Surgical management of an enterocutaneous umbilical fistula caused by an incarcerated Richter's hernia in a one-year-old Quarter Horse filly

This article reports a case of a one-year-old Quarter Horse filly with an enterocutaneous fistula resulting from an umbilical hernia since birth, treated successfully by en bloc resection of the hernial sac with the fistula and closure of the ileum with a modified Heineke-Mikulicz technique. This consisted of closing the intestinal wound transversely to the long axis after excision of the fistula to help preserve a sufficient intestinal lumen and prevent potential stricture formation after longitudinal closure. Umbilical hernias are reported to have an incidence of 0.5–2.0% usually resolve spontaneously. Reducible hernias do not represent a surgical emergency whereas incarcerations should always undergo surgery as soon as possible. Enterocutaneous fistulae occur uncommonly as a result of congenital umbilical herniae that developed spontaneously into Richter's herniae or Littré herniae or they are induced traumatically or iatrogenically after therapeutic attempts. In most cases, enterocutaneous fistulae do not require immediate surgery. However, the excision of the fistula should be scheduled within a few days after diagnosis. In the current case, the owner reported a healthy development of the filly after 1 year without any functional problems. This case represents an example of successful use of the Heineke-Mikulicz technique to establish an alternative to standard end-to-end anastomosis.     

Complications of umbilical hernias in horses: 13 cases (1972-1986)

Of 147 horses treated for umbilical hernias over a 13.5-year period, 13 horses (8.8%) developed complications in association with umbilical defects. Six horses had intestinal incarceration; the incarceration was reduced manually in 3 horses before admission, resolved without treatment in 2 others, and was surgically reduced in one. Herniorrhaphy was performed on 4 of the 5 horses in which the incarceration did not require surgical reduction, and the fifth was managed conservatively. A horse with a parietal hernia and a horse with intestinal stragulation were treated surgically; in the latter, the involved intestine was resected. These 8 horses recovered. Three horses developed an umbilical abscess and 2 developed an enterocutaneous fistula through their umbilical hernias. Four of these horses responded well to surgery, but one horse with an enterocutaneous fistula died from electrolyte imbalances and peritonitis after an unsuccessful attempt at simple closure. The results of this study confirmed that complications of umbilical hernias are rare in horses; however, when they do develop, they may be one of various forms, some of which are insidious in onset.     

Surgical Management of the Trauma-Induced Colocutaneous Fistula in a Horse

There are few published reports of equine enterocutaneous fistulae, and they are almost always related to umbilical hernias. Colocutaneous fistula as a result of a penetrating wound has not been reported in horse. In this case report, surgical treatment of a traumatic colocutaneous fistula in an 8-year-old stallion is described. Under inhalation anesthesia, the fistula was removed completely, and the resultant defect on the left ventral colonic wall was closed. The defect of abdominal wall was closed routinely. The horse regained his previous performance, and no surgical complication was observed at 1 year’s follow-up.     

Occurrence and economic importance of congenital hernia in German Fleckvich calves

The frequency of congenital hernia was investigated in German Fleckvieh calves being driven up for sale on livestock markets for breeding and fattening calves in Miesbach and Traunstein. Data were collected on 77 livestock auctions in the years 1996 and 1997. Altogether 53,105 calves were examined and 1.8% of these calves showed a congenital umbilical hernia. The incidence of umbilical hernia was significantly influenced by the sex of the calf, the occurrence of multiple births, the market place/market date, the sire and the sire line. Red Holstein blood proportion, lactation number, duration of pregnancy and 305 day milk performance were not of significant importance. Herd milk level did not influence the incidence of congenital umbilical hernia, however, herdmate averages for calves differed significantly in their incidence. The average difference of the market price between male calves affected by congenital umbilical hernia and not affected male calves amounted to 75 DM, in female calves, however, only to 38 DM. The risk, that a congenital umbilical hernia is not closing within an age of 15 months, depends on the width of the hernial opening in the newborn calf. An opening of 4 cm and more has only a healing chance of 50% and less. However, negative effects on fattening and carcass traits could be not found. The genetic influence on congenital umbilical hernia was obvious. The analyses indicated that the incidence of congenital umbilical hernia observed could not be explained by one autosomal recessive gene locus, but it seemed much more likely that more than one gene locus is involved or a mixed multifactorial monogenic mode of inheritance may be the underlying genetic mechanism. Breeders should be aware of the implications of congenital hernias and thus, congenital hernia should get more attention in the selection process of young sires.     

