SURGICAL MANAGEMENT OF CONCURRENT SCROTAL AND INGUINAL HERNIAS IN A UNILATERAL CRYPTORCHID WEST AFRICAN DWARF SHEEP

Size: px

Start display at page:

Download "SURGICAL MANAGEMENT OF CONCURRENT SCROTAL AND INGUINAL HERNIAS IN A UNILATERAL CRYPTORCHID WEST AFRICAN DWARF SHEEP"

Sophie McDonald
5 years ago
Views:

1 ISSN: Print Online FUNAAB 2016 SURGICAL MANAGEMENT OF CONCURRENT SCROTAL AND INGUINAL HERNIAS IN A UNILATERAL CRYPTORCHID WEST AFRICAN DWARF SHEEP T.A.O OLUSA, A.O. SONIBARE, A.O EGBETADE AND R.A AJADI College of Veterinary Medicine, Department of Veterinary Medicine and Surgery Federal University of agriculture, Abeokuta, Nigeria *Corresponding author:ayo_sike@yahoo.com; Tel: ABSTRACT An uncommon case of scrotal and inguinal hernias in a 6 months old unilateral cryptorchid West African Dwarf (WAD) sheep was presented to the Veterinary Teaching Hospital, Federal University of Agriculture, Abeokuta-Nigeria. The ram was noticed few days after birth with two bulging masses around the ventral region which gradually increases in size as the animal grows. On examination, the content of the swellings were reducible and the right testicle was not palpable within the scrotal sac. Ultrasonography confirms the hernia contents as intestinal loops. The animal was sedated with xylazine HCL administered intramuscularly at a dosage of 0.1 mg/kg and anaesthetized epidurally with 1.5mls of 2% lignocaine HCL administered into the lumbosacral space. Herniorrhapy was performed on the scrotal hernia, followed by orchidectomy while the inguinal hernia was corrected using hernioplasty. Cryptorchidism may have predisposed to the hernias in this case. Thorough assessment of cryptorchid animals is essential as the opening created by the non-descendent testis could be a risk factor for herniation; therefore such affected ram should not be used for breeding purposes because of the heritable nature of the defect. Keywords: Unilateral cryptorchid, undescended testis opening, hernia in lamb Journal of Natural Science, Engineering and Technology INTRODUCTION Herniation is defined as the protrusion of an organ or part of an organ or a tissue through a defect in the lining of the cavity within which it is normally enclosed (Read, 1985; Hassan, 2008). Typically, hernias consist of three parts: firstly an hernial sac formed by skin, subcutaneous tissue, and invaginated peritoneum; secondly hernial contents which usually comprises a loop of bowel or omentum or both or rarely other viscera; and thirdly a hernial ring or orifice, an opening in the abdominal wall which may be natural or acquired through which hernial contents protrude (Nelson, 1988; Hassan, 2008). Hernias may be congenital or acquired in nature (Al-Sobayil and Ahmed, 2007) and it has been reported in several species such as humans, horses, dogs, cats, cattle, swine, sheep and goats (Hayes, 1974; Nelson, 1988; Al-Sobayil and Ahmed, 2007). It may occur as an isolated defect or may be associated with defects of other parts of the body (Al-Sobayil and Ahmed, 2007). Although scrotal hernia is a rare disorder in small ruminant (Roberts, 1988; Radisic et al., 2010), abdominal and or umblical hernia is however relatively more common accounting for 15.9% and 68.2% of disorders found in Swiss and Saudi Arabian sheep population 122

