
in dogs (Jahromi et al., 2009). Prognosis was evaluated to be
good in this case due to the absence of incarceration and
intestinal perforation or leakage. Iatrogenic damage to the
urethra or accidental injury to other perineal structures can
occur during resection of vaginal mass while urine retention,
incontinence and urethral obstruction may be noticed after
resection. However, bitch in the present case did not show any
Singh et al (2014). Concurrent Inguinal Hernia and Vaginal Leiomyoma in a Bitch
ISSN 2308–2798
of the postoperative complications or reoccurrence of hernia or
vaginal leiomyoma till one month after the surgery.
REFERENCES
Abdin–Bey MR and Ramadan RO (2001). Retrospective Study of Hernias in
Goats. Scientific Journal of King Faisal University (Basic and Applied
Sciences). 2 (1):77–81.
Bojrab MJ (1975). Current techniques in small animal surgery I. Lea &
Febiger. Philadelphia, 248 – 254.
Byers CG, Williams JE, Saylor DK (2007). Pyometra with inguinal herniation
of the left uterine horn and omentum in a Beagle dog. J.Vet. Emerg.
Crit. Care. 17: 86–92.
Fossum TW, Choyl SH, Doland AH, Ann LJ, Howard BS, Michae DW (2002).
Small Animal Surgery. 2nd ed. Mosby Inc Missouri, 261–267.
Jahromi AR, Nazhwani SD, Gandmani MJ, and Mehrshad S (2009).
Concurrent bilateral inguinal and umbilical hernias in a bitch: a case
report, Vet. Arhiv. 79 (5): 517–522.
Karagiannis GS, Pelekanis M, Loukopoulos P, Haris N, Ververidis HN and
Kaldrymidou E (2011). Canine Uterine Leiomyoma with Epithelial
Tissue Foci, Adenomyosis, and Cystic Endometrial Hyperplasia. Case
Reports in Veterinary Medicine. Volume 2011 (2011), Article ID 901874,
4 pages. http://dx.doi.org/10.1155/2011/901874
Klein MK (2001). Tumors of the female reproductive system. In: S.J. Withrow
and E.G. MacEwen (eds), Small Animal Clinical Oncology. W. B.
Saunders, Philadelphia, PA, USA, 445–454.
MacLachlan NJ, Kennedy PC (2002). Tumors of the genital system. In: D.J.
Meuten (ed.), Tumors in domestic animals, 4th ed., Iowa State
University Press, Ames, IA, 547–573.
Miettinen M, Fetsch JF (2006). Evaluation of biological potential of smooth
muscle tumors: Review. Histopathology. 48(1): 97.
Miller MA, Ramos-Vara JA, Dickerson MF, Johnson GC, Pace LW, Kreeger
JM, Turnquist SE and Turk JR (2003). Uterine neoplasia in 13 cats. J.
Vet. Diagn. Invest. 15: 575-522
Smeak DD (1993a). Abdominal hernias. In: Slatter D. (ed.), Textbook of Small
Animal Surgery, 2nd ed., WB Saunders, Philadelphia U.S.A. volume 1:
433–454.
Smeak DD (2003). Abdominal Hernias. In: Slatter D. (ed.), Text Book of Small
Animal Surgery. 3rd ed., W B. Sunders, Philadelphia, U.S.A, 452–455.
Waters DJ, Roy RG, Stone EA (1993). Retrospective study of inguinal hernia
in 35 dogs. Vet. Surg. 22, 44–49.
Yilmaz R, Akkoc A, Ozyigit MO (2009). Ileal leiomyoma in a captive zebra
(Equus burchelli). Turk. J. Vet. Anim. Sci. 33(5): 443–446.