Surgical management of congenital and perinatal abnormalities of the urogenital tract

Surgical management of various congenital and perinatal abnormalities of the urogenital tract are discussed, including ruptured bladder, ruptured urachus, ureteral defect, patent urachus and umbilical remnant infection, ureteral ectopia, congenital inguinal hernia, and atresia ani and rectourethral or rectovaginal fistula.     

Risk Factors for Congenital Umbilical Hernia in German Fleckvieh

Risk factors for congenital umbilical hernias were investigated in German Fleckvieh calves up for sale at livestock markets. Data from 53,105 calves were collected from 77 livestock auctions in 1996 and 1997. The overall incidence of congenital umbilical hernia was 1.8%. A significant influence on incidence was exerted by the sex of the calf, the occurrence of multiple births, the market place/market date, the sire and the sire line. The proportion of Red Holstein blood in the calf, the dam's lactation number, gestation length, 305 day milk performance and the herd milk level were not significant factors. Herdmate averages for calves differed significantly in their incidence. Heritability estimates on the liability scale for congenital umbilical hernia were about 0.4 and progeny groups of sires at risk for congenital umbilical hernia were in the range 0.1% to 14.2%. The segregation pattern could not be explained either by an autosomal recessive or by an autosomal dominant monogenic model. It seems likely that more than one gene locus is involved in the underlying genetic mechanism. Breeders should be aware of the genetic implications of congenital umbilical hernias.     

A single umbilical artery and omphalophlebitis in an Arabian foal

In women, a single umbilical artery has been associated with congenital abnormalities and post-natal problems for the infant. This paper describes a case of a single umbilical artery in the amniotic portion of an abnormally long umbilical cord of a recipient mare carrying an Arabian foal. In this case, the single umbilical artery did not appear to be associated with congenital abnormalities that resulted in fetal demise or serious post-partum problems. However, the placenta showed signs, both during gestation and after delivery, of disturbances in its fluid dynamics, and omphalophlebitis developed in the foal at age one week. How such cord anomalies might disturb fluid homeostasis in the placenta or bias the foal to umbilical infection remains to be determined. Notwithstanding, careful examination of the umbilical cord at birth could alert attending veterinary clinicians to be particularly discerning in their examination of the umbilicus.     

Surgical repair of a congenital lateral abdominal wall hernia in a neonatal foal

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.     

Dental bridging as a treatment for large oral fistulae in two horses

Chronic orocutaneous, oronasal, or orosinus fistulae can be challenging to repair. This report describes placement of a dental bridge as a treatment for oral fistulae and outcome in two horses. A 12-year-old, Westphalian gelding was presented for nasal discharge because of an oromaxillary fistula after dental repulsion of the Triadan 209 4 years earlier. The second case, a 5-year-old Oldenburg mare was presented for an orocutaneous fistula 7 weeks after dental repulsion of the Triadan 208. Both were treated by placing an 8-shaped cerclage wire, inserted through the rostral and caudal interdental spaces and crossing at the level of the missing tooth. Polymethylmethacrylate (PMMA) was then used to seal the fistula. No significant complications occurred during or after the surgery. In both cases clinical signs did not recur. In the first case the dental bridge is currently (5 years after the intervention) in place. In Case 2 the construction was removed after 1.5 years and the fistula had healed completely. This case report suggests that placing a dental bridge composed of cerclage wire and PMMA should be considered as an easy, noninvasive and efficient way to manage large oromaxillary or orocutaneous fistulae.     

Incarcerated umbilical hernia in the horse: a case with a review of the literature

Umbilical hernias are common in foals. This article provides a review of the literature and presents a case of an 1.5-year-old Friesian mare with an incarcerated umbilical hernia. After reposition of the incarcerated intestine (with a lot of effort), the practising veterinarian referred the mare to the Department of Equine Sciences. Preperforative peritonitis was diagnosed, presumed to be caused by necrotic bowel. After laparotomy, this tentative diagnosis was confirmed. The necrotic part of the small intestine was resected and intensive medical treatment was started. Initially, the mare recovered well, but seven days after surgery her general condition deteriorated and she had to be euthanized. At necropsy, impaction of the stomach and rupture of the stomach wall were found. The impaction was probably a result of the generalized peritonitis.     

