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Surgical Repair of Perineal Hernia in a Male Dog by Internal Obturator Transposition Herniorrhaphy Technique

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Surgical Repair of Perineal Hernia in a Male Dog by Internal Obturator Transposition Herniorrhaphy Technique VETERINARY CLINICAL SCIENCE Journal homepage: www.jakraya.com/journal/ vcs CASE REPORT Surgical Repair of Perineal Hernia in a Male Dog by Internal Obturator Transposition Herniorrhaphy Technique Chauhan S.A., Suryawanshi R.V., Tayyab Attar, A.H. Ulemale, Toufik Shaikh and Shubhum Pant Department of Surgery and Radiology, Krantisinh Nana Patil College of Veterinary Science, Shirwal, Satara, Maharashtra, India. Abstract A chronic case of perineal hernia in a 9-year-old nondescript male dog was treated surgically by internal obturator transposition herniorrhaphy *Corresponding Author: technique. Radiography and sonography assisted in planning the surgery as Shalaka Chauhan it gave a fair idea of hernial contents which included, urinary bladder, Email: [email protected] hyperplastic prostate gland, small and large intestine. The animal was maintained on fluid therapy, antibiotic coverage and supportive therapy. Received: 10/05/2020 The dog recovered uneventfully and progressively became healthy with the Accepted: 02/06/2020 resumption of normal urination and defecation. Perineal hernia, Internal obturator muscle, Transposition, Keywords: Herniorrhaphy, Dog, Prostate hyperplasia. 1. Introduction urinary incontinence. Physical examination revealed Perineal hernia refers to the failure of the that the swelling extended almost to the inguinal region muscular pelvic diaphragm to support the rectal wall, and there was pain on palpation. On X-ray lumbosacral resulting in herniation of pelvic and, occasionally, lateral view revealed perineal herniation of intestinal abdominal viscera into the subcutaneous perineal loops, presence of stool, and gas. Spondylosis and region. The most common presentation of perineal bridging at the level of L4 and L5. Liver and urinary hernia in dogs is a unilateral or bilateral non-painful bladder shadows are not seen due to the elevation of the swelling of the perineum. Clinical signs do occur, but coccygeal vertebra due to the presence of hernia. Blood not always. Clinical signs may include constipation, profile revealed Hb - 9.8 g/dl (L) (10 - 16g/dl), PCV - obstipation, dyschezia, tenesmus, rectal prolapse, 23.1% (L) (30-50%), WBC - 23400 (H) (6000-1600). stranguria, or anuria. The definitive diagnosis of Ultrasonographic examination revealed a backward perineal hernia is based on clinical signs and findings displacement of the urinary bladder due to benign of weak pelvic diaphragm musculature during a digital prostate hyperplasia. Size of prostate lobes was 4.5 x rectal examination (Gosai et al., 2019). In dogs, 3.1cm and 5.4 x 3cm. perineal hernias are mostly treated by surgical intervention. Appositional herniorrhaphy is sometimes 3. Treatments difficult to perform as the levator ani and coccygeus Pre-operative management: The dog was kept muscles are atrophied and unsuitable for use. on lactulose syrup 5ml bid for 5 days along with Alternative techniques of perineal herniorrhaphy were haemup syrup 5ml bid for 5 days. To correct the described in the 1980s. The weaker ventral area of the dehydration, Ringer’s lactate solution was initiated as perineal diaphragm seems to be better supported by 20ml/kg body, along with 10ml/kg body weight of transposition of the internal obturator muscle, with Sodium chloride with the addition of 25% dextrose. To decrease in the recurrence rate below 10% (Bellenger check the pain Inj. Melonex was given @ 0.2mg/kg and Canfield, 2002). Additional techniques bwt IM. transposition of both the internal obturator muscle and Prior to the surgery urine was removed with the superficial gluteal muscle showed excellent results help of catheter to avoid spillage during the procedure in 89.7%, good results in 7.7%, and poor results in and also to ease to push back the hernial contents. Soap 2.6% of the cases (Raffan, 1993), in addition to the use enema helped to empty the rectum. Inj. Atropine@ of synthetic implants and biomaterials, Pexy techniques 0.04mg/kg IM was used followed by Xylazine @ (Clarke, 1989) may be used to prevent rectal prolapse 1.5mg/kg IM and Diazepam@ 0.25 mg/kg IV were and bladder and prostate gland displacement. used as pre-anaesthetics. General anaesthesia was induced with Inj. Ketamine @ 10mg/kg IV and 2. History and Diagnosis maintained with 2:1 ratio of Inj. Ketamin and Inj. A 9 year old male non-descript dog was brought Diazepam. The animal was placed in dorsal with a history of swelling present at the right perineal recumbency, and the perineal region prepared for a region for two months, constipation, dehydration, and curvilinear incision beginning at the coccygeus muscle, Veterinary Clinical Science | April-June, 2020 | Volume 08 | Issue 02 | Pages 33-35 © 2020 Jakraya Chauhan et al...Surgical Repair of Perineal Hernia in a Male Dog By Internal