Incidence of diaphragmatic hernia
In present study, incidence of diaphragmatic hernia was seen in both cattle (n=17) and buffaloes (n=15) indicates prevalence was higher in dairy animals irrespective of species.
Singh et al., (2006) reported that, prevalence of diaphragmatic hernia in buffaloes was higher than other species, which might be due to lesser collagen content, elasticity and less blood supply to the diaphragm of a buffalo. In present study, the incidence of diaphragmatic hernia was higher in recently calved animal (14 animals) followed by second trimester (8 animals); third trimester (7 animals) and first trimester (3 animals) pregnant animals which might be due to strenuous contraction or pressure exerted on diaphragm causes tear or weakness in diaphragm and eventually piercing of reticular foreign bodies during labor pain leads to herniation of reticulum into thoracic cavity. Similar conclusions were drawn by
Prasad et al., (1977); Singh et al., (1979) and
Nigam et al., (1980) during their studies.
Sahu et al., (2003) and
Sodhi et al., (2020) reported that, 44% occurrence of diaphragmatic hernia were common during act of calving.
Age of affected animals ranged between 3.5- 14 years (7.109±0.406) in which 20 animals were reared under free range grazing system and remaining 12 animals were maintained in stall feeding system. Irrespective of rearing system, the vulnerability of ingestion of metallic foreign bodies by the dairy animals might be due to presence of metallic objects in the concentrate or machine grinded feed, metabolic disorders, voracious feeding habits, industrialization and large ruminants’ do not discriminate metal material in feed. Similar findings were recorded by
Sharma and Kumar (2006) and concluded that, traumatic reticulo peritonitis as a consequences of perforation of reticulum leads to diaphragmatic hernia.
In present study, majority of reticular metallic foreign bodies were directed towards diaphragm which could be exciting factor for setting inflammatory changes and weakening the diaphragm. Similar observations were also reported by
Deore and Jahagirdar (1971); Singh et al., (1980) and
Krishnamurthy et al., (1985) concluded that, innate weakness of the diaphragm, chronic and repeated trauma by the foreign bodies were responsible for diaphragmatic hernia in buffaloes.
Clinical findings
The duration of illness ranged between 4-35 days (16.563±1.627) according to the history of illness recorded during presentation at teaching hospital. Clinically all animals showed partial or complete anorexic, recurrent tympany, regurgitation (Fig 1), atonic rumen, cachexia depressed condition and sudden drop in milk production. Out of 32 cases, 11 animals showed scanty faeces and they were non responsive to medicinal treatment. These findings are in accordance with
Singh et al., (2006); Athar et al., (2010) and
Abdelaal et al., (2014) stated that, animals with diagrammatic hernia showed recurrent tympany, scanty faces and non-responsive medicinal therapy. Thirteen animals had atonic rumen and remaining animals showed hypomotility which is considered to be a sign of indigestion and which might be attributed to the restricted contraction or motility of reticulum due to its herniation into thoracic cavity.
Auscultation of thoracic cavity between 5th -6th intercostal spaces in 19 of 32 animals, revealed biphasic reticular sound close to heart indicative of herniation of reticulum into thoracic cavity which were reconfirmed with radiography.
Prasad et al., (1977) and
Narale et al., (2006) reported that, 42 buffaloes and 196 suspected cases of diaphragmatic hernia were diagnosed by auscultation of reticular sound in thoracic region, blood picture (Neutrophilia with leukocytosis) and by plain and contrast radiographic examination using barium meal.
Ruminal motility was increased (5.344±0.188 per five minutes) in all animals with alkaline ruminal pH (7.547±0.096) could be attributed to dietary changes, causing abnormal buffering mechanism in rumen that lead to impaction, indigestion and eventually diaphragmatic hernia. Similar findings were noted by
Akbar and Kumari (2006) and they analyzed that, any deviation in ruminal pH causes indigestion, which disrupts the rumen environment resulting in reduced metabolic activities and ultimately inhibiting milk production.
Singh et al., (1979) also found alkaline pH of rumen in buffaloes affected with diaphragmatic hernia during rumenotomy.
All physiological parameters were in normal range (Table 2) however bradycardia were recorded pre-operatively in all animals however, it was restored on 7th day postoperatively might be attributed due to displacement of heart away from chest wall due to reticular herniation. Similar findings were reported by
Sahu et al., (2002) and
Athar et al., (2010) during their study.
