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Learning About Umbilical Hernias

By Laurie Ball-Gisch

3826 N. Eastman Rd.
Midland, MI 48642

Recently, a seasoned ewe of mine very independent and healthy—and that never had lost a lamb, nor ever needed lambing assistance—was showing signs of labor, but not settling into it seriously. She had sequestered herself into a corner of the barn (note, she never comes into shelter, but is one of my “leader” ewes and is always out and about). But something about her demeanor made me think she was more restless than she should have been. She was digging in the straw, but then would head out to the field, only to come back into the barn.

After several hours of noting this behavior, I saw that she was finally staying put in the barn. I would peek in at her through a small window occasionally, not wanting to spook her and disrupt her progress. When she finally had a water bag present, I checked on her every 20-30 minutes or so. When too much time went by, I had my father-in-law, Willie, hold the ewe for me so I could check the lamb’s progress.

There was a fairly large lamb, presented correctly, but because her head and front feet were dry, I pulled the lamb. As soon as I lifted the lamb to shake her and make sure she was breathing, I noted a strange red “something” on her abdomen and said to Willie, that there was something “weird” there. He said “That’s just the ewe’s ‘cleanings’.” I laid the lamb down in front of the ewe (I call her “Dansa”), and she immediately started to clean her off.

It was a beautiful black spotted lamb and was sitting up, shaking its head and Dansa was encouraging it to get up. I got curious as to whether or not it was a ewe or ram and snuck in and lifted the hind legs to check. When I did, it exposed the abdomen. To my horror, I realized that the redness I had just observed was in fact the lamb’s entire intestines and stomach, all outside of her abdominal cavity.

The first lamb shortly after she was born. All of the mass was outside her abdominal cavity at delivery.
The first lamb shortly after she was born. All of the mass was outside her abdominal cavity at delivery.

The mass was the size of my hand and I was shocked and immediately saddened. There was obviously a hole in her abdomen and I wasn’t sure whether or not everything had come out during a hard birth or whether it had actually grown on the outside of her body cavity in the womb.

Because I had never seen anything like this before, my first thought was that I must shove it back in and stitch her up. But looking at the size of the mass of intestines, and the fact that I could clearly see her stomach, I realized there was no way I had the skill to push all of that back through a hole and know that it was in the right place. Not only that, she had already been lying on the straw on the barn floor, and it would be covered with bacteria.

I am so thankful that I have a husband who can do the really hard stuff on the farm; he euthanized the lamb for me and buried her. I asked him to check her over before he buried her, to let me know what he found. He said that there was a hole in her abdomen, about the size of a nickel, halfway between her navel and her crotch. We both agreed that the strange swollen size of her organs would have made it impossible for us to repair this birth defect.

I had no way of knowing that just two days later, I would face another herniated newborn lamb. But the lesson I learned on that Sunday afternoon, had me mentally prepared to save another lamb.

Another Incident

On Tuesday, another one of my older ewes was in labor in the field. As I watched from afar, I realized she was taking too long and was too restless. She was up and down and moving restlessly from spot to spot.

I maneuvered my gates so that I could move her into a catch pen area to check her and went to get my father-in-law (who lives across the road) to help me by holding her. Her first lamb was an 11-pound ewe lamb, big for an Icelandic lamb. Thankfully I was able to pull the lamb and she was still alive. I left mom and newborn alone to bond and moved to a hidden spot to watch her progress in case she had a second lamb.

It was a very strange sensation to push a needle through skin having never done this before. It was also hard to do because the lamb was struggling to get loose.
It was a very strange sensation to push a needle through skin having never done this before. It was also hard to do because the lamb was struggling to get loose.

After about half an hour, she began to lie down and push, but once again was up and down too many times. We held her again and when I checked, the lamb had one leg bent backward, which I straightened out easily and even at 10 pounds, when the ewe pushed, the lamb pretty much slid into my arms.

I lifted her to shake her a bit to make sure she was breathing well. As I lifted her, I noticed a strangely colored “bump” on her abdomen. I couldn’t believe I was seeing little intestines coming out onto her belly. But because I recognized right away what was happening, I laid her on her side, stomach upward and had Willie pin her legs down. I pushed her intestines back in and pinched the skin shut. I had Willie then hold the skin shut.

Rough & Ready Umbilical Hernia Repair

I immediately knew that this hernia was repairable, only because I had just been through the experience on Sunday when I knew instinctively that lamb’s hernia was not repairable. I now keep an “emergency” tube of a lamb colostrum product called “NurseMate Lamb ASAP®” (see sheep! March/April 2006, p.11) in my pocket during lambing season, in case a lamb needs an extra jolt of energy before it might be able to get up and nurse. I administered the recommended 15cc to the lamb, knowing we would be delaying her ability to get up and nurse right away. I then ran into the house to find needle and thread.

