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Inguinal Hernia in an 8-Year-Old MN Yorkshire Terrier: Our Case Of the Month: May 2020

Patient Information

Age
8 Years
Gender
Male, Neutered
Species
Canine

Keywords

Blood Chemistry

Clinical Signs

Exam Findings

Images

Inguinal hernia prior to surgery.
Entrapped small intestine, inguinal hernia.
Inguinal intestinal entrapment.
Doppler assessment of the herniated intestine appears normal indicating intestinal vascular viability.
Area of small intestines that had been entrapped.
A 2 inch section of purple/black small intestine, evidence where inguinal ring had strangled it.

This is a perfect example of the SonoPath mantra - "if it's sick it needs a probe, and on day one". Vague but serious clinical signs were present that could have pointed to many diagnoses - but without expedient application of the probe there may have been a different outcome for this little dog.  Awesome imaging was obtained by SonoPath Mobile's Shari Reffi, CVT, SDEP® certified clinical sonographer, and expedient image interpretation done by Eric Lindquist, DMV, DABVP, Cert. IVUSS, giving the clinic the answers it needed to take their patient to surgery the same day. 

History

An 8-year-old male neutered Yorkshire terrier was presented for vomiting, anorexic, lethargy, dehydration, and azotemia. A 2 x 2cm dense mass was palpated in the left inguinal region. Non-reducible. R/O renal disease, pancreatitis. Current meds: Cerenia; Famotidine; Ampicillin; Baytril. CBC: pmns 22K; PCV 67%; TP 9.6; Bun 48; Creat 3; Phos 10 (values improving with fluids).

Image Interpretation

Entrapped small intestine via inguinal hernia noted. Hernia measured approximately 2.0 cm. Regional inflammation and localized peritonitis.

DX

Inguinal hernia

Outcome

IV fluid support, plasma expanders, and immediate surgical intervention were recommended, rectifying the hernia entrapment. A portion of intestinal resection likely would be necessary for this patient depending upon the viability of the herniated intestine. Once the patient is stabilized, a workup for PDH/Cushing’s disease would be warranted if the clinical parameters are present. Concurrent cystotomy recommended given the bladder calculus. GI biopsies warranted. This is a surgical emergency. Doppler assessment of the herniated intestine appeared normal indicating intestinal vascular viability. The patient underwent surgery for resection, anastomosis, and inguinal hernia repair. The patient is doing great post-operatively.

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