Sciatic perineal hernia in two dogs

A sexually intact, male Chihuahua and a spayed female poodle were presented with left perineal masses. The masses were identified as perineal hernias by rectal palpation. Surgical exploration of the perineal region in each dog revealed retroperitoneal fat protruding between the sacrotuberous ligament and the coccygeus muscle (sciatic perineal hernia). The hernias were repaired using modifications of the standard or internal obturator flap herniorrhaphies. The levator ani muscle was grossly and histologically normal in the Chihuahua and grossly normal in the poodle. No short- or long-term complications were reported in either case. The management of sciatic perineal hernia is similar to the more common caudal perineal hernia.     

Surgical treatment of perineal hernia in the dog

In a nine-year period 101 dogs which were available for subsequent follow-up studies, were subjected to perineal hernia surgery. In thirty-six dogs the hernia was bilateral and, therefore, 137 hernias were initially operated. In 111 operations the standard perineal technique was adopted. In twenty-six operations the superficial gluteal muscle was reflected and sutured into the hernial defect (‘gluteal flap’). Later, following recurrence of hernia or new development on the second side, a further sixteen operations were done, including three anal splitting procedures. In all cases the deep sutures were of monofilament nylon. A post-operative follow-up was carried out for a minimum period of 12 (average 39) months. The operative and post-operative complications included superficial and deep wound infection, partial or complete sciatic paralysis, rectal prolapse and recurrence of the hernia following breakdown of the repair, as well as occurrence of the hernia on the opposite side. The success rate (75 per cent excluding six immediate post-operative fatalities) judged by remission of signs and lack of recurrence was higher in the standard technique (81 per cent) than the gluteal flap method (64 per cent). Anal splitting was unsuccessful and resulted in faecal incontinence. The standard technique was slow, sometimes gave limited exposure but was rarely associated with wound breakdown (13 per cent of operations), though sciatic paralysis was only noted in this procedure. The gluteal flap method was longer, gave excellent exposure with no risk of sciatic nerve damage, but was often associated with wound breakdown (58 per cent). Both techniques led sometimes to rectal prolapse. Castration with hernial repair resulted in a lower recurrence rate (13 per cent v. 20 per cent). Castration should be carried out in all cases of perineal hernia.     

Treatment of perineal hernia in the dog—a reassessment

The results of treatment of fifty-four dogs seen at the University of Pennsylvania Veterinary Hospital with perineal hernia were analysed. Conservative treatment was not satisfactory for dogs which strained to defaecate. Perineal herniorrhaphy was followed by recurrence of the hernia in 37% of the dogs; continued straining to defaecate, urinary problems and rectal prolapse were other post-herniorrhaphy sequelae. Anal splitting was performed in eight dogs; soiling of the anal area and occasional incontinence were reported in some dogs.     

Ultrasonography and surgical management of a perineal hernia in a donkey

This case report records a unilateral perineal hernia in a 7-year-old female donkey. The donkey had a history of unilateral swelling lateral to the left vulvar lip and difficulty in defaecation. Upon palpation, the swelling was painless, soft and reducible. Ultrasonography revealed a hyperechoic hernia sac containing dilated nonmotile bowel with homogenous hypoechoic contents. Primary herniorrhaphy was performed after repositioning of the herniated bowel. The donkey made an uneventful recovery with no recurrence or complications for 6 months of available follow-up. In conclusion, perineal hernia should be considered in the differential diagnosis of perineal swellings in donkeys. Clinical examination, ultrasonography and surgical exploration are valuable for definite diagnosis of perineal hernia in donkeys. Surgical herniorrhaphy was successful in correcting the problem in this case.     

Serum testosterone and estradiol 17-beta concentrations in 15 dogs with perineal hernia

Serum testosterone and estradiol 17-beta concentrations, and serum testosterone-to-estradiol ratio were evaluated in 15 dogs (greater than or equal to 5 years old) with perineal hernia (9 sexually intact males and 6 castrated males) and in 9 clinically normal sexually intact male dogs greater than or equal to 5 years old. There was no significant difference in serum testosterone-to-estradiol ratio between sexually intact male dogs with perineal hernia and clinically normal sexually intact male dogs. In castrated dogs with perineal hernia, serum testosterone concentration and testosterone-to-estradiol ratio were significantly (P less than 0.05) lower, compared with those values in sexually intact dogs with perineal hernia and in clinically normal sexually intact male dogs. There was no significant difference in serum estradiol 17-beta concentration among sexually intact male dogs with perineal hernia, castrated dogs with perineal hernia, and clinically normal sexually intact male dogs. Serum testosterone and estradiol 17-beta concentrations in dogs with perineal hernia did not differ from those values in clinically normal male dogs of the same age. Castration cannot be recommended for the treatment of perineal hernia unless a castration-responsive contributing factor such as prostatomegaly is identified, unless the pelvic diaphragm of dogs with perineal hernia has high sensitivity to normal or low serum testosterone and estradiol 17-beta concentrations, or unless there is documentation that other androgens and/or estrogens are involved.     