I found a circular needle and some quilting thread which I doubled over. Willie held the struggling lamb, and with mama ewe leaning over us, licking her off, I stitched the skin closed as quickly as I could. I poured iodine over the wound, which was an umbilical tear. The herniated area started right at the umbilical, and the cord was torn off. It was about an inch and a half in length. The intestines were fairly small and grayish in color and not much had come out, so I was confident that it was alright for me to push it back in and repair the hole. I also administered 2cc of Penicillin G as well as Vitamin B complex and Vitamin A&D injectable.

Here is what the ewe lamb’s belly looked like six days after surgery, the wool around the stitches still yellow from the iodine.
Here is what the ewe lamb’s belly looked like six days after surgery, the wool around the stitches still yellow from the iodine.

Because it was raining on all of us, we then moved mama and lambs into a clean pen in the barn. I watched while the ewe continued to clean off, talk to, and encourage her lambs to nurse. The two lambs were pretty much identical in size—so much so, that I honestly couldn’t tell which lamb I had just sutured unless I looked at the belly.

I phoned my veterinarians’ office and asked that Dr. Pol phone me when he got back from his farm calls. When he called later that afternoon, I told him what had happened and asked how much PenG I should give the lamb and for how many days. He laughed to hear that I had taken on this surgery all on my own and said I did a great job. Please note, though, that there definitely had to be two sets of hands, one for holding and one for stitching. The success with this lamb came about because of recognizing the injury immediately. This prevented her from losing more intestines as she struggled to stand, and also kept her clean from contamination.

There were basically only two things that Dr. Pol said he would have done differently. He told me that he squirts a syringe full of PenG directly into the wound before stitching. He also said that cotton threads absorb too much moisture (and hence, bacteria) with more potential for infection. So “surgical threads” are preferred. But of course, I was working only with what I had in the house. I asked Dr. Pol if I could buy surgical thread anywhere and he said not to his knowledge. He told me that he uses outdated surgical thread from hospitals, which they throw away. (He did tell me that the next time I come to the office he’d be happy to give me some yardage of surgical thread so I’d have some on hand here at the farm. I’ve been told another option is to use fishing line, because it will not wick moisture.)

He told me to treat the lamb with 1cc of PenG two times per day for five more days and keep an eye on the wound. He told me if it got swollen, reddened and infected, to bring her in to the office and he would drain the wound for me. Thankfully, the lamb finished her rounds of penicillin and by the end of April I let her, her mom and sister out of the barn and into the fresh air. I weighed her and she had gained almost a pound a day, so she was eating well and obviously very healthy.

Other Advice On Hernias

In Laura Lawson’s book Managing Your Ewe and her Newborn Lambs (page 293) I read that, “Usually, umbilical hernias are a result of excessive traction of an oversized newborn lamb at birthing time.” I’m surprised that in ten years of lambing, and having many large lambs here and having heard of fellow shepherds having oversized lambs, that I have never encountered this situation before.

Lawson goes on to say, “In addition, it may be a result of cutting the umbilical cord too close to the abdomen. Occasionally, it occurs when the gap in the muscles of the navel region fails to close soon after birth. This gap gives the blood vessels from the placenta access to the unborn lamb’s circulation.”

Immediately after the "surgery" was finished the lamb was released to its ewe and other lamb.
Immediately after the “surgery” was finished the lamb was released to its ewe and other lamb.

As a side note, we never cut the umbilical. We have always left it as it dangles and dip it in iodine. I know some advise cutting them, but I was told long ago just to let it be and that has worked well for us.

Lawson goes on to say, “A veterinarian must surgically repair a hernia. An elliptical incision is made diagonally around the hernia to miss the penis in a ram lamb. Fluid and fat are removed around the hernia. The small hernia is then pushed inside and the area closed with two sets of sutures internally and one set of sutures externally. After surgery, the lamb may have a small amount of bloat. This is relieved by passing a tube through the mouth to the stomach. Lastly, the lamb is given an injection of long acting penicillin and a tetanus antitoxin shot.” In the case of my ewe lamb, it’s a good thing I didn’t read the book first!

Whether umbilical hernias in lambs are congenital or accidental seems to be debatable. Nathan Griffith (editor of sheep!) did some additional research for me and came up with conflicts of information even within the same source. He e-mailed me to say that: “The 5th edition of the Merck Veterinary Manual still carried the ‘excess traction in large lambs’ explanation. Currently, Merck lists umbilical hernia as a congenital abnormality.”

