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The body wall
/content/chapter/10.22233/9781910443248.chap4
The body wall
- Author: Davina Anderson
- From: BSAVA Manual of Canine and Feline Abdominal Surgery
- Item: Chapter 4, pp 45 - 63
- DOI: 10.22233/9781910443248.4
- Copyright: © 2015 British Small Animal Veterinary Association
- Publication Date: November 2015
Abstract
The body wall consists of sheets of muscle that maintain abdominal integrity, provide support and strength for movements such as jumping and twisting and, when tense, are rigid enough to protect the abdominal contents. Open surgery on intra-abdominal structures involves breaching this well designed system, and it is important to ensure a robust and long-lasting repair of any approach to the abdominal cavity. This chapter covers the body wall anatomy, surgical approaches, closure, and complications. Practical tips are highlighted throughout. Operative techniques: Midline laparotomy (coeliotomy); Flank laparotomy; Inguinal hernia repair; Prepubic tendon rupture repair.
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Figures
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4.3
(a) Cross-section of the abdominal wall muscles, showing aponeuroses inserting on the linea alba. (b) External view of the ventral surface of the abdomen and abdominal wall openings. EAO = external abdominal oblique; IAO = internal abdominal oblique; RA = rectus abdominis; TA = transversus abdominis. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2015 British Small Animal Veterinary Association
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4.3
(a) Cross-section of the abdominal wall muscles, showing aponeuroses inserting on the linea alba. (b) External view of the ventral surface of the abdomen and abdominal wall openings. EAO = external abdominal oblique; IAO = internal abdominal oblique; RA = rectus abdominis; TA = transversus abdominis. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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4.4
Anatomy of the inguinal ring in the dog. (a) Internal inguinal ring. (b) External inguinal ring. EAO = external abdominal oblique; IAO = internal abdominal oblique; RA = rectus abdominis. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2015 British Small Animal Veterinary Association
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4.4
Anatomy of the inguinal ring in the dog. (a) Internal inguinal ring. (b) External inguinal ring. EAO = external abdominal oblique; IAO = internal abdominal oblique; RA = rectus abdominis. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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4.5
Lateral view of inguinal area in the dog. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2015 British Small Animal Veterinary Association
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4.5
Lateral view of inguinal area in the dog. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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4.6
Surgical approaches to the abdomen. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2015 British Small Animal Veterinary Association
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4.6
Surgical approaches to the abdomen. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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4.8
Midline incisional hernia with herniated abdominal contents (evisceration). © 2015 British Small Animal Veterinary Association
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4.8
Midline incisional hernia with herniated abdominal contents (evisceration).
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4.10
An example of postoperative discharge instructions. © 2015 British Small Animal Veterinary Association
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4.10
An example of postoperative discharge instructions.
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4.11
Abdominal wall (paracostal) hernia in a cat. © 2015 British Small Animal Veterinary Association
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4.11
Abdominal wall (paracostal) hernia in a cat.
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4.13
Inguinal hernia in a 5-year-old male hound. Note the dramatic scrotal swelling. (Courtesy of J Niles) © 2015 British Small Animal Veterinary Association
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4.13
Inguinal hernia in a 5-year-old male hound. Note the dramatic scrotal swelling. (Courtesy of J Niles)
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4.14
Inguinal hernia. (a) Indirect herniation and (b) direct herniation in the male dog. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2015 British Small Animal Veterinary Association
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4.14
Inguinal hernia. (a) Indirect herniation and (b) direct herniation in the male dog. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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4.15
Necrotic jejunum that had become incarcerated in the inguinal canal of the dog in
Figure 4.13
. Note: a scrotal ablation and abdominal exploratory were performed in this dog. (Courtesy of J Niles) © 2015 British Small Animal Veterinary Association
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4.15
Necrotic jejunum that had become incarcerated in the inguinal canal of the dog in
Figure 4.13
. Note: a scrotal ablation and abdominal exploratory were performed in this dog. (Courtesy of J Niles)
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4.16
A sheet of porcine SIS being used to repair a chronic abdominal wall hernia. Note how the polypropylene mattress sutures have been pre-placed. (Courtesy of J Niles) © 2015 British Small Animal Veterinary Association
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4.16
A sheet of porcine SIS being used to repair a chronic abdominal wall hernia. Note how the polypropylene mattress sutures have been pre-placed. (Courtesy of J Niles)
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4.18
Prepubic tendon rupture in a Domestic Shorthaired cat following a road traffic accident. The cat’s head is to the right of the photograph. The abdominal wall (black arrows) has been avulsed from the pubis (white arrow). The bladder can be seen in the centre of the picture. (Courtesy of J Niles) © 2015 British Small Animal Veterinary Association
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4.18
Prepubic tendon rupture in a Domestic Shorthaired cat following a road traffic accident. The cat’s head is to the right of the photograph. The abdominal wall (black arrows) has been avulsed from the pubis (white arrow). The bladder can be seen in the centre of the picture. (Courtesy of J Niles)
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4.19
Devitalized area of jejunum found on abdominal exploration prior to repair of the prepubic tendon in the cat in
Figure 4.18
. An intestinal resection and anastomosis were performed. (Courtesy of J Niles) © 2015 British Small Animal Veterinary Association
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4.19
Devitalized area of jejunum found on abdominal exploration prior to repair of the prepubic tendon in the cat in
Figure 4.18
. An intestinal resection and anastomosis were performed. (Courtesy of J Niles)
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4.20
Cat with prepubic tendon rupture clipped for surgery (note extensive bruising). © 2015 British Small Animal Veterinary Association
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4.20
Cat with prepubic tendon rupture clipped for surgery (note extensive bruising).