Retroflexion of the urinary bladder associated with a perineal hernia in a female cat

A case of retroflexion of the urinary bladder into a bilateral perineal hernia in a female domestic shorthaired cat, three weeks postpartum, is reported. The bladder was repositioned and a cystopexy performed. A pelvic ostectomy was also carried out in order to alleviate the narrowing of the pelvic canal caused by an untreated acetabular fracture. Bilateral perineal herniorrhaphy was performed.     

Rectum diverticulum/perineal hernia surgery through longitudinal contracting of the wall of the rectum

Older male dogs often exhibit the symptoms of rectum diverticulum and perineal hernia. In order to point out the often common reason of these disorders, the term "rectum diverticulum/perineal hernia complex" has been introduced. In a large group of such patients two methods of surgical correction of this problem were retrospectively evaluated. Only patients were included in this evaluation that were euthanized if recurrence occurred. In 21 patients (group 1) the often performed method of Bojrab was used, both in rectum diverticulum and in perineal hernia operations. In group 2 15 dogs were subjected to the same operation technique, but we performed an additional pleating contraction of the herniated gut wall layers. In case of visible recurrence at an age of at least 11 years the dogs were euthanized. Group 1 showed a postoperative survival time of 3.61 +/- 0.96 years until recurrence, group 2 revealed recurrence not before 4.93 +/- 0.93 years post operationem. The difference is significant (p < 0.05). It is the opinion of the authors that additional longitudinal contracting by pleating of the gut markedly prolonges the point of time when recurrence appears.     

Use of porcine dermal collagen in the repair of perineal hernia in dogs--a preliminary report

Porcine dermal collagen was used for the repair of 27 perineal hernias in 21 dogs. The material was generally well tolerated and the overall success rate was 59.3 per cent.     

Evaluation of concurrent perineal hernia in adult male dogs presenting with nontraumatic,acquired inguinal hernias

A possible association between the development of nontraumatic, acquired inguinal hernias (NAIH) and perineal hernias (PH) has been postulated in adult dogs. The objective of this study was to evaluate the frequency of concurrent diagnosis of PH in dogs presented with NAIH and determine potential risk factors for concurrent PH and NAIH. Medical records of adult male dogs presented for NAIH to 4 hospitals between 2007 and 2017 were retrospectively reviewed. Twenty-one dogs with NAIH were included, 8 of which had concurrent PH. There were no significant differences between dogs with and without PH; however, among dogs with both conditions, intact dogs (8.1 ± 1.4 years) were younger than neutered dogs (11.7 ± 1.0 years; P = 0.007). Thirty-eight percent of male dogs presenting for NAIH had concurrent PH, indicating that these conditions commonly occur together. Dogs presenting for NAIH should be carefully evaluated for concurrent PH before surgical intervention.     

产房仔猪阴囊疝快速手术操作细则

阴囊疝是产房仔公猪常见的一种外科疾病,患有阴囊疝的仔公猪生长缓慢,饲料报酬低,肉的品质差。因此,文章从生产实际出发,就产房患有阴囊疝仔公猪的诊断要点、手术流程、注意事项进行阐述,以期为一线兽医人员提供借鉴,对猪场生产管理者有所帮助。     

Use of laparotomy in a staged approach for resolution of bilateral or complicated perineal hernia in 41 dogs

