Tuesday, July 12, 2011

501. The mother of all perineal hernias

Yesterday, Tuesday, July 12, 2011, at 7 pm, I reviewed the Silkie with the bilateral perineal hernia. He had passed stools and the owners were there and had fed chicken. "It is OK to feed till 10 pm," I said and took away the water bowl. "I will be operating on him tomorrow at 10 am."

"He passed blood in his soft stools," the lady said.
"Could it be the colour of the reddish sticks (treats) you feed him?" I asked.
"No," she said. "He did not have this stool colour previously."

So, the dog may be having colitis due to the accumulation of stools in his rectum as you can see from the palm-sized hernia. Will post photo later. This means that there cannot be a delay in surgical repair of the mother of perineal hernia. I will start at 9.30 am today. It is 4.37 am now. Will review the photos back, side and front for the best approach as this surgery is much more challenging than a simple small perineal hernia.

"You will see a messy big hole with ill-defined muscles," I said to Dr Vanessa earlier. I thought of asking her to perform the surgery. I said to her: "It will be very difficult to stitch up the muscles as they don't exist normally due to atrophy and pressure over many months from the hernia. On the lower 1/3, the pudendal nerve and blood vessels are supposed to be located. If the vet stitches up the pudendal nerve while closing up the big hole, I don't know whether the dog will be paralsyed or not!" This is what I fear most. The nerve just can't be seen now since the muscle anatomy is no longer normal.

So, it is not just an old dog with high anaesthetic risk. It has also surgical risk as the defect is more than 6 inches long, 3 inches deep and 3 inches wide. (One inch = 2.5 cm). I really prefer not to perform such a surgery. If a vet picks and choose, then the mother of all perineal hernias will not be chosen. And the poor dog will suffer from soft stools to bloody diarrhoea, dehydration and death from intestinal strangulation.

So, there is no time to spare. I need to operate today Wednesday 9.30 am as scheduled.

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