Last week June underwent a major operation. June is a seven-year-old black female Chow Chow, certainly not a common breed in Malta.

Chow Chows originated in China. The literal translation for their Chinese name is Fluffy Lion Dog. Chows are an important breed, not only because they have a very long history as a strong working dog in northern China, but because they are also thought to be a very ancient breed with a distinct line, which later contributed to more modern breeds, such as the Samoyed and Pomeranian.

A particular characteristic of Chows is their distinctive blue tongue. From the cultural aspect, they remain a visible feature on Buddhist temples and palaces where stone replicas are placed at the entrances, seemingly to guard against the marauding warriors of their time

I had examined June as an emergency earlier in the day after she had suffered a whole week of persistent vomiting. Having excluded all other possibilities, I started to suspect the cause originated from a hernia she had had for a long time.

By the evening, the question of whether to operate or not was no longer an issue. June’s vomiting had continued unrelentingly. We were going to have to perform emergency exploratory abdominal surgery with a primary focus on a suspect incarcerated hernia.

The word hernia derives from Latin and means protruded viscus. It is a disorder where part of the body is displaced from its natural position and protrudes abnormally through a tear or a natural opening. More often than not it refers to parts of the body found in the abdominal cavity. The most common natural openings through which hernias occur are the umbilicus and the inguinal canal.

The umbilicus is commonly referred to as the navel or belly button. It is the opening through which the umbilical cord feeds the foetus from the placenta while in the uterus.

The umbilical cord is broken at the moment of birth when its function becomes redundant. Quite often the resulting breach does not completely close and a small bulge may be visible at the umbilicus. This is referred to as an umbilical hernia. Depending on the extent and nature of this hernia this is usually the least dangerous of all types of hernias.

The same cannot be said in the case of the inguinal hernia. The inguinal canal is a natural opening present in both males and females and situated in the groin area. Its function is mainly related to the development of the sexual organs. When this virtual canal is open, various abdominal organs may protrude through it. In this case surgery is indicated since herniated organs can slowly increase to a very large size. A complication that may occur in females is that if, during pregnancy, a portion of the uterus is herniated in the inquinal canal, the consequences can be obviously catastrophic.

Each type of hernia has its own prognosis and treatment according to its type, location and clinical manifestation

Less common hernias are the perineal hernia and the rarely occurring internal hernia. Perineal hernias are usually associated with older male dogs. A bulge is seen on the side of the anus and the cause of the problem is often an enlarged prostate. The enlarged prostate causes repetitive straining which contributes to the hernia developing. The problem is normally well controlled by castration since castration has the secondary effect of reducing the size of the prostate.

The internal hernia is a rare type of hernia. In this case, abdominal organs become entrapped in a tear in the belly tissues. This is certainly one of the more difficult to diagnose.

Hernias can also occur through openings which are not natural. This is always of concern following a sudden trauma to the abdominal wall where a tear may occur externally and a bulge becomes visible in the abdominal wall. It can also occur in the diaphragm which may cause various degrees of respiratory distress. Your veterinarian would check for this through an X-ray.

Either way, it may be necessary or urgent for the hernia to be operated and reduced, depending on where it is located. In general, the two things that you should always be aware of in the case of hernias is first of all whether the volume of herniated organs can increase and, secondly, whether or not the blood circulation of protruding organs can be compromised.

This latter circumstance would cause these organs themselves to swell which, in turn, would continue to incarcerate the displaced organs within the hernia, preventing them from returning to their natural location. This explains the term ‘incarcerated’ which, literally, means trapped. The consequences of an incarcerated hernia range from localised inflammation and discomfort to debilitating pain. Left untreated, the consequences are severe, if not fatal.

Each type of hernia has its own prognosis and treatment according to its type, location and clinical manifestation. It is critical that whenever a hernia is suspected, you seek professional veterinary advice immediately and that all possible outcomes are clearly discussed. This would help you decide what is best for your pet. If your vet decides that immediate surgery is not called for, they will determine a monitoring programme for the well-being of your pet.

June’s history was also not so straightforward. Her owners told me she had always had an umbilical hernia, which later re-emerged after undergoing a Caesarean section. Until that time, she was well and stable and the bulge in her belly had become such an intrinsic part of her that it was overlooked.

June’s clinical examination revealed that under her Chow Chow heavy double coat lay a bulge in the umbilical region. This kicked off the possibility that her persistent vomiting might be related. The hernia was also rather hard and June was clearly in pain when it was touched. X-rays and ultrasound followed and, after taking some blood tests, we decided to operate. The primary expectation of the operation would be to find an incarcerated hernia with the possible involvement of an intestinal loop. Our suspicions were proven correct.

We did find an incarcerated hernia. But what we also found was that due to the damage already caused, it had become impossible to release the intestinal loop which had become trapped in the hernia. This meant that the compromised intestine needed to be removed and the resulting two ends of the intestine needed to be attached to reform a continuous intestine.

June’s owners have informed me she is doing well. However, it has only been a few days since surgery. Resectioning part of the intestine is always a delicate intervention and considerable aftercare by the pet’s owners is needed. June’s owners are very willing to give her all the care and attention she needs. We are hoping she will continue to do well and that her hernia episode would be something of her past.

thisweekwiththevet@gmail.com

Dr Martin Debattista is a veterinary surgeon.