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Welcome
Speaker:
Girjesh Upmanyu.
Perineal Hernia in
Dogs.
HERNIA AND ITS
CLASSIFICATION
Hernia
• Abnormal protrusion of contents of a body
cavity through normal or abnormal
opening
• Constituents of hernia –
 Hernial ring
 Hernial sac
 Hernial contents – Intestine, Omentum,
Urinary Bladder, etc.
Classification
Based on Location :
i) External hernia – Ventral H, Inguinal H,
Umbl. H, Perineal H
ii) Internal Hernia – Diaph. H
Based on functional alterations:
i) Reducible
ii) Irreducible – incarcerated H
strangulated H
Classification
III. Based on hernial contents
i) Enterocoele – intestines
ii) Epliplocoele – Omentum
iii) Reticulocoele – reticulum
iv) Vesiculocoele – urinary bladder
IV. Based on cause
i) Congenital – anatomical variations
ii) Acquired – trauma
Diff diagnosis
Treatment:
• Reduction of contents and application of
bandages for 2-3 weeks
• Local infiltration of irritants
• Herniorrhaphy – suturing of hernial ring
• Hernioplasty – covering the gap
with mesh and suturing it
• Kelotomy – enlarging the hernial ring
Perineal hernia
• It is abnormal protrusion/ displacement of pelvic or
abdominal viscera through the weakened/ruptured
pelvic diaphragm into the region around the anus called
the perineum.
• It occurs when the perineal muscles separate, allowing
the rectal, pelvic or abdominal contents to displace.
• It is common in dog and un common in ruminants but
has been recorded in cattle and buffaloes
• This condition occurs secondary to a weakening of the
muscles
Pelvic diaphragm is composed of:
• Coccygeus muscle
• Levator ani muscle
• External anal sphincter muscles.
Anatomy
Etiology
• Cause of pelvic diaphragm weakening is poorly
understood but is believed to be associated with male
hormones
• Straining
• Congenital or acquired muscle weakness-tenesmus
• Atrophy
• Trauma
• Breed disposition – welsh corgies, boxers, boston
terriers,coolies
• Sex
• Tail docking
• Prostatic enlargement
Classifications of Perineal Hernia
• Based on Location
1. Unilateral
2. Bilateral
• Based on Position
1. Dorsal
2. Ventral
3. Sciatic or Caudal
Hernias
Hernial Contents and Hernial Sac
• Contents are contained in perineal fascia as perineal
peritonium is usaully intact so it forms the true sac
• Contents may include
1. Pelvic or retroperitneal fat
2. Peritonial fluid
3. A deviation, dilation or sacculation of the rectum
4. A rectal diverticulum
5. Prostrate gland
6. Urinary bladder
7. Small intestines
Diagnosis
• History
– Affected animals usually are presented for treatment because of
difficulty in defecation or urination
– Some owners notice swelling lateral to the anus
• Clinical signs
– Perineal swelling
– Constipation
– Dyschezia
– Tenesmus
– Rectal prolapse
– Stranguria
– Anuria
– Vomition
– Fecal incontenance
– Digital palpation of hernial ring
Differential diagnosis
• Perineal neoplasia
• Perineal gland
hyperplasia
• Anal sacculitis
• Anal sac neoplasm
• Perineal fistula
• Anal sac abscess
• Rectal neoplasia
• Anal trauma
• Anal dermatitis
Biochemical analysis
• If urinary bladder is involved( stranguria,anurea)
1. Raised serum urea
2. Raised serum creatinine
3. Raised phosphate concentrations
4. Raised serum potassium concentrations- usually after
24 hrs. of obstruction.
Diagnostic Imaging
• Usually not required
• Ultrasonography can be done to ascertain the
presence of absence of small intestine, prostrate, U
bladder
• Positive contrast cytogram – U.B.
Surgico-medicinal management
• The goal of treatment is to relieve and prevent
constipation, dysuria and organ strangulation
1. Conservative management
• Causative factors should be corrected
• Normal defection sometimes can be maintained using
laxative , stool softeners , dietary changes , enema.
• High fibre diet
• Occasional enema or manual evacuation of faeces
Cont…..
2. Surgical management
• Herniorrhaphy should always be recommended.
• Castration is recommended during herniorrhaphy
because it has been reported to reduce recurrence
• Non castrated dogs have a recurrence rate 2.7
times greater than castrated dogs.