2 T.A.O OLUSA, A.O. SONIBARE, A.O EGBETADE AND R.A AJADI respectively (Al-Sobayil and Ahmed, 2007; Greber et al., 2013). Scrotal hernia is usually an extension of inguinal hernia, when the abdominal organs protrude through an enlarged inguinal ring into the scrotum (Al- Sobayil and Ahmed, 2007; Radisic et al., 2010). abdominal hernias in a 6 month old unilateral cryptorchid West African Dwarf (WAD) Ram treated at the Veterinary Teaching Hospital of Federal University of Agriculture, Abeokuta, Nigeria. MATERIALS AND METHODS Cryptorchidism is the failure of one or both testes to be positioned in the scrotum at the time normal for a species (Amann and Veeramachaneni, 2006; Smith et al., 2012). Typically, cryptorchidism is detected at birth or shortly thereafter. Postpubertal abnormalities associated with cryptorchidism (e.g., testis tumors, atypical concentrations of reproductive hormones, altered spermatogenesis in scrotal testis), are not only caused by elevated temperature of an abdominal location, but as a delayed manifestation of testis dysgenesis (Veeramachaneni, 2006). For almost all populations, unilateral cryptorchidism is far more common than bilateral cryptorchidism (Smith et al., 2012). Among cryptorchid males, a unilateral phenotype represented 78, 90, 45-70, 81-93, 66-89, 59, 100, and 62% for cats, cattle, dogs, horses, humans, pigs, rabbits and sheep respectively (Amann and Veeramachaneni, 2006; Smith et al., 2012). Although both hernia and cryptorchidism have separately been reported as common defects in farm animals and sheep in particular (Nelson, 1988; Al-Sobayil and Ahmed, 2007; Amann and Veeramachaneni, 2006; Smith et al., 2012), no co-existing case of hernia and cryptorchidism has been reported in sheep to the authors knowledge. This report therefore describes the surgical management of concurrent scrotal and ventral A 6 month old West African Dwarf (WAD) ram, weighing 10kg was presented to the Veterinary Teaching Hospital of Federal University of Agriculture, Abeokuta, Nigeria. The lamb was observed to have lived with an undiagnosed bulgy mass since birth which started like a pouch around the caudoventral region of the abdomen and gradually increases in size as the animal grows. The animal appeared unthrifty and underweight although appetite was never affected by the condition. Physical examination revealed an abnormally enlarged, asymmetric and non-painful to touch scrotum. The right scrotum appeared several times larger than the left (Plate 1) and the content were reducible into the abdominal cavity. The right testicle could not be palpated within the mass. The left testicle was firm and moves normally within the scrotal sac. The ventral abdominal hernia was also reducible and the hernia ring was large approximately 4 inches in diameter. Ultrasonography revealed concentric hyperechoic bands (red arrows) of the hernia ring enclosing raised hyperechoic bands (black arrows) of herniated intestinal loops and a homogenous hypoechoic (green arrow) area of the retained testis (Plate 2). 123

Plate I: Ram showing the concurrent scrotal (A) and ventral abdominal hernias (B) and the normal left descendent testis (C) Plate II: Ultrasonography: Images of the hernia

The mucous membrane was pinkish, while temperature and other physiological parameters were within normal range.

3 Plate I: Ram showing the concurrent scrotal (A) and ventral abdominal hernias (B) and the normal left descendent testis (C) Plate II: Ultrasonography: Images of the hernia contents Hernia ring (A), Herniated intestinal loops (B) and retained testis (C) Feacal and blood samples were taken for parasitology and haematology evaluations. The mucous membrane was pinkish, while temperature and other physiological parameters were within normal range. Faecal and blood examination were negative for gastro intestinal parasite ova and haemo-parasites respectively. Haematological values were presented in Table 1. The caudo-ventral region of the animal was aseptically prepared for surgery. The ram was sedated with 124

4 T.A.O OLUSA, A.O. SONIBARE, A.O EGBETADE AND R.A AJADI xylazine hydrochloride (Xyl-M2, Arendonk, Belgium) administered I/M at a dosage of 0.1 mg/kg followed by epidural anaesthesia achieved by administration of 1.5mls of 2% lignocaine into the lumbosacral space. Food was withheld for about 18 hours and water for 6 hours prior to surgery. Table 1: Pre-surgical haematological values for the ram S/N Parameters Ref. Range (Olayemi et al, 1999) 1 PCV (%) ± Hb (g/dl) 3.79 ND 3 WBC (109/L) ± Neutrophils (%) [109/L] 62 [9.55] 7.86 ± Lymphocytes (%) [109/L] 38 [5.85] 7.87 ± Eosinophils (%) ± Basophils (%) 0 ND 8 Monocytes (%) ± 0.01 The ram was restrained in lateral recumbency. A ventral full skin incision measuring about 6cm was made on the scrotal hernia. The hernia sac (i.e. tunica vaginalis communis) was punctured to gain access into the content and the ring. The hernia content (small intestine) was returned into the abdominal cavity through the hernia ring and the ring was closed with a size 1 nylon using double row of continuous mattress suture pattern. The rudimentary spermatic cord of the nondescendent testis was ligated with size 1chromic catgut and resected. The left descended testis was accessed through the interseptum and its tunica vaginalis bluntly dissected to reveal the spermatic cord which was then ligated with size 1chromic catgut and resected along with the testis. The ventral abdominal hernia was opened via a ventral paramedian full skin incision of about 12cm and the hernia sac was punctured to gain access to the hernia content and ring. Severe adhesion was noticed between some part of the omentum and the abdominal wall. These were bluntly dissected and the intestine was return back into the abdominal cavity. The hernia ring was located and carefully closed with a size 1 nylon using double row of continuous mattress suture pattern while sub-cuticular was closed with size 1 chromic catgut using simple continuous suture pattern. The redundant skin was resected and skin incision was reconstructed and closed in T-shaped plasty using a combination of horizontal and vertical mattress suture patterns with size 1nylon. 125

Plate III: Return of intestinal loops back into the abdominal cavity Postoperative analgesia was achieved with intramuscular administration of 0.