Large colon strangulation due to a diaphragmatic hernia in a mare: A case report

This report describes a case of diaphragmatic hernia with incarcerated large colon in a 16-year-old Tennessee Walking Horse mare. This mare was presented with an acute episode of abdominal pain that was not responsive to analgesic therapy. Treatment consisted of resection of the devitalized large colon and closure of the rent in the diaphragm.     

Closure of the abdominal wall at the umbilicus and the development of umbilical hernias in a group of foals from birth to 11 months of age

The closure of the body wall defect at the umbilicus was studied in relation to the development of umbilical hernias in a group of 44 normal foals, 25 of which were followed from birth until five months of age, and 19 from birth until 11 months of age. At birth, 19 of the foals had a defect in the body wall at the umbilicus that was termed a 'palpable umbilical ring'. In 18 of them this defect disappeared within four days, but in the other the ring did not close and a hernial sac with abdominal contents was palpable. This foal was considered to be the only foal to have a truly congenital umbilical hernia. Twelve foals developed an umbilical hernia between five and eight weeks of age. The prevalence of umbilical hernias was much higher than in other studies, possibly owing to the prospective nature of the study.     

Inguinal enterocutaneous fistula in a dog

A two‐year‐old Jack Russell terrier presented with a chronic history of weight loss and the recent development of a discharging wound in the left inguinal region that was confirmed by ultrasound and contrast radiography to be an enterocutaneous fistula. One day following admission the dog displayed signs of abdominal pain and the general condition deteriorated. At exploratory coeliotomy there was evidence of septic peritonitis and a segment of jejunum was found firmly adhered to the left inguinal canal. The affected jejunal segment was excised and an end‐to‐end anastomosis performed. A penrose drain was placed in the inguinal wound which was subsequently managed with open drainage. The inguinal wound healed successfully by second intention and the dog returned to normal body condition. The left testis became atrophic and castration was performed several weeks later. To the authors’ knowledge this is the first veterinary case report of an inguinal enterocutaneous fistula.     

Enterocutaneous Fistulae in Horses: 18 Cases (1964 to 1992)

Enterocutaneous fistulae are rare in horses and occur most commonly as a complication of umbilical hernias or their treatment. Horses with enterocutaneous fistulae may be successfully treated by en bloc resection of the body wall and intestine or by allowing second intention healing. Complications associated with surgical intervention include fever, colic, incisional problems, and recurrence of the fistula. Nonsurgical management of two horses with presumptive large colon fistulae resulted in resolution of the fistulae without complications.     

Surgical repair and reconstruction of a nasal fistula following intra-lesional formalin injection

A 6-year-old Cleveland Bay mare was referred to the University of Liverpool Equine Hospital for repair of an iatrogenic nasocutaneous fistula. The fistula had developed following attempted ablation of an epidermal inclusion cyst located in the right nasal diverticulum with intra-lesional formalin 6 weeks previously. Subsequent tissue necrosis resulted in the formation of a full-thickness defect in the overlying tissues and the creation of a 5 × 5 cm nasocutaneous fistula. Surgical management consisted of initial debridement of the fistula and use of a commercial dermal regeneration mesh to bridge the defect, acting as a tissue scaffold. The levator labii superioris muscle was utilised to cover the scaffold by transecting it close to its proximal origin and reflecting it rostrally. Finally, a transposition skin flap was created adjacent to the site and was rotated to cover the defect. The mare made an excellent recovery, and follow-up confirmed complete healing of the surgical site with an excellent cosmetic outcome.     

