Monday, January 11, 2016

INTERN Inguinal hernia with strangulated uterine horns - Miniature Schnauzer

Miniature Schnauzer, Female, Not spayed, 7 years



HOOK







MEDICAL HISTORY
The owners were busy and delayed the scheduled operation. Within a week, the swelling became bigger. The black patch of skin became gangrenous. The dog was given antibiotics for 7 days before the operation.










PRACTISE EVIDENCE-BASED MEDICINE
1. Blood test was not done to reduce medical costs. However, I prescribed 7 days of spiramycin and metronidazole antibiotics (Stomorgyl) before surgery.

2. X-rays and ultrasound.
The owner went to another vet for a second opinion. The vet performed X-rays and ultrasound and confirmed inguinal hernia with pyometra and a bladder stone. X-ray is shown below:




SURGERY - OVARIOHYSTERECTOMY BY Dr Daniel Sing. Domitor and ketamine IV at 0.33 ml and 0.4 ml for an 8.5 kg old dog. This was  followed by isoflurane and oxygen gas. Antisedan IM was given to reverse the domitor effects. IV drip was given during and after surgery. Methone pain killer injection was given SC. The dog was not in pain post-operation. 




Gangrenous skin seen as black patch before surgery. This indicated blood supply to this area of skin was compromised, leading to death of skin cells. 



A foul rotting smell was present in the operating room as the gangrenous uterine horns were taken out.  





The time taken between first skin incision (12.59pm) and completion of skin stitching (2.12 pm) was
73 minutes. 2 packets of Monosyn were used.

The owner was WhatsApp the gangrenous uterus and omental tissues that packed the inguinal hernia. This would update her on how serious the dog's medical condition was. Gangrene can kill a dog after surgery as the toxins cause multiple organ failure. .




CONCLUSION


Surprisingly, this dog survived the operation and anaesthetic.






Hernias are best repaired when they are small. It will be much less costly and worrying about anaesthetic death on the operating table as in this case of a sick dog being operated upon.

If the dog had been spayed when she was young, she would not have got pyometra (pus in the uterus).

This is a very rare case of strangulated uterus being herniated through the inguinal ring and becoming a gigantic inguinal hernia. It is also a rare case with a happy ending. Much depends on the state of health of the patient, when to do surgery and the skills and experience of the veterinary surgeon and his or her team.














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