Obturator Transposition Herniorrhaphy Technique Fig 1: X-ray showing a hernial contain – intestinal Fig 2: USG reveals hyperplastic prostate gland along loops full with feces and gas. urinary bladder displaced into the hernia Fig 3: Hernial Sac and contents Fig 4: Hernial sac contents included, urinary bladder, prostate gland, large and small intestine loops. Fig 5: Herniated urinary bladder on the left side and Fig 6: Internal obturator muscle transposition enlarged prostate gland on the right side. technique of herniorrhaphy . Fig 7: Immediate post operative with the drain. Fig 8: Postoperative 4 th day and 15 th day curving over the hernial bulge lateral to the anus and large intestine, prostate gland and mesentry that were extending 2-3cm ventral to the pelvic floor. Followed repositioned by applying gentle pr essure. Then the by the incision of the subcutaneous tissue and fascia periosteum and internal obturator muscles from the along the caudal border of the ischium and origin of the ischium were transposed dorsomedially, the muscles internal obturator muscle. The hernial contents were are rolled into the defect to allow the apposition identified to be urinary bladder, loops of the small and between the coccygeus, levator ani, and eternal anal Veterinary Clinical Science | April-June , 2020 | Volume 08 | Issue 02 | Pages 33-35 © 2020 Jakraya 34 Chauhan et al...Surgical Repair of Perineal Hernia in a Male Dog By Internal Obturator Transposition Herniorrhaphy Technique sphincter (Fossum, 1997). Simple interrupted sutures females (Burrows and Harvey, 1973; Hayes, 1978). are taken with Vicryl No. 2 by apposing the combined Hormonal imbalance has an impact on the development levator ani and coccygeus muscles with the external of perineal hernia, with possible involvement of benign anal sphincter muscle dorsally. Then sutures taken prostatic hyperplasia (Bellenger and Canfield, 2002). between the internal obturator and external anal However, it has not been definitely confirmed, except sphincter medially and the levator ani and coccygeus for castration appearing to be a major factor in reducing muscles laterally. Subcutaneous sutures are taken with the incidence of the disease (Hayes, 1978). Basinger Vicryl No. 2-0. Skin is sutured with the Nylon using a and Luther (1993) observed that 80% of dogs older horizontal mattress pattern. Penrose drain was placed than six years and 95% of dogs older than nine years inside for felicitating drainage. Post surgery, the dog had benign prostatic hyperplasia. Dogs with enlarged was kept on Tab Cefotaxime 500mg bid for 5 days, Tab prostate usually have tenesmus during defecation. The Melonex 2.5mg bid for 3 days and Tab Emenz 10 mg perineal diaphragm is weakened because of tenesmus. bid for 5 days and a strict liquid diet for 10 days. Benign prostatic hyperplasia can be alleviated and Sutures were removed by 15 th day. perineal hernia recurrence can be reduced by castration. In the current case transposition of the internal 4. Discussion obturator muscle provided strength to the perineal wall A multitude of factors has been incriminated in and the dog recovered uneventfully. the etiopathogenesis of perineal hernia. Suggested theories include congenital predisposition, structural 5. Conclusion weakness of the pelvic diaphragm, hormonal Therefore from this case it could be concluded imbalance, prostatic disease, and chronic constipation. that recurrence of hernia or contralateral occurence of Yet, the etiology most likely involves a combination of hernia could be prevented by the internal obturator contributing factors (Bojrab, 1981). The disease occurs muscle transposition techniques and castration in this 9 predominantly in older male animals and rarely in year old male dog. References Basinger RR and Luther PB (1993). Prostatic disease. In: Fossum TW (1997). Small animal surgery, (Ist Ed.), Mosby- disease mechanism in small animal surgery. (2nd Ed.) Year Book, Inc...Chapter 16 . pp. 354. (Bojrab MJ, Ed.). Lea and Febiger, Philadelphia . pp. Gosai RK, Chauhan PM, Patel KD and Patelia HR (2019). 538-544. Perineal hernia in a buffalo: a case report. Veterinary Bellenger CR and Canfield RB (2002). Perineal hernia. In: Research International, 07(1): 13-14. textbook of small animal surgery. (3rd Ed.) (Slatter D Hayes HM (1978). The epidemiologic features of perineal Ed.). Saunders, Philadelphia . pp. 487-498. hernia in 771 dogs. Journal of the American Animal Bojrab MJ (1981). Perineal herniorrhaphy. Compendium , Hospital Association , 14: 703-712. Continuing Education for Veterinarians , 3: 8-15. Raffan PJ (1993). A new surgical technique for repair of Burrows CF and Harvey CE (1973). Perineal hernia in the perineal hernias in the dog. Journal of Small Animal dog. Journal of Small Animal Practice , 14: 315-332. Practice , 34: 13-19. Clarke RE (1989). Perineal herniorrhaphy in the dog using polypropylene mesh. Australian Veterinary Practitioner , 19: 8-14. Veterinary Clinical Science | April-June, 2020 | Volume 08 | Issue 02 | Pages 33-35 © 2020 Jakraya 35 .
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