EQUINE VETERINARY EDUCATION / AE / OCTOBER 2014
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Fig 3: Photograph during surgery showing the smooth border of the cranial margin of the abdominal wall defect in the transverse abdominal muscle (*).
Fig 2: Lateral radiograph of the filly showing loops of small intestine ventral to the body wall (arrowheads).
bwt and ketoprofen (Ketofen)5 at 2.2 mg/kg bwt were administered i.v. to the foal. Anaesthesia was induced using a combination of diazepam6 (0.05 mg/kg bwt i.v.) and ketamine (Ketaset7; 2.0 mg/kg bwt i.v.) and maintained with sevoflurane (SevoFlo)8 in 100% oxygen. The filly was positioned in left lateral recumbency with her
right hindlimb suspended to expose the hernia. An 8 cm cranial to caudad elliptical skin incision was made over the hernia. Electrocautery was used to control haemorrhage. The subcutaneous tissues were bluntly dissected to expose the hernia sac and the sac digitally disrupted. Multiple loops of nondistended small intestine were immediately visible, with several loops trapped cranially between the skin and the rib cage. The small intestine was examined and found to be uncompromised with a normal, light pink serosal surface and progressive peristalsis. Prior to replacement in the abdomen, the small intestine was coated with 200 ml carboxymethylcellulose. Once the small intestine had been returned to the abdomen, a 4 cm vertical linear body wall defect was clearly visible in the transverse abdominal muscle just caudal to the last rib. The defect appeared congenital in origin as the muscle edges on either side of the defect were smooth and rounded (Fig 3). The muscle edges were trimmed with a No. 10 scalpel blade and the defect closed with 2 polydioxanone (PDS)9 using interrupted cruciate sutures. The fascia at the dorsal most aspect of the defect was very thin, so the 2 most dorsal sutures were anchored around the last rib. The aponeurosis of the external abdominal oblique was closed with 0 polyglactin 910 (Vicryl)9 and the subcutaneous tissue with 3-0 PDS in a simple continuous pattern. The skin was closed with 2-0 PDS in a continuous horizontal mattress pattern. A sterile lap sponge was placed over the incision and an elastic (elastikon)10 abdominal bandage placed for support prior to recovery. The filly recovered well from anaesthesia and appeared comfortable following surgery. She was maintained on ketoprofen (2.2 mg/kg bwt i.v. b.i.d.) for 2 days and amikacin (20 mg/kg bwt i.v. s.i.d.) and ampicillin (20 mg/kg bwt i.v.
Fig 4: Ultrasound image of the fluctuant swelling found at the surgical site on Day 4. The large seroma (*) is clearly visible just below the skin surface and the underlying body wall is still intact (arrowheads).
q.i.d.) for 4 days post operatively. The abdominal bandage was maintained for 4 days post operatively.
Complications On the third day after surgery, fluctuant swelling was present at the previous hernia site. Ultrasound examination revealed a large subcutaneous seroma located below the incision (Fig 4). On Day 4, approximately 150 ml of serosanguinous fluid was drained from the seroma by making a 1.5 cm incision through the skin and subcutaneous tissue at the most ventral aspect of
© 2014 EVJ Ltd
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