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- Prepubic hernias do well
Prepubic hernias do well
JAVMA 2024
Grace Rein, Andra Voges, Mary Snipes, et al.
Background
Prepubic hernia (PPH) results from the avulsion of the prepubic tendon, often caused by high-impact trauma, leading to herniation of abdominal organs or disruption of the abdominal wall. The study aimed to evaluate clinical presentation, concurrent injuries, diagnostic imaging findings, treatment methods, and short-term outcomes in dogs and cats with PPH.
Methods
A retrospective analysis was conducted on 71 dogs and 16 cats diagnosed with PPH at two academic veterinary institutions between 2008 and 2023. Clinical data, including signalment, trauma details, imaging, treatment, and outcomes, were collected. Imaging findings were reviewed by board-certified radiologists, and statistical analysis was performed to summarize data and outcomes.
Results
-Presentation and Diagnosis:
-PPH was most commonly caused by vehicular trauma (87.3% in dogs, 37.5% in cats).
-Common diagnostic methods included radiographs (60.5% in dogs, 62.5% in cats) and CT scans.
-Herniation of abdominal organs occurred in 49.3% of dogs and 37.5% of cats, often involving the urinary bladder or intestines.
-Concurrent Injuries:
-Orthopedic injuries were prevalent, including pubic fractures (76.1% in dogs, 62.5% in cats) and sacroiliac luxation (56.3% in dogs, 68.8% in cats).
-Urinary tract trauma was noted in 12.7% of dogs and 12.5% of cats, occasionally leading to uroabdomen.
-Treatment:
-PPH was surgically repaired in 56.5% of dogs and 43.8% of cats, with muscle apposition and pubic bone tunnels being the primary methods.
-Orthopedic repairs and other soft tissue surgeries were often performed simultaneously.
-Conservative management was a viable option for cases without organ herniation.
-Outcomes:
-Short-term outcomes were favorable, with complications primarily related to surgery or concurrent injuries.
-Median hospitalization duration was 7 days for dogs and 6.5 days for cats.
-Only one case of PPH repair failure was reported, which was successfully revised surgically.
Limitations
This retrospective study was limited by its small sample size, variability in surgical approaches, and loss of follow-up in several cases. The study lacked detailed reasons for choosing specific treatment modalities and long-term outcomes for many cases.
Conclusions
PPH commonly accompanies severe trauma and is often associated with significant concurrent injuries. While radiographs are effective for diagnosis, CT or surgery may be required for definitive identification. Surgical repair methods yield good short-term outcomes, although conservative management can be appropriate in cases without herniated organs. Further research is needed to standardize treatment protocols and assess long-term outcomes.
Left lateral (A) and ventrodorsal (C) radiographs and sagittal (B) and dorsal (D) reconstructed CT images in soft tissue window at the level of the urinary bladder of a cat that present- ed following unknown trauma (window level, 40 HU, and window width, 300 HU, for all images; thickness, 0.6 mm). Cranial is to the top of panels C and D and to the left of panels A and B, and the right side is to the left of the image (identified by the letter R on
the image). There is disruption of the ventral abdominal body wall with retraction from the pubis (blue arrows), thickening of the body wall (white asterisk), and mild fluid streaking of the inguinal fat and ventral displacement of the urinary bladder beyond the body wall into the inguinal tissues (yellow star). Orthopedic injuries in this cat include bilateral sacroiliac luxation (white ovals), left pubic fracture (white arrow), and right femoral head luxation and femoral neck fracture (red asterisk).
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