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EQUINE VETERINARY EDUCATION / AE / OCTOBER 2014
Case Report
Surgical repair of a congenital lateral abdominal wall hernia in a neonatal foal
J. A. Hill* and M. Story† College of Veterinary Medicine, Oregon State University, Corvallis, Oregon; and †Equine Orthopaedic Research Center, Colorado State University, Fort Collins, Colorado, USA. *Corresponding author email:
jhilldvm@gmail.com
Keywords: horse; hernia; foal; lateral abdominal wall; congenital
Summary A 16-hour-old Quarter Horse filly presented for evaluation of a soft mass in the right caudoventral lateral abdominal wall. Radiography and ultrasonography confirmed the presence of a nonreducible lateral abdominal wall hernia with small intestine located between the skin and body wall. The size of the defect itself could not be imaged and the filly was taken to surgery. A 4 cm vertical defect that appeared congenital was found in the transverse abdominal muscle and was repaired by primary apposition. This case report describes the repair and outcome of this unusual type of congenital hernia.
Introduction
Congenital abdominal wall defects are reported to occur in several species including man, dogs and horses. In horses, congenital hernias occurring at the umbilicus are the most commonly reported, occurring in 0.5 to 2.0% of foals (Markel et al. 1987; Freeman and Spencer 1991). Lateral abdominal wall hernias have also been described, but they are reported secondary to blunt trauma to the body wall as opposed to congenital in origin. To the authors’ knowledge, only a few case reports exist in the human literature that describe a lateral congenital abdominal wall hernia (Nicksa et al. 2009; Raghu et al. 2013). This case report describes a neonatal foal that presented with a congenital lateral abdominal wall hernia that was successfully surgically repaired.
Case report
History A 16-hour-old, 50 kg, Quarter Horse filly presented to Littleton Equine Medical Center for evaluation of a presumed abdominal wall hernia. The filly was seen earlier in the day by the referring veterinarian at which time her physical examination parameters were within normal limits and an IgG Snap Test (Idexx)1 was >8.0 g/l.
Clinical examination Upon arrival at Littleton Equine Medical Center, the filly was bright and alert, with heart rate 99 beats/min (reference range [rr] 80–110 beats/min), respiratory rate 40 breaths/min (rr 20–35 breaths/min), and temperature 37.9°C (rr 37–38.7°C). A large, soft fluctuant swelling (15 × 16 cm) was present in the right caudoventral lateral abdominal wall and contained palpable loops of small intestine (Fig 1). The hernia was nonpainful and nonreducible. There was no history or evidence of trauma.
Diagnostic imaging Dorsoventral and lateral computed radiographic projections were taken to evaluate the foal for any evidence of trauma.
© 2014 EVJ Ltd
Fig 1: Photograph of the right side of the filly prior to surgery. The large, soft fluctuant swelling is clearly visible in the right caudoventral abdomen (arrowheads).
On the lateral projection (Fig 2), several loops of small intestine were clearly visible ventral to the body wall and outside of the abdominal cavity. No fractured ribs or evidence of trauma were found. Abdominal ultrasound performed with a 7.5 MHz linear
probe confirmed the presence of motile, nondistended loops of small intestine between the skin and body wall. The defect in the body wall was not clearly visible by ultrasound due to the overlying small intestine and, therefore, the true size of the underlying defect was unknown. The filly and her dam were admitted to the barn for
monitoring. Abdominal ultrasonography demonstrated that the herniated loops of small intestine were motile and nondistended and the filly showed no behavioural signs of discomfort. Thus no evidence of strangulation was present and the surgery was scheduled to proceed the following morning.
Surgical repair Prior to surgery, a 16 gauge × 8.25 cm polyurethane (Mila)2 catheter was aseptically placed in the right jugular vein. Ampicillin sodium3 at 20 mg/kg bwt, amikacin4 at 25 mg/kg
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