Additionally he found this reference: “Scottish sheep vet Andrew Eales mentions in his book Practical Lambing & Lamb Care (page 93), ‘This problem may have a genetic component and it is probably unwise to keep treated lambs as replacements. Take professional advice on prevention if more than the occasional lamb is affected.’

“Sheep vets Karl A. Linklater & Mary C. Smith—in their book Color Atlas of Diseases & Disorders of the Sheep & Goat (page 19)—flatly state, ‘Open umbilical hernias are usually congenital. They can result in eventration of loops of gut through the patent umbilical orifice. These hernias can be reduced successfully by surgery.’”

Nathan also mentioned to me that “Inherited umbilical hernias can show up later in life, too. When that happens, the guts drop through the inherited gap in the peritoneal muscles but are ‘caught’ by the skin, since by that time the navel has sealed itself.”

I’ve searched others of my shepherding books to try to understand what happened with Dansa’s lamb. Most of the times when I looked up “abdominal hernia” all I read about are hernias in adult ewes, related to pregnancy.

I have wondered if it’s possible that my doomed spotted lamb may have had either a birth defect, or suffered an injury in utero. Sometime during that Sunday night, Dansa expelled a dead fetus about 2 pounds in size that was still encased in its placenta but was rotted. Perhaps Dansa was injured by a blow to the side earlier in the pregnancy, which killed the twin and perhaps caused injury to the abdomen of the lamb I pulled that day.

Thankfully the dead fetus did not leak, and was not retained, which would have caused infection in Dansa. She did spend several days running around the farm looking for her lamb, but physically she’s fine. Hopefully she’ll go on to have a nice set of healthy twins next year.

Dr. Haynes goes on to say, “A hernia is an interruption of the continuity of the abdominal wall with an outpouching of the peritoneum. The condition is serious if a loop of intestine passes through the opening. It may become strangulated, causing severe pain with necrosis of that part of the bowel due to interruption of the circulation, and death of the animal. If the intestine has been there long enough for adhesions to form, surgery is the only solution to the problem.

“Umbilical hernias are obvious at or soon after birth, but must be distinguished from an umbilical abscess or hematoma. They are most common in calves. …Hernias result from omission of nature or accident and, except in the case of hereditary umbilical hernia of calves, little can be done to prevent them.” (pages 289-290)

The lamb (left) at six days of age with her dam and twin.
The lamb (left) at six days of age with her dam and twin.

One of my shepherd colleagues is also a veterinarian. When I asked him about the hernias, he told me that he believes they were accidental in nature, and not congenital, stating that there are very, very few instances of hernias in lambs and sheep. Because there is no relationship between the dams and sires of the two affected lambs, and because I have a long lambing history with those bloodlines, I tend to agree with his analysis.

But Is It Breedable?

I had been debating whether or not the sutured ewe lamb would be breedable, or whether she should be kept only as a pet/fleece sheep.

When we had our spring shearing day, I asked one of our helpers, an Emergency Medical Technician if she would remove the stitches from the lamb so that I could watch how it is done. While she was doing that for me, she showed me that there is a very small hernia next to where I had stitched. I asked her if the lamb could ever be bred. She said she certainly wouldn’t recommend it in her first year, and that probably it would be safer not to risk a pregnancy with her, in case there is a weakness in the abdominal wall.

I have decided not to breed this lamb, but have no hesitation with breeding her dam again, or her full sister. Even if this is a congenital condition, it is likely the result of random combination of DNA and recessive genetics. I would just not breed the dam to the same sire again, to be safe.

I believe bad experiences can bring positive outcomes. I not only gained a healthy ewe lamb by acting quickly based on what I had just gone through; I am convinced that if I hadn’t dealt with Dansa’s lamb on Sunday I would not have been mentally prepared to save my ewe lamb on Tuesday. Through this experience, I gained a large measure of confidence in my own ability to make quick, life-saving decisions in my flock.

It really brought home the concept of “survival of the fittest” in experiencing such a stark contrast between a lamb that could not be saved and one that could. Life and death decisions on the farm are often not in our hands, but sometimes, they are.

References: Haynes, N. Bruce. Keeping Livestock Healthy: A Veterinary Guide. Storey Communications, Inc. Pownal, Vermont. 1985, page 289-290. Lawson, Laura. Managing Your Ewe and Her Newborn Lambs. LDF Publications, Culpeper, Virginia. 1997, page 193

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