Page 855 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

830 CHAPTER 4

VetBooks.ir 4.157 on p/r palpation, when two loops of small intestine are
detected passing into the internal inguinal ring. Other
distended loops of small intestine may also be pal-
pable within the abdominal cavity. Ultrasonographic
examination of the distended scrotum can help differ-
entiate testicular torsion from scrotal hernia, particu-
larly if palpation p/r is not feasible. Distended loops
of small intestine may be evident on transabdominal
ultrasonographic examination.

Management
Congenital hernia in the foal
Most hernias resolve spontaneously by 3–4 months
Fig. 4.157 Intraoperative view of strangulated small of age. Daily manual reduction is recommended.
intestine in the stallion pictured in 4.156. A local bandage following manual reduction can also
be applied; however, formation of pressure sores by
the bandage is possible. Surgery is indicated if the
Acquired hernia in the adult hernia becomes incarcerated, if it is very large or if it
Most acquired hernias are unilateral. They are vari- has not spontaneously resolved by 6 months of age.
ably reducible and more commonly result in acute A bilateral closed castration is recommended.
intestinal strangulation (Fig. 4.157). The scrotum
and inguinal region may be swollen and cold to Acquired hernia in the adult
the touch. Thickening at the neck of the testicle is Supportive therapy is imperative, as these horses
usually present. The horse is usually presented for are often systemically compromised. It may be pos-
colic because of incarcerated small intestine. Signs sible to reduce acute herniation by careful p/r and/or
of abdominal pain range from mild to severe, with external manipulations; however, reducible hernias
decreased to absent intestinal motility. Reflux may occur infrequently. Prior to performing any manip-
be obtained on passage of a NG tube depending on ulations, the stallion should be sedated, and epidural
the duration of the obstruction. anaesthesia administered to avoid local trauma. The
incarcerated loop is grasped gently p/r and traction
Differential diagnosis is applied. Alternatively, this procedure can be per-
In foals, scrotal distension may also be caused by uro- formed under general anaesthesia with the animal in
peritoneum, trauma or abscessation. In adults, tes- dorsal recumbency which may lessen tension on the
ticular torsion is the main differential diagnosis, but inguinal rings and facilitate reduction. Rectal tear is
orchitis and hydrocoele should also be considered. a potential complication.
In cases where manual reduction is not pos-
Diagnosis sible, immediate surgical correction of the condi-
Congenital hernia in the foal tion via an inguinal approach +/− laparotomy is
Diagnosis is made on physical examination. Ultra- recommended. Intestinal resection is often neces-
sonographic examination of the inguinal region sary. The inguinal region is approached initially,
demonstrates the presence of normal motile small- the vaginal ring is enlarged, and the intestine is
intestinal loops in the vaginal tunic. Less frequently, returned into the abdomen. Ideally, a laparotomy is
the tip of the caecum or pelvic flexure can be herniated. then performed to verify the integrity of the intes-
tine, and the small intestine is decompressed and
Acquired hernia in the adult resected if needed. In some cases, the non-viable
Palpation of the scrotum and testicular region will intestine can be resected in the inguinal region,
identify an abnormality. A definitive diagnosis is made especially in cases where it would be difficult to