15,000 IU of penicillin streptomycin was given IM for 4 days to prevent post-operative infection.

5 Plate III: Return of intestinal loops back into the abdominal cavity Postoperative analgesia was achieved with intramuscular administration of 0.2mg/kg of 5% Tramadol (Plethico Pharmaceuticals Limited, India); the animal recovered uneventfully from anaesthesia. 15,000 IU of penicillin streptomycin was given IM for 4 days to prevent post-operative infection. Skin stitches were removed 10 days after the surgery and the animal was reported to have healed without complications and was thriving well 5 months after surgery. DISCUSSION AND CONCLUSION Most reported cases of abdominal hernia in food producing animals are associated with trauma (Al Sobayil and Ahmed, 2007) and trauma due to horning from other animals appeared to be the most common cause of such hernias. Although increased intraabdominal pressure during mounting for the males and pregnancy and the act of parturition in females are other probable causes of scrotal and inguinal hernias. The ventral abdominal hernia reported in this case was however congenital based on the history. Hernias could be congenital or acquired in nature. Scrotal hernias are considered as an extension of inguinal hernia, when the abdominal organs protrude through an enlarged inguinal ring into the scrotum (Al- Sobayil and Ahmed, 2007). Unilateral scrotal hernias in rams and lambs have been described in various breeds of sheep and inguinal hernia in two ewes (Weaver, 1968; Carr, 1972; Braun and Cole, 1985; Roberts, 1988; Al-Sobayil and Ahmed, 2007; Radisic et al., 2010). In most cases, scrotal hernia is acquired, usually caused by a trauma such as a horn injury in group-housed males. However, Dennis and Leipold (1968) described two congenital scrotal hernias in lambs found at necropsy. Although, the heritability of scrotal hernia has not yet been fully understood (Braun and Cole, 1985), it is assumed that, due to inbreeding, Merino rams may be genetically predisposed to the development of scrotal hernia as a result of an inherited failure (i.e. an enlarged inguinal ring) which is recessive in nature (Carr, 1972; Roberts, 1988). Nevertheless, most experts agree that an enlarged inguinal ring is a hereditary fail- 126

T.A.O OLUSA, A.O. SONIBARE, A.O EGBETADE AND R.A AJADI ure, so an affected ram and its siblings should not be used in breeding (Smith et al., 2007; Smith et al., 2012).

the ram to prevent the trait from being passed to its progeny. The location of undescended testes differs greatly among species.

subcutaneous locations may predominate while for man, abdominal retention is less common (~8%) and 90% of undescended testes are subcutaneous (outside the external inguinal ring or near the neck of

In terms of sizes and shapes, cryptorchid testes vary;it is usually smaller, in size and weight than normal testes (Plate IV).

6 T.A.O OLUSA, A.O. SONIBARE, A.O EGBETADE AND R.A AJADI ure, so an affected ram and its siblings should not be used in breeding (Smith et al., 2007; Smith et al., 2012). The scrotal hernia presented here was congenital and coupled with unilateral cryptorchidism which is a well-documented congenital defect in most species of animals; orchidectomy was carried out on the ram to prevent the trait from being passed to its progeny. The location of undescended testes differs greatly among species. According to Amann and Veeramachaneni (2006), for cats, dogs and horses, 50, 92 and 47-60% of retained testes were in the abdominal cavity; no reliable data is available for pigs although subcutaneous locations may predominate while for man, abdominal retention is less common (~8%) and 90% of undescended testes are subcutaneous (outside the external inguinal ring or near the neck of the scrotum) The non-descendent testis in this ram was found just at the external inguinal ring near the neck of the scrotum. In terms of sizes and shapes, cryptorchid testes vary;it is usually smaller, in size and weight than normal testes (Plate IV). Abdominal testes were generally smaller than those present in the scrotum, and almost invariably of globoid or spheroidal shape; inguinal testes are generally rather more elongated (Smith et al., 2012). Cryptorchidism have been known to predispose affected animals to testicular tumour, among other deleterious effects (Amann and Veeramachaneni, 2006) just as animals with abdominal and or scrotal hernias usually have low productivity and reproductive abilities. For these reasons, an animal having malformations such as unilateral cryptorchidism, abdominal and scrotal hernias coexist (although rare) are better culled shortly after birth if the conditions are diagnosed early in life. However, these conditions may be manageable if the animal survives its first 6 months of life although it may exhibit reduced weight gain when compared to its age mate despite its normal appetite and routine deworming programme for the flock. Most cryptorchid bulls are slaughtered and unilateral cryptorchid bulls usually are not used for breeding. Cryptorchid boars typically are killed neonatally as they are deemed unsuitable for breeding and rearing to market weight because it would result in a carcass gery was effective in correcting these defects in the ram under study and is thus recommended for such caseswhen diagnosed. Plate IV: REMOVED TESTES- DESCENDENT (L); NON DESCENDENT (R) 127

Plate V: ANIMAL SOME HOURS AFTER SURGERY CONCLUSION Herniation as reported in this case probably resulted from a larger than normal inguinal canal rings coupled

A thorough assessment of cryptorchid animals is therefore essential as the opening created by the non-descendent testis could be a risk factor for herniation.

