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Inguinal Hernias
See the page on Hernias for a general discussion on causes, types, treatments, etc.

Definition - What is it?

Cause - Why did this happen?

Signs - How do I know if my pet has an inguinal hernia?

Diagnosis - How does my veterinarian confirm an inguinal hernia?

Treatment - What should I do about it?

Post-op care - What can I expect after surgery?

Prognosis - Will my pet be OK?

Definition:

Herniation/protrusion of abdominal contents through the naturally existing inguinal ring (which contains arteries, veins, and nerves)

  • Direct hernias - organs or tissues pass through 
  • the inguinal ring adjacent to the normal evagination of the vaginal process (this is a  unintentionally-confusing named tissue and does not refer to the female vagina)
    • Less common in small animals (and people)
    • Can be very large
  • Indirect hernias - organs or tissues enter the cavity of the vaginal process itself
    • In males, indirect inguinal hernias are a specific sub-type known as scrotal hernias, which will be covered on a separate page.

Images courtesy of Slatter's Textbook of Small Animal Surgery

Causes

  • Congenital (birth defect)
    • Relatively rare
    • Often co-exist with umbilical hernias
    • Breed predisposition in Basenji, Pekingese, Basset hound, Cairn terrier, and West Highland white terrier
    • Males more common than females
    • Possibly heritable (confirmed in Golden Retrievers, Cocker Spaniels, and Dachsunds)
      • Neutering of affected pets is generally recommended
  • Acquired
    • Relatively common in dogs
    • Most frequent in intact female dogs
    • Anatomical variation
      • Larger diameter and shorter length canals in females
    • Sex hormones
      • Estrogen especially
    • Nutritional or Metabolic status
      • Increased risk in obese animals

Signs

  • Swelling in inguinal region (groin) 

    • Medial and cranial to the pelvic brim

    • Small or large

    • Contents

      • Fat/omentum

      • Intestine/bowel (possibly)

      • Less commonly bladder, uterus, or spleen

    • Unilateral (one side) or bilateral (both sides)

      • Left side more common in dogs

    • Soft and reducible unless incarcerated or strangulated

    • May cause swelling and edema of testicle in a male dog due to venous or lymphatic obstruction - may resemble scrotal hernia
  • Pain on palpation (feeling/manipulation) of the swollen region if:
  • Vomiting if:
    • Bowel obstruction/strangulation
    • Toxemia from urine obstruction
    • Pain
  • Specific signs dependent on tissues involved

Diagnosis

  • History important to determine if there is involvement of bowel or other organs
  • Palpation (physical examination by a veterinarian)
    • Feeling the enlarged inguinal ring following reduction of the hernial contents helps confirm the hernia type
    • Be certain to examine with inguinal rings
    • If can't be reduced, the hindquarters can be elevated (reduces pressure in the back of the abdomen)
    • If non-reducible, must differentiate from mammary tumors, lipomas (fatty tumors), enlarged lymph nodes, abscesses, and hematomas
  • Radiographs (x-rays) can confirm bowel outside the abdominal cavity (barium contrast may confirm presence of bowel if no gas seen to identify bowel)
  • Ultrasound may rule out other causes of swelling
  • Bladder catheterization and draining vs. contrast injection may confirm bladder involvement
  • Computed Tomography (CT/CAT scan)
  • Surgical exploration can be considered for a more rapid and less costly diagnosis and treatment and/or if the above diagnostics are not an option

Treatment

  • Surgery is the only option
    • Uncomplicated unilateral hernia
      • Incise over the hernia sac and reduce the contents
    • Approach the hernia from the abdomen if organs are traumatized or incarcerated
      • Remove any devitalized tissue
    • Ligate the hernial sac as close to the inguinal ring as possible, and remove the distal portion of the sac
    • Partial closure of the femoral canal with care not to compress the vital neurovascular structures
    • Muscle repair with trauma
    • Surgical mesh (Prolene) can be used to close larger defects or when the muscle is more friable (fragile)

Post-operative care

  • Appropriate pain management
  • Pet may be reluctant due to stretching and motion in the repair
  • Hematoma less likely with appropriate hemostasis (control of bleeding during surgery)
  • Infection/abscessation less likely, but may require opening of the skin and subcutaneous tissues
  • A drain may be used if  there is a large volume of dead space (gaps between tissue planes), or if there is significant inflammation or tissue damage
  • Controlled leash walking
    • Beneficial for decreasing post-operative edema
    • Crate restriction when not being walked
    • Prevent excess activity, which could break down the repair
    • Sedation may be helpful to prevent excess activity in crate
  • E-Collar

Prognosis

  • Generally good
  • Recurrence is unlikely with appropriate post-op exercise restriction
  • Your pet can generally return to a normal life

See the page on Hernias for a general discussion on causes, types, treatments, etc.

Please schedule an appointment with our board-certified surgeon, Dr. Jeff Christiansen at the clinic of your choice, to discuss hernias and surgery to improve your pet or patient's length and quality of life.

If you have additional questions, please feel free to e-mail Dr. Christiansen directly.

Some information on this page is based on data from Slatter's Textbook of Small Animal Surgery