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4.21
Paracostal hernia repair. Muscle layers are attached to the costal arch sequentially, using mattress sutures anchored to the ribs. EAO = external abdominal oblique muscle; IAO = internal abdominal oblique muscle; IC = intercostalis muscles; RA = rectus abdominis; TA = transversus abdominis. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2015 British Small Animal Veterinary Association
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4.21
Paracostal hernia repair. Muscle layers are attached to the costal arch sequentially, using mattress sutures anchored to the ribs. EAO = external abdominal oblique muscle; IAO = internal abdominal oblique muscle; IC = intercostalis muscles; RA = rectus abdominis; TA = transversus abdominis. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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4.22
(a) Inguinal seromas usually present with a non-painful soft fluctuant swelling in the inguinal area. This cat has a bilateral swelling that is predominantly situated in the inguinal area, even when the forelimbs are elevated. (b) In dorsal recumbency, during preparation for surgery, palpation of the caudal abdominal wall is unremarkable and the seroma spreads bilaterally over the inguinal area. (a, Reproduced from
Charlesworth and Moores (2012)
with permission from the Journal of Small Animal Practice; b, © Tim Charlesworth) © 2015 British Small Animal Veterinary Association
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4.22
(a) Inguinal seromas usually present with a non-painful soft fluctuant swelling in the inguinal area. This cat has a bilateral swelling that is predominantly situated in the inguinal area, even when the forelimbs are elevated. (b) In dorsal recumbency, during preparation for surgery, palpation of the caudal abdominal wall is unremarkable and the seroma spreads bilaterally over the inguinal area. (a, Reproduced from
Charlesworth and Moores (2012)
with permission from the Journal of Small Animal Practice; b, © Tim Charlesworth)
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Midline laparotomy with incision deviating laterally around the prepuce (the forceps are grasping the severed preputial muscle).
Midline laparotomy with incision deviating laterally around the prepuce (the forceps are grasping the severed preputial muscle). © 2015 British Small Animal Veterinary Association
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Midline laparotomy with incision deviating laterally around the prepuce (the forceps are grasping the severed preputial muscle).
Midline laparotomy with incision deviating laterally around the prepuce (the forceps are grasping the severed preputial muscle).
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Mayo scissors being used to enlarge incision in linea alba.
Mayo scissors being used to enlarge incision in linea alba. © 2015 British Small Animal Veterinary Association
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Mayo scissors being used to enlarge incision in linea alba.
Mayo scissors being used to enlarge incision in linea alba.
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Scalpel being used to extend linea alba incision. Underlying organs are protected by elevating the linea alba prior to incision.
Scalpel being used to extend linea alba incision. Underlying organs are protected by elevating the linea alba prior to incision. © 2015 British Small Animal Veterinary Association
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Scalpel being used to extend linea alba incision. Underlying organs are protected by elevating the linea alba prior to incision.
Scalpel being used to extend linea alba incision. Underlying organs are protected by elevating the linea alba prior to incision.
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Sutures are pre-placed using PTFE pledgets to reduce the risk of them tearing through when tightened. (© J Williams)
Sutures are pre-placed using PTFE pledgets to reduce the risk of them tearing through when tightened. (© J Williams) © 2015 British Small Animal Veterinary Association
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Sutures are pre-placed using PTFE pledgets to reduce the risk of them tearing through when tightened. (© J Williams)
Sutures are pre-placed using PTFE pledgets to reduce the risk of them tearing through when tightened. (© J Williams)
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(© J Williams)
(© J Williams) © 2015 British Small Animal Veterinary Association
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(© J Williams)
(© J Williams)