4
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Unilateral dorsal (lumbar) abdominal hernia in a catⱡ
Z. BOZKAN TATLI*, C.G. BELLEK, E.D. AVCI, Z. BILGEN SEN, M SARIERLER
Department of Surgery, Faculty of Veterinary Medicine, Adnan Menderes University, 09016, Aydin, TURKEY
*Corresponding author: zbozkan@adu.edu.tr
ⱡThis case report was presented as a poster presentation at the 14th National
Congress of Veterinary Surgery, 23-26 October 2014, Antalya-Turkey
SUMMARY
A 3-year-old female mix breed cat was presented with complaint of swelling
on the lumbar area. Clinical examination revealed a lumbar hernia and any
other abnormality was not detected as a result of the laboratory, radiographic
and ultrasonographic examinations. Surgical treatment was decided. There
were two small muscle tears in addition to the main hernial defect on the
right lateral abdominal side and peritoneum was disrupted. After surgical
debridement of limited infected areas and adhesions, the hernial defects
were sutured, and then double layered polypropylene mesh was placed over
the muscle sutures. Bandage around the abdomen could be removed one
day after surgery relying on that the polypropylene mesh will be enough
to support sutures, because the cat with bandage was very uncomfortable.
To the author’s knowledge, lumbar hernia which small intestine herniated
subcutaneously into the dorsal region has not been reported previously in
cats and lumbar hernia should be remembered as a mass lesion of the dorsal
region.
Keywords: Feline, Cat, Abdominal, Lumbar, Dorsal,
Hernia
Introduction
Hernia is the protrusion of a part of organ, an organ,
or organs from their anatomical cavity though a defect or
anatomical hole to another place where they should not be.
Classification of herniation, such as abdominal, perineal
is done according to the anatomical location [5]. Also,
abdominal hernias are classified according to localization
of the swelling which is typical sign of herniation [1, 5].
The hernia consists of three parts as the ring, the sac, and
the contents. In some cases, the swelling may be seen little
far from hernial ring because of movement of the contents.
Hernias can be treated conservatively or surgically depending
on size of hernial ring and its’ complication risk [5].
Figure 1: Preoperative photographs of the cat.
BOZKAN TATLI (Z.) AND COLLABORATORS
ⱡCe travail a été présenté oralement dans 14iéme Congrès National de la
Chirurgie Vétérinaire, 23-26 Octobre 2014, Antalya-Turquie
RĖSUMĖ
Hernie abdominale dorsale (lombaire) chez un chat
Nous rapportons le cas d’une chatte de 3 ans présentant un gonflement sur
la région lombaire. L’examen clinique a révélé une hernie lombaire. À la
suite des examens radiographiques, laboratoire et échographiques aucun
anomalies n’a pas été détecté sauf que l’hernie lombaire. On a décidé de faire
le traitement chirurgicalement. Il y avait deux petites déchirures musculaires.
En plus de l’hernie sur le côté abdominale droite le péritoine était déchiré.
L’hernie a été suturée après le débridement chirurgical des zones infectées et
des adhérences. Le traitement chirurgical a été suivi d’un double maillage de
polypropylène sur les sutures musculaires.
Mots-clés : Chat, Hernie, Chirurgie
Case Histories
A 3-year-old female mix breed cat was presented with
complaint of swelling on the lumbar area. According to
history, the cat was bitten by a dog and the bite wounds were
treated by a veterinarian 20 days ago, 2 weeks after dog attack,
a swelling was noticed at the lumbar region. The swelling had
a soft fluctuating consistent which resembles the intestinal
hernia on palpation but there were no a palpable hernial ring
or reducibility (Figure 1/A, B). Plain abdominal radiography
and positive contrast peritoneography (Omnipaque 300
mgI/ml, Opakim; Turkey, at dose of 2 ml/kg BW of iohexol)
revealed that swelling on dorsal region was an abdominal
hernia (Figure 2/A, B). Complete blood count and chemistry
Revue Méd. Vét., 2015, 166, 11-12, 316-318
DORSAL ABDOMINAL HERNIA IN A CAT
parameters (Urea, 22 mg/dl [15–32 mg/dl]; cholesterol 118
mg/dl [77–258 mg/dl]; aspartate aminotransferase, 36 U/L
[12–42 U/L]; glucose, 73 mg/dl [70–120 mg/dl]; alanine
aminotransferase, 32 IU/L [29–145 IU/L]; total bilirubin,
0.20 mg/dl [0.1–0.3 mg/dl]; gammaglutamyltransferase,
1 IU/L, [0–5 IU/L]; creatinine 1.5 mg/dl [0.9–2.1 mg/dl],
Amylase 774 IU/L, [496–1874 IU/L]) were in reference range
(8) and operative intervention was decided. Considering the
elapsed period after injury and the extremely large hernial
sac passed beyond the lumbar vertebrae, an ultrasonographic
examination was needed before surgical intervention to
evaluate adhesion or any other abnormalities. Hair of the
region was shaved for both ultrasonographic examination
and surgery. Shaving probably triggered intestinal peristaltic
and the hernial sac became larger and intestinal segments
became visible under skin. Ultrasonography revealed no
major complications or adhesions.
