Wednesday, August 29, 2012

1069. Update: Perineal hernias (bilateral).


Did the maid do it?

Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS

First written: 30 November, 2008

Update: 30 August, 2012 TOA PAYOH VETS

Be Kind To Pets

Veterinary Education

Project 2010-0129

Friday, August 3, 2012

1023. Did the maid cause the perineal hernias?



Today Saturday, I came to work at 9 am. Reviewed the case of the Jack Russell who had passed away on the op table yesterday.



This was a case of a very poor prognosis because



1. The bladder was twisted. During surgery, this bladder was dark red and bleeding when seen from the hernia side, only a small portion of the neck of the bladder was the normal pink.



2. The associate vet was not able to catherise and lots of dark red blood inside the swollen bladder leaked out).



3. In addition, fresh blood leaked out from the anus.



An emergency surgery to reduce the bladder size was done but the dog passed away after the repair of the right perineal hernia. The owner said that around 4 weeks ago, the dog gave a loud cry as the maid had hit him. He was frightened of the maid since then. "Did the backside swelling disappear after some time?" I asked the father. "Yes," he said. "I could feel some water inside the swelling. It disappears but now it comes back again and grows much bigger."



So, was the maid's hitting cause the perineal hernias (left and right) to develop? It is a possibility but I don't think so. Old male, not sterilised dogs do develop perineal hernias and this Jack Russell fitted the picture. He was around 10 years old, not neutered and had a large perineal swelling that could reduce. I diagnosed perineal hernia.



The associate vet (Vet 1) diagnosed tumour e.g prostate tumour as there was too much bleeding from the penis. "Are you sure?" Vet 1 asked me. "Yes, I am 100% sure. I based this on the history of the backside swelling increasing in size and disappearing when pressed some 4 weeks ago. Look at the big swellings on the backside." As the dog came in recumbent and not able to stand up, the perineal hernia swellings were NOT obvious. The profuse bleeding from the anus and the penis distracted from the not so obvious perineal hernial swelling especially when the dog was so ill and lying on his die panting. Therefore, I would not expect Vet 1 to miss the diagnosis of perineal hernia which was the main problem. All associate vet cases are monitored by me to ensure a high standard of care and all vets have to learn from experiences of "challenging" cases presented. A normal standing dog will show the perineal hernia swelling but this dog was down and out and therefore its bilateral backside swellings were not obvious.



The father requested an X-ray to confirm the diagnosis of tumour. "Normally, no X-ray will be done if it is a perineal hernia," I said to the vet. "However, the owner had requested X-ray to confirm. It should be done. In any case, this dog would die soon as he could not stand up and was in great pain, passing blood in the urine and stools. This is serious and the owner has been told. I had shown the owner past case images of perineal hernia from www.toapayohvets.com and he understood what the problem was."



X-RAY

Showed a large swollen bladder trapped on the right perineal side while the left side was swollen with intestines filled with stools



Blood test - the owner did not want a blood test.



SURGERY. The dog passed away on the operating table after the bladder was emptied of over 30 ml of fresh blood and pushed back into the abdomen and the skin stitched. The owners knew that the chances of survival was practically low but wanted to take the chance.



CONCLUSION. If the perineal hernias were discovered much earlier, chances of survival are good. Male dogs are prone to getting perineal hernias and one prevention is to get the male dogs neutered early in his life. This may appear "cruel" to the internet generation. Therefore perineal hernias and anal tumours do present in the some of the older non-sterilised males in old age.





tpvets_logo.jpg (2726 bytes)5558 - 5565. Bilateral perineal hernias. Twisted bladder (right side) and twisted intestines (left side) trapped inside the perineal hernias     webpage:
http://www.sinpets.com/dogs/20120829bilateral_perineal_hernias_jack_russell_toapayohvets.htm

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