Bovis ISSN 2398-2993

Umbilical hernia: surgical correction

Contributor(s): Ash Phipps , Adam Dunstan-Martin

Introduction

Introduction

  • In bovines umbilical hernias are the most common congenital defect.
  • Umbilical hernias can be divided into 3 categories:
    • Uncomplicated umbilical hernia.
    • Umbilical hernia with subcutaneous infections (abscess).
    • Umbilical hernia with umbilical remnant infection.
  • Cause: failure of normal development and closure of umbilicus, infection at site of umbilicus, manual breakage of the umbilicus, clamping or ligation of the umbilical cord and potentially excessive straining.
There is often a hereditary element to this condition. Careful consideration should be given as to whether it is appropriate to correct this deficit in animals which are to be used for further breeding.
  • Diagnosis: clinical signs, physical examination and ultrasonography.
  • Treatment: various medical and surgical options.
  • Prognosis: usually good.
Age predisposition
  • Occurs in an estimated 4 to 15% of calves.
  • Reported most frequently at 5-7 weeks after birth.
Sex predisposition
  • Females are much more frequently affected than males.
Breed predisposition
  • Seems to occur more frequently in Holstein Friesian calves. However it can occur in any breed of cattle.
Cost considerations
  • No intervention.
  • Less invasive non-surgical treatment.
  • Invasive surgical treatment (ligation of the hernial sac, suturing of the hernial sac, open herniorrhaphy and closed herniorrhaphy).

Pathogenesis

Etiology
  • Failure of normal development and closure of the umbilicus - reasons for failure of closure are unknown.
  • Postulated reasons include:
    • Heritable factors.
    • Inflammation of the umbilicus.
Specific
  • Inflammation and sepsis of the umbilicus.
  • Post - calving infection of umbilical infection.
  • Manual traction and breakage of the umbilicus.
  • Clamping or ligation of the umbilical cord at calving (particularly post cesarean section).
  • External trauma to umbilicus.
  • Excessive straining.
  • Cloned calves (less collagen in the ventral abdominal wall).
  • Hypoplasia of the abdominal musculature.
  • Multiple births (twins, triplets etc).
  • Short gestation calves.

Pathophysiology

  • Failure of the abdominal musculature to close properly around the umbilical structures.

Timecourse (incubation, duration)

  • Small umbilical hernias, with an internal ring size of <2 cm diameter rarely cause strangulation as the body wall deficit is generally too small for abdominal contents other than omentum to pass through.
  • Umbilical hernias, with an internal ring size of >2 cm diameter, are unlikely to repair naturally, and represent a potential site of abomasal and intestinal incarceration.

Diagnosis

Clinical signs
  • Usually present shortly after birth.
  • Non-painful (non-strangulated and non-infected hernias).
  • Variable contents - omentum, small intestine or abomasum.
  • Size and shape of hernial ring varies.
  • <2 cm diameter opening usually resolve spontaneously rarely cause strangulation as the body wall deficit is generally too small for abdominal contents other than omentum to pass through.
    • 2-5 cm may require treatment.
    • >5 cm require treatment - usually surgical.
  • Nature of umbilical ring determines degree of fibrosis and possibility of suture retention.
With umbilical defects >5cm and surgical intervention is not possible or not feasible, the animal may be kept and fattened for slaughter. However, this does carry a minor risk of entrapment and strangulation of abdominal contents.
Diagnostic investigation
  • External digital palpation.
  • Ultrasonography:
    • This is useful (even at time of surgery)  
      • Particularly for non-reducible hernias to identify contents of hernial sac and differentiate from umbilical abscessation.
Confirmation of diagnosis
  • Discriminatory diagnostic features:
    • History.
    • Clinical signs
      • Close examination of the umbilical region.
  • Definitive diagnostic features:
    • Ultrasonography.
Gross autopsy findings
  • Variable-sized defect in abdominal musculature at umbilicus with variable sized hernial sac and contents.
Differential diagnosis
  • Omphalitis.
  • Omphaloarteritis. Omphaloarteritis/phlebitis
  • Omphalophelbitis.
  • Acquired hernia.
  • Rupture of abdominal wall.
  • Umbilical abscess.
  • Urachal cysts/rupture.

Uses

  • Management of an umbilical hernia in a young calf .

Further Reading

Publications

Refereed Papers

  • Recent references from PubMed and VetMedResource.
  • Sutradhar B C, Hossain M F, Das B C, Kim G & Hossain M A (2009) Comparison between open and closed methods of herniorrhaphy in calves affected with umbilical hernia. J Vet Scu 10 (4), 343-347 PubMed.
  • Herrmann R, Utz J, Rosenberger E, Doll K & Distl O (2001) Risk factors for congenital umbilical hernia in German Fleckvieh. Vet J 162 (3), 233-240 PubMed.
  • McIlwraith C W & Robertson J T (1998) Herniorrhaphy using synthetic mesh and a fascial overlay. Equine surgery advanced techniques 2, 365-370.
  • Virtala A M K, Mechor G D, Gröhn Y T, Erb H N (1996) The effect of calfhood diseases on growth of female dairy calves during the first 3 months of life in New York State. J Dairy Sci 79, 1040–1049 PubMed.
  • Gilman J P W & Stringam E W (1953) Hereditary umbilical hernia in Holstein cattle. J Hered 44 (3), 113-116.

Other sources of information

  • Anderson D E & Rings M (2008) Current veterinary therapy: food animal practice. Elsevier Health Sciences.
  • Divers T J & Peek S (2007) Rebhun's diseases of dairy cattle. Elsevier Health Sciences.
  • Fubini S L & Ducharme N (2004) Farm animal surgery. Elsevier Health Sciences.


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