仔猪脐疝治疗方法的探讨

为探索预防、治疗仔猪脐疝简便而有效的方法,笔者用保守法成功治愈9头病例,通过对病例和病史资料进行分析,并同其他保守和手术治疗方法相比较,总结出各种方法的适应症和优缺点。结果表明,先天性脐疝与遗传和断脐方法有关,后天性脐疝发生的根本原因是腹压过大。可复性疝应优先采取保守疗法,不可复性疝应积极进行手术治疗。预防措施为早期淘汰相关有害基因,规范断脐方法及饲养管理过程中尽可能消除或减缓一切使腹压增大的因素。     

Congenital stricture of the vestibulo-vaginal fold in a mare with normal karyotype

A diagnosis of congenital stricture of the vestibulo-vaginal fold was reached in an 11-year-old mare without previous reproductive records, during a breeding soundness examination. The mare had an annular stricture of the vestibule–vaginal fold that did not allow palpation or vaginoscopic visual examination of the anterior portion of the vagina. Endoscopic evaluation of both anterior and posterior portions of the vagina revealed a normal mucosa without scar tissue. Ultrasound examination of the cervix, uterus and ovaries did not reveal any other abnormality. The mare had a normal karyotype – 64 XX. Vestibulo-vaginal stricture or stenosis is a congenital anomaly that occurs when there is an incomplete perforation of the hymen or occurs in association with hypoplasia of the genital canal that results in the formation of an annular fibrotic stenosis at the vestibule–vaginal junction. To our knowledge, this is the first report of vestibulo-vaginal stricture in a mare with confirmed normal karyotype, 64,XX.     

Laparoscopic Adhesiolysis in a Horse

Objective —The purpose of this report was to describe the use of laparoscopy as a method of treatment for abdominal adhesions in the horse.
Clinical Report —Unilateral ovariectomy for removal of a granulosa cell tumor was performed through a diagonal paramedian approach in a 14-year-old Arabian mare. Progressive incisional swelling and hemorrhage culminated in acute incisional dehiscence with herniation of ileum on the sixth postoperative day. Septic peritonitis that responded to parenteral antibiotic therapy was identified 7 days after hernia repair. Seven days later, the mare had signs of abdominal pain, and adhesions of small intestine to the paramedian incision were identified on rectal palpation. Transrectally assisted laparoscopic adhesiolysis was performed. No further complications occurred.
Clinical Relevance —Laparoscopic adhesiolysis may provide better observation of adhesions and reduced postoperative morbidity compared with laparotomy.     

A vaginal mucosal pedicle flap technique for repair of rectovaginal fistula in mares

OBJECTIVE: To describe the use of a vaginal mucosal pedicle flap for repair of rectovaginal fistulae (RVF) in mares. STUDY DESIGN: Clinical case report. ANIMALS: Three mares with RVF. METHODS: After debriding the RVF, a dorsally based U-shaped mucosal and submucosal pedicle flap (2-4 mm thick) was dissected from the vaginal wall, rotated approximately 90 degrees angle to close the ventral aspect of the fistula and sutured in position with 10-13 single sutures that did not penetrate the rectal mucosa. This positioned the vaginal mucosa so that it was continuous with the rectal mucosa. RESULTS: Two RVF healed by 1st intention whereas for the 3rd RVF, 2 additional single sutures were required to repair partial dehiscence after 10 days. At 6 weeks and 6 months all RVF were healed. One mare subsequently foaled without complications. CONCLUSIONS: RVF can be closed by use of a rotation flap of vaginal tissue. CLINICAL RELEVANCE: Tension-free closure of RVF can be achieved by rotating a pedicle flap of vaginal mucosal tissue without undue wound tension, and should be considered as an alternative to conventional appositional techniques.     

Comparison of herniorrhaphy versus clamping of umbilical hernias in horses: a retrospective study of 93 cases (1982-1994).

Many uncomplicated umbilical hernias have been managed successfully in foals by the application of a hernia clamp. Isolated reports of complications following clamp application have led some authors to suggest that it is an unsuitable method of treatment. Little information has been published comparing the complication rates associated with the use of hernia clamps and herniorrhaphy in the treatment of umbilical hernias. The purpose of this retrospective study was to report the characteristics of clinical cases of umbilical hernia and to compare the complication rates following these 2 treatment approaches. Information was collected from records or from owners to identify the occurrence of complications and owner satisfaction following treatment. Of 93 cases, 10 complicated and 18 uncomplicated hernias were treated by herniorrhaphy, 40 uncomplicated hernias were treated by clamping, 1 originally uncomplicated hernia was treated by both techniques, and 24 cases were untreated. Nineteen percent of uncomplicated hernias treated by herniorrhaphy, and 19% of those clamped developed minor complications. This study demonstrates that although minor complications may be associated with either technique, they generally do not result in significant morbidity.