Factors which could predispose to cryptorchidism which includes estrogen exposure in pregnancy, delayed closure of the umbilicus and testicular hypoplasia may not

Early reportage of abnormal growths on animals before they become life threatening will reduce losses which are preventable through either simple manipulations or

8(2): 185-191 Amann, R. P., Veeramachaneni D. N. R. 2006. Cryptorchidism and associated problems in animals. Anim. Reprod., 3 (2): 108-120. Braun, W.F., Cole W.J.

7 Plate V: ANIMAL SOME HOURS AFTER SURGERY CONCLUSION Herniation as reported in this case probably resulted from a larger than normal inguinal canal rings coupled with failure of the testicles to descend. A thorough assessment of cryptorchid animals is therefore essential as the opening created by the non-descendent testis could be a risk factor for herniation. RECOMMENDATION Animal with traits of cryptorchidism must not be used to breed. Factors which could predispose to cryptorchidism which includes estrogen exposure in pregnancy, delayed closure of the umbilicus and testicular hypoplasia may not necessarily be under direct control hence the avoidance of breeding with unilateral cryptorchids is beneficial. Early reportage of abnormal growths on animals before they become life threatening will reduce losses which are preventable through either simple manipulations or inexpensive surgeries. REFERENCES Al Sobayil, F.A, Ahmed A.F Surgical treatment for different forms of hernias in sheep and goat. J Vet Sci. 8(2): Amann, R. P., Veeramachaneni D. N. R Cryptorchidism and associated problems in animals. Anim. Reprod., 3 (2): Braun, W.F., Cole W.J Unilateral scrotal hernia repair in a ram lamb. J Am Vet Med Assoc. 187: 500. Carr, P.M An apparently inherited inguinal hernia in the Merino ram. Aust Vet J, 48, Dennis, S.M., Leipold, H.W Congenital hernias in sheep. J Am Vet Med Assoc, 152: Greber, D, Doherr M, Drogemuller, C., Steiner A Occurrence of congenital disorders in Swiss sheep. Acta Veterinaria Scandinavica. doi: /

8 T.A.O OLUSA, A.O. SONIBARE, A.O EGBETADE AND R.A AJADI Hassan N.J Umbilical hernias among sheep in Dohuk. Al-Qadisiya Journal of Vet. Med. Sci. 7 (2): In: Textbook of Small Animal Surgery Vol 1. Slatter Douglas. Pp W.B. Saunders Philadelphia Hayes, W. M Congenital umbilical and inguinal hernias in cattle, horses, swine, dogs, and cats. J. Am. Vet. Res. 35: Nelson, D.R The abdominal wall. In: Textbook of Large Animal Surgery.ehme, F.W. (Ed) 2nd edition, Pp William & Wilkins. Baltimore. Olayemi, F.A., Farotimi, J. O., Fagbohun, O.A Haematology of West African Dwarf Sheep under two different management system in Nigeria. African Journal of Biomedical Research 3: Harapin, I., Kos, J., Babic, T.,Nedeljkovic G Surgical treatment of a unilateral scrotal hernia in a ram- a case report. Vet. Arhiv 80 (1): Read, R Cranial abdominal hernias. Roberts, S. J Scrotal hernia in rams. A case report. Cornell Vet, 78: Smith, K.C, Brown, P.J, Morris, J,. Parkinson T.J Cryptorchidism in North Ronaldsay Sheep. Veterinary Record. 161(19): Smith, K.C, Brown, P.J, Barr F.J., Parkinson, T.J Cryptorchidism in Sheep: A Clinical and Abattoir Survey in the United Kingdom. Open Journal of Veterinary Medicine. 2: Veeramachaneni D.N Germ cell atypia in undescended testes hinges on the aetiology of cryptorchidism but not the abdominal location per se. Int J Androl, 29: Weaver A.D Inguinal hernia in the ewe: two case reports. Vet Rec 83: (Manuscript received: 10th November, 2015; accepted: 14th June, 2016) 129

Surgical treatment for different forms of hernias in sheep and goats

J. Vet. Sci. (2007),G8(2), 185 191 J O U R N A L O F Veterinar y Science Surgical treatment for different forms of hernias in sheep and goats Fahd A. Al-Sobayil, Ahmed F. Ahmed* Department of Veterinary