• Diaphragmatic means related to diaphragm

• Hernia means – the protrusion of the contents of

a body cavity
• Through a normal or abnormal opening in the
wall of that cavity
• either to lie beneath the intact skin or to occupy
adjacent body cavity
 Constituents of hernia
1. Hernia ring
2. Hernial sac
3. Hernial contents
 Classification of hernia
Classification according to –
• Location:
- External hernia: eg. Ventral hernia, umblical hernia etc.
- Internal hernia: eg. Diaphragmatic hernia

• Functional alterations:
-Reducible hernia
-Irreducible hernia
 Irreducible hernia
1. Hernia with adhesions
2. Incarcerated hernia
3. Strangulated hernia

• Contents of the sac: enterocele(intestine)

Epiplocele (omentum)
Enteroepiplocele (intestine + omentum)
Reticulocele (reticulum)
Hysterocele (uterus)
Varicocele(urinary bladder)
 On the basis of cause
• Traumatic hernia
• Infectious hernia

Diaphragmatic hernia
It is defined as the passage of abdominal viscera into the thoracic
cavity through a congenital or acquired opening in the diaphragm
Commonly it is the reticulum which herniates into the thorax
however, the omasum, abomasum, loops of intestine ,spleen or
liver may also get involved
 Aetiology

• Weaking of the diaphragm by lesions of traumatic reticuloperitonitis

• Congenintal defect
• Physical force likeincreases intra-abdominal pressure during pregnancy or
act of parturition
• Tympany
• Violent fall
• Mostly caused by the presence of foreign body in the reticulum
Areas at the junction of the muscular and tendinous portions of the
diaphragm are more prone to rupture due to lack of tone and thickness
 Clinical signs
• Recurrent tympany
• Abrupt fall in milk yield
• Scant defecation or diarrhoea
• Brisket oedema
• Jugular pulsation
• Abduction of elbow
• Anorexia
• Dehydration
• Auscultation revealed muffled sound
• Progressive emaciation
• Weakness
 Common site of occurrence
• In most cases common site of the diaphragmatic rupture lies
about 12 to 15 cm ventral to the hiatus oesophagi and
• 12 cm ventral to the foramen venacava
• Close to the central musculotendinous junction
• Generally there is only one hernial ring but occasionally multiple
rings may be present
 Diagnosis
• Diagnosis is based on history and clinical signs
• Most patients have a history of recent parturition or
pregnancy of different duration before the onset of
symptoms
• Recurrent tympany,partial or complete cessation of
lactation,cardiac heart sounds are muffled
For confirmation plain or contrast radiographs or
Left flank exploratory laparotomy and rumenotomy will be
required
 Treatment
• First step in the treatment is laprorumenotomy
• The procedure of rumenotomy described below is similar for
cattle and buffaloes
• Rumenotomy is done in standing position in cattle and buffaloes
• Rumenotomy is indicated to remove impacted
feed,trichobezoars,phytobezoars and foreign bodies
• Rumenotomy is done through an incision in the left flank
 Clipping and shaving of incision site

Scrubbing
.
Local infiltration of anaesthesia (2 % Lignocaine)

Scrubbing

Site of incision in cattle is equidistant from the tuber coxae and last rib beginning 5 cm ventral to the lumbar
transverse process
.
Drapes may be applied leaving the site for proposed incision
.
The skin incision should be long enough to allow the surgeon’s arm inside the abdomen

The skin is incised with a smooth but firm motion

Then dissection of subcutaneous fascia and oblique muscles , transversus abdominis muscle
(the length of incision from skin to the peritoneum should be in a descending order to facilitate
closure)

The abdominal cavity should be thoroughly explored to examine the wall of the diaphragm ,outer
wall of reticulum ,spleen and liver for any pathological lesion

Weingarth rumenotomy ring is then applied

Part of the rumen is then brought out of the abdominal incision

One of the rumen forceps is fixed to the dorsal part of the rumen wall

The forceps is then hooked into the dorsal eye of the frame

A similar procedure is repeated with another forceps at the ventral part of the rumen at a distance of
about 10 to 12 cm
The tense and exposed part of the rumen is then incised and the rumen hooks are placed into the cut edges of the
rumen wall ,pulled away and hooked on to the ring

(The scalpel used to incise the rumen wall should be discarded)

Evacuate the contents of rumen and then explore it for foreign body

before closure of the rumen ,rumen cud placed from a healthy animal

The rumen wound edges should be thoroughly cleaned

Surgeon must rescrub before suturing the wound

 All soiled instruments should be discarded

The surgeon must scrub again before suturing the muscles

Rumen – lambert pattern with no. Two or three catgut

Reinforced using Cushing pattern
peritoneum and transversus abdominis muscle – two or three catgut
the two oblique muscles + subcutaneous fascia
skin – simple interrupted (non absorbable suture material)
Common approaches for diaphragmatic herniorrhaphy are abdominal and thoracic

The animal is kept off feed for 48 hours following ruminal evacuation
A number of combinations have been used for the induction of anaesthesia:-
1) 6 percent chloral hydrate solution (30-60mg/kg) followed 15 to 20 minutes later
by thiopentone sodium(5) to effect
2) 6 chloral hydrate (50-60 mg/kg) followed 15 min. Later by diazepam (0.3-
0.5mg/kg)

The induction is followed by endotracheal intubation

A positive pressure ventilator is then connected to the endotracheal tube for

intermittent positive pressure ventilation

Anaesthesia is maintained by using isoflurane

 Transabdominal approach
Animal is shifted to supine position

Site is prepared for surgery(clipping, shaving, scrubbing)

The abdomen is entered through an incision of 25-35 cm in length About 5 cm caudal to the xiphoid
cartilage Running parallel to the coastal arch

Incise subcutaneous ,muscles , peritoneum

Adhesions between reticulum and diaphragmatic ring are severed by blunt dissection

Palm of hand is glided through the ring to carefully break the adhesions

Reticulum is withdrawn into the abdominal cavity

The ring is closed with continuous lock stitch suture using non absorbable suture material
finally abdomen wound is closed in two or three layers
 Transthoracic approach

Prepare the site for incision or surgical operation

A cutaneous incision of about 25 cm in length bis made midway on the

seventh rib and is extended ventrally to the costochondral junction

rib resectioning should be done to enter thoracic cavity

After pleura has been incised ,the herniated reticulum comes into view

Adhesions of the reticulum with the lungs , pericardium, and pleura are
separated carefully

Reticulum is pushed into the abdominal cavity and

the ring is closed the same way
The surgical wound is closed in layers i.e.

The pleura and periosteum together,

intercostal muscles and then superficial muscles and fascia together

Continuous lock stitch sutures using heavy chromic catgut

Skin is sutures with min absorbable suture- simple interrupted pattern

 Post operative care

Broad spectrum antibiotics for 5 to 7 days

Analgesics for 3 to 5 days in addition to adequate fluid therapy

It is recommended that the operation in case of advanced pregnancy should be

postponed to a date after parturition

A breeding rest of at least three to four months should be allowed in non pregnant
animals after surgery

Hernioplasty is indicated to avoid recurrence of hernia

Differential diagnosis

Traumatic reticuloperitonitis
Bloat
intestinal obstruction
Congestive heart failure