OBJECTIVE: To evaluate the value of laparotomy as the initial step in the treatment of bilateral or complicated perineal hernia (PH) in dogs. STUDY DESIGN: Retrospective study. ANIMALS OR SAMPLE POPULATION: Forty-one dogs with PH. METHODS: Dogs with bilateral or complicated PH treated by a 2-step approach between November 1997 and December 2001 were studied. Inclusion criteria for complicated PH were: recurrence of PH, unilateral PH with a major rectal dilatation, PH with a concurrent surgical prostatic disease, and PH with retroflexed bladder. Colopexy, vas deferens pexy, cystopexy, and prostatic omentalization were performed during laparotomy as needed. Later, PH was performed by internal obturator muscle flap (IOMF) or if there was a perineal rent or weakness on the contralateral side, appositional herniorrhaphy was performed. Outcome was followed for >/=6 months. RESULTS: PH were bilateral (20 dogs) or unilateral (21). Twenty-one (51%) dogs had prostatic disease (clinical or ultrasonography diagnosis; 17 confirmed histologically) and 12 (29%) had urinary bladder retroflexion. Forty-one colopexies, 32 vas deferens pexies, 6 cystopexies, and 9 prostatic surgeries (omentalization or perineal cyst resection) were performed. PH was performed 2-20 days (median, 6 days) later: 61 IOMF transpositions, 13 appositional. Mean follow-up time was 26.6 months (range, 6-54 months, median, 27 months). PH was resolved in 37 (90%) dogs; 4 dogs had recurrence, and all occurred within 6 months. Thirty-eight (92%) dogs had an improved quality of life (good in 34 dogs, fair in 4 dogs). Wound complications occurred in 7 dogs (17%). Postoperative urine dribbling occurred in 15 dogs (37%) and was irreversible in 7 dogs (17%). Postoperative fecal straining persisted in 18 dogs (44%), and was permanent in 4 dogs (10%). Fecal incontinence did not occur. CONCLUSIONS: In bilateral or complicated PH, fixation of the urinary bladder and colon, and treatment of prostatic disease increase the chances of resolution. Emptying of the perineal space by organ pexy allows improved observation during herniorrhaphy. Despite a 90% clinical resolution, dogs with complicated PH treated by a 2-step protocol may have persistent urinary and fecal disorders. CLINICAL RELEVANCE: To improve the prognosis of bilateral or complicated PH, investigation and treatment of concomitant lesions (rectal, prostatic, bladder) should be part of a rational surgical strategy using a 2-step protocol.     

Transplanting the superficial gluteal muscle in the treatment of perineal hernia and flexure of the rectum in the dog

The authors distinguish between perineal hernia and flexure of the rectum. They describe in detail an operative procedure to treat these conditions using a transplanted superficial gluteal muscle to reinforce the ischio rectal fossa.     

一例小公犬嵌闭性脐疝的手术诊治

犬脐疝是指犬的腹腔脏器连同腹膜经脐孔进入脐孔部皮下所造成的疾病。可复性脐疝主要症状为患犬的脐部出现一个局限性半球状突起,质地柔软,无热无痛,按压囊状物或仰卧时肿胀物体积会减小,甚至消失;用手可以摸到疝口;听诊该部有肠蠕动音。而嵌闭性脐疝触摸肿胀,指压囊状物坚实紧张,若疝内容物是肠管,则表现急腹症症状,听诊该部没有肠蠕动音,     

Epidermal growth factor and active caspase-3 expression in the levator ani muscle of dogs with and without perineal hernia

Objectives : To perform a histological and immunohistochemical study of epidermal growth factor, transforming growth factor‐alpha and their receptor, as well as the apoptotic signal active caspase‐3 in the levator ani muscle of dogs with and without perineal hernia. Methods : Biopsy specimens of the levator ani muscle were obtained from 25 dogs with perineal hernia and 4 non‐affected dogs and were processed for Masson and immunohistochemical staining. Results : The affected dogs exhibited myopathological features, internalised nuclei, destruction and abnormal size of muscle fibres, which were replaced by collagen. The immunohistochemical study revealed active caspase‐3, epidermal growth factor, transforming growth factor‐alpha and epidermal growth factor receptor in the levator ani. Compared to the healthy muscle, transforming growth factor‐alpha staining intensity was lower in the affected muscle, whereas epidermal growth factor receptor and active caspase‐3 staining were higher. Clinical Significance : Pelvic diaphragm muscle weakening is the leading cause of perineal hernia in the dog. Survival and death signals expressed in these muscles may contribute to the pathogenesis of this disease. This study reports epidermal growth factor, transforming growth factor‐alpha and epidermal growth factor receptor immunohistochemical expression in the skeletal muscle and suggests that perineal hernia in the dog is accompanied by levator ani muscle atrophy, increased expression of epidermal growth factor receptor, caspase‐3 activation, and decreased expression of transforming growth factor‐alpha.