The hair of the operation region was shaved, the skin was
cleaned and disinfected with povidone-iodine before the
surgical procedure. Later, a transverse incision over the hernial
sac from proximal to the distal was made. The peritoneum
was disrupted and large amounts of small intestines were just
below the skin (Figure 3/A). The intestines were repositioned
after checking intestinal segments in terms of any pathology.
There was a large hernial defect on the right lateral abdominal
wall (Figure 3/B). In addition, two abdominal muscle tears
were identified just ventrally and dorsally to the main hernial
defect but there was no herniation through these 2 tears.
Figure 2: Positive contrast peritoneography of the cat.
Figure 3: Intraoperative appearances of the intestine and hernial defects.
Revue Méd. Vét., 2015, 166, 11-12, 316-318
317
The hernia was repaired with sutures (Polyglactin 910,
Surgilactin; UK) (Figure 4/A) after surgical debridement of
limited infected tissues and adhesions. A double layered
polypropylene mesh (2 cm x 8 cm, Heine Medizin®,
Germany) was placed over the sutures, because the muscles
were thought to be too weak to hold the sutures securely
(Figure 4/B). The polypropylene mesh was covered with
subcutaneous fat tissues, then skin were closed routinely
(Figure 4/C). Cefazolin sodium (İespor; I.E.Ulagay, Turkey),
intramuscularly, at 25 mg/kg dose rate was prescribed twice
a day for 10 days.
A bandage around the abdomen was removed one day
after surgery relying on that the polypropylene mesh will be
enough to support sutures, because the cat with bandage was
very uncomfortable. The cat become more active immediately
after removal of the bandage and returned to her normal
life within postoperative two days. When the cat does not
under the supervision of the owner, Elizabethan collar were
placed until the skin stitches have been removed. The cat was
followed up for 6 months by phone call and any complication
was not reported.
Discussion
The most common causes of traumatic abdominal
hernias are traffic accident and animal bite injuries, most
often involving the prepubic and paracostal area [1, 7]. In our
case, the hernial ring positioned close to paracostal area was
consistent with the literature, but hernial sac extending to the
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Figure 4: Repairing of the hernial defects
lumbar area was unusual. Only one case of lumbar hernia
which is kidneys herniated has been reported previously in
cats [4] to the author’s knowledge. Meshes usually are used to
repair full thickness muscle defects in the abdominal wall and
there are several types of the meshes in terms of construction,
configuration and pore size [2, 3]. In our case, a polypropylene
mesh was used so as to cover the sutures for support to weak
abdominal muscles after repairing the muscle tears. Cats do
not tolerate large bandages [6], and mesh placement gave us
the advantage of to remove the bandage as early as one day
after surgery. Based on the information gathered by phone
call, cat returned to her normal life within two days.
This case was considered appropriate to share because
the lumbar  hernia which small intestines herniated
subcutaneously into the dorsal region has not been reported
previously in cats to the author’s knowledge. So, the lumbar
hernia should be considered as a mass lesion of the dorsal
region. It is also thought that early removal of the abdominal
bandage contributed to the early return to normal life of the
cat.
Conflict of interest
The authors do not have any potential conflicts of interest
to declare
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BOZKAN TATLI (Z.) AND COLLABORATORS
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