Radiographic findings
Right lateral or standing radiographs of animals revealed loss of diaphrgmatic continuity and presence of reticulum into the thoracic cavity with presence of metallic foreign bodies (Fig 2; Fig 3 and Fig 4) in the herniated portion of reticulum was a constant feature in 27animals whereas in remaining animals, foreign bodies were extra-reticular space directed towards xiphisternum and some of them embedded into the adhesions (Fig 5; Fig 6 and Fig 7). Similar radiographic reports were cited by
William et al., (2003); Narale et al., (2006) and
Athar et al., (2010) and concluded that, radiography was an excellent tool for diagnosis of reticular foreign bodies as herniation of reticulum and loss of continuity of diaphragmatic line.
Haematobiochemical findings
Among the haematological parameters, neutrophilia (49.44±3.84) and lymphopenia (38.88±2.22) were consistently observed in all animals pre-operatively but it was restored to normal range post surgically on 7th day (Table 4). Similar findings have been recorded by
Sethuraman and Rathor (1979) and
Kaur and Singh (1994) in their study and they noted, marked neutrophilia (56.1±2.3%) and lymphopenia (40.3± 2.1%) in buffaloes suffering with diaphragmatic hernia. All animals showed non-significant decrease in the blood haemoglobin level (9.94±0.64) which resumed its normal range (10.07±0.51) post surgically. Lowered haemoglobin levels might be due to chronic anorexia and nutritional deficiency. Similar observation was also reported by
Tagra et al., (2001) and
Narale et al., (2006) and reported that, altered haemoglobin parameters were stabilized to normal value by the 8th postoperative days. Mild to moderate dehydration was recorded in few buffaloes pre-operatively suggestive of chronic inflammatory changes and anorexia during course of disease and was corrected with fluid therapy
(Narale et al., 2006).
Pre-operatively all animals showed significant increase in level of serum creatinine (3.19±0.37IU); creatine kinase (595.14±47.24IU) and lactate dehydrogenase (1968.596± 172.88IU) could be due to chronic inflammatory changes at cellular level but these values were restored to normal range on 7th postoperative days (Table 4).
Rose et al., (2009) and
Brancaccio et al., (2010) recommended that estimation of various muscle enzymes will provide better information about the muscular damage which also represents disturbances to muscle energy process.
Surgical treatment
Metallic foreign bodies includes nail, sewing neddle, sharp metallic objects (Fig 8) were retrieved from reticulum via standard rumenotomy procedure where as extra-reticular foreign bodies were removed during herniorrhaphy procedure in animals. After 24 hours they were subjected to repair of diaphragmatic hernia (herniorrhaphy) under anaesthetic protocol Inj. Diazepam @ 0.1 mg/kg and Inj. Ketamine hydrochloride @ 2 mg/kg and I/V and maintained on 3.5% isoflurane anaesthetics and found to be smooth and safer in all the animals with minimal cardiovascular effects. Isoflurane anaesthetics showed moderate to deep surgical anaesthesia, adequate jaw relaxation, profuse salivation, adequate muscle relaxation and complete loss of corneal or palpebral reflexes. Few animals showed regurgitation after induction of anaesthesia or during endotracheal intubation could be attributed to the relaxation of cardia.
Carrol and Hartsfield (1996) compared induction of anaesthesia with ketamine and thiopentone sodium in clinical cases of critically ill cattle, sheep and goat and observed that ketamine produced better and smooth anaesthesia with mild cardiovascular stimulation.
Kaur and Singh (2004) and
Steffey (1986) observed that, regurgitation was found to be rare complication in ketamine anaesthesia in cattle.
Postxiphoid 8-10cm crescent shaped incision found to be more reliable and accessible during herniorrhaphy in all animals. Out of 32, 16 animals showed grade-4 adhesion; 8 animals (grade-3); 5 animals (grade-2) and 3 animals (grade-1) characterized by heavy and tough fibrosed band attached to ventro-lateral surface of diaphragm to the cranial wall of reticulum and they were dissected bluntly according to
Saini et al., (2007) and
Randhawa and Singh (2007) in their study.
The approximate diameter of diaphragmatic dent in present study was ranged 3-12 cm (Fig 9) located at left, mid and right hemisphere in 13, 8 and 11 animals respectively.
Singh et al., (1996) and
Saini et al., (2001) studied the location of diaphrgmatic ring in cattles and concluded that, most the hernial ring was located at left hemisphere of diaphragm. Herniated ring were sutured with thick non-absorbable suture material
i.
e. No.2 Silk (Fig10) and before placing last suture, lungs were hyperventilated to expel air from thoracic cavity. Most of the animals were kept on positive pressure ventilator with pure oxygen during surgical procedure and postoperative period till animals regains spontaneous breathing as recorded by
Saini et al., (2001). In present study, twenty seven animals were recovered uneventfully without complications and remaining five animals were succumbed during surgical procedure could be due to chronic pericarditis and respiratory fatigue as reported by
Prasad et al., (1982) and
Saini et al., (2001) in their study.
