Treatment. Surgical treatment has not proved successful. Expectant and medicinal treatment are the only available resorts and then only in the slighter cases. Quiet and the absence of all excitement is the first consideration to allow of an arrest of any increase of the hernia and the establishing of a healing process in the torn margins. Bouley strongly advises bleeding to allay abdominal pain. Chloral hydrate (1 ounce for the larger animals) will often meet the same end, with the additional advantage that it counteracts fermentation and tympany. The unloading of stomach and bowels by a cathartic, and the use of flaxseed meal or other concentrated food of a laxative nature are indicated. Small animals may be lifted by their fore limbs, and the abdomen may be meanwhile manipulated to favor the return of the hernial mass by gravitation. Large animals should be placed in a stall having an inclination downward and backward for the same reason. When it can be ascertained that the hernia consists of a loop of small intestine only, it is permissible, especially in cattle, carnivora and omnivora, to make an incision in the flank and with the disinfected hand to attempt the reduction of the hernia and the placing of a bulky viscus, like the rumen, stomach or liver in the way of its return. In case of violent abdominal pain Bouley advises active counter-irritation over the abdomen, but as strangulation is usually present in such cases, this measure may be held to be inferior in value to gravitation, anodynes, antiseptics, unloading of the gastro-intestinal organs and absolute rest or surgical interference.
DIAPHRAGMATIC HERNIA OF THE RETICULUM.
Anatomical reasons. Gullet, weight of stomach, riding, dystokia. Symptoms. Tendency to chronicity. Treatment.
In ruminants this is the most common phrenic hernia of a hollow abdominal viscus. On the right side the gastric and intestinal organs are separated from the diaphragm by the flat mass of the liver. A laceration in this region must therefore be extensive to allow of the protrusion of any abdominal organ into the chest. The left half of the diaphragm, however, comes in direct contact with the reticulum and any opening large enough to admit of this viscus is likely to entail hernia of the second stomach. The lesion is further favored by the fact that the gullet passes through this part of the diaphragm and is connected with the stomachs in the furrow between the first and second stomachs. In case, therefore, that the gullet is violently dragged upon by the weight of the contents of the overloaded or tympanitic paunch, or when the animal rises on its hind limbs, in riding its fellow, the foramen sinistrum is liable to be enlarged by laceration, and the second stomach most naturally protrudes through the opening. The strain thrown on the diaphragm in violent abdominal contraction, as in difficult parturition, is mainly expended on this left half, and the laceration takes place around the œsophagus, or as in cases reported by Schurinck and Siedamgrotzky through the aponeurotic portion. The protrusion may be composed of the second stomach alone, or together with portion of the paunch as observed by Schmidt in a goat, or of the third and fourth stomachs as in a case in a bull reported by Baraillé. The edges of the orifice may show, in recent cases, the fringed or irregular jagged outline with blood clots and thickening, or in chronic cases the pale, fibrous, smooth, even outline already described under diaphragmatic hernia.
The symptoms are like those of other forms of phrenic hernia, in ratio with its extent. The tendency to survival, and chronicity is greater than in the monogastric animals, 1st because the entrance of the smaller viscera is barred by the great gastric masses applied against the wound, and 2nd by the quiet uneventful life of the ox and the absence of active work and violent excitement.
Treatment will not differ from that of other forms of phrenic hernia.
HERNIA THROUGH THE MESENTERY, OMENTUM OR OTHER FOLD OF PERITONEUM.
Definition. Causes: Concussions in horse especially, anatomical conditions in cattle, pediculated tumors, dystokia, hernia of small intestine in horse, ox, broad ligament, pelvic hernia. Lesions: Congestion, hemorrhage of hernial viscus, adhesions, softening, thickening, strangulation. Symptoms: Intestinal obstruction, rectal exploration. Treatment: Laparotomy.
Definition. This consists in a protrusion through an opening, congenital or acquired, in the double fold of peritoneum (mesentery) which passes off from the abdominal wall to support a viscus, or that which passes from organ to organ (omentum).
Causes. The lacerations of mesentery or omentum are attributed to sudden concussions of various kinds (falls, blows, leaps, violent efforts), and have been especially found in horses in which the bulk and weight of the contents of the digestive organs furnish a special predisposition. In ruminants in which the contents of the abdomen are equally bulky and heavy the lesion is rarely seen, probably because the great bulk of the ingesta lies in the first three stomachs, and because the large intestines are folded up in the mesentery which supports the small, thereby strengthening this means of support and restricting the freedom of movement on the part of the intestines themselves. In carnivora the limited bulk of the intestines and their contents, and the relative shortness of the mesenteric folds largely obviate the predisposition.