Surgical Management:- Techniques
• Internal obturator
transposition
herniorraphy
• Traditional
Herniorapphy
Schematics of the internal obturator muscle
transposition procedure
Suture placement for Internal Obturator Transposition
herniorrhaphy
(1, external anal sphincter; 2, coccygeus muscle; 3
superficial gluteal muscle; 4, ischial tuberosity; 5,
internal obturator muscle; 6, retractor penis muscle)
Post Operative Complications
• Tenesmus
• Neuropraxia
• Urinary incontinence
• Surgical wound infections
Prognosis after surgery
• Favourable- 15% reoccurance
• Antibiotics, stool softeners, high fibre diet shall be
given
• Elizabethan collar
• Dogs with bilateral hernia shall have one side
repaired at a time
CASE NO:- 1318
A Soft puffy swelling palpable of the left side in the perineal
region just below the base of tail
Case no_1318
• History;
– Constipation
– Swelling on lateral side of anus from last 2 months
– Loss of appetite
• Clinical signs
– Perineal swelling
– Constipation
– Dyschezia
– Tenesmus
Diagnosis
Palpation of the affected site revealed
hernial ring
Based on history and clinical signs the case
was diagnosed as perineal hernia and
surgical intervention was advised
Premedication & Anaesthesia
• Atropine sulphate @ 0.04mg /kg b wt. i/m
• Diazepam @ 0.5mg/kg b wt. i/v
• Xylazine @ 2 mg/kg b wt. i/m
• Ketamine Hydrochloride @ 10 mg./kg b wt. i/v
SURGICAL
PROCEDURE
Prepared site
Positioning of the animal
Temporary closure of anus
After closure
Incision on the swelling
Hernial ring
Suturing of hernial ring
After closure
Skin closure
Post operative care
• Ceftriaxone @ 20 mg/kg b wt. i/m for 3 days
• Melonex @ 0.5 mg/kg b wt. i/m for 3 days
• CPM @ 0.25mg/kg b wt i/m
for 3 days
• Liquid diet for 5 days
Post Operative Dressing of the Suture Line.
Hernial Contents:
Thank
you

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Perineal Hernia in Dogs: Causes, Symptoms, Diagnosis and Treatment

  • 4. Hernia • Abnormal protrusion of contents of a body cavity through normal or abnormal opening • Constituents of hernia –  Hernial ring  Hernial sac  Hernial contents – Intestine, Omentum, Urinary Bladder, etc.
  • 5. Classification Based on Location : i) External hernia – Ventral H, Inguinal H, Umbl. H, Perineal H ii) Internal Hernia – Diaph. H Based on functional alterations: i) Reducible ii) Irreducible – incarcerated H strangulated H
  • 6. Classification III. Based on hernial contents i) Enterocoele – intestines ii) Epliplocoele – Omentum iii) Reticulocoele – reticulum iv) Vesiculocoele – urinary bladder IV. Based on cause i) Congenital – anatomical variations ii) Acquired – trauma
  • 8. Treatment: • Reduction of contents and application of bandages for 2-3 weeks • Local infiltration of irritants • Herniorrhaphy – suturing of hernial ring • Hernioplasty – covering the gap with mesh and suturing it • Kelotomy – enlarging the hernial ring
  • 9. Perineal hernia • It is abnormal protrusion/ displacement of pelvic or abdominal viscera through the weakened/ruptured pelvic diaphragm into the region around the anus called the perineum. • It occurs when the perineal muscles separate, allowing the rectal, pelvic or abdominal contents to displace. • It is common in dog and un common in ruminants but has been recorded in cattle and buffaloes • This condition occurs secondary to a weakening of the muscles
  • 10. Pelvic diaphragm is composed of: • Coccygeus muscle • Levator ani muscle • External anal sphincter muscles.
  • 12. Etiology • Cause of pelvic diaphragm weakening is poorly understood but is believed to be associated with male hormones • Straining • Congenital or acquired muscle weakness-tenesmus • Atrophy • Trauma • Breed disposition – welsh corgies, boxers, boston terriers,coolies • Sex • Tail docking • Prostatic enlargement
  • 13. Classifications of Perineal Hernia • Based on Location 1. Unilateral 2. Bilateral • Based on Position 1. Dorsal 2. Ventral 3. Sciatic or Caudal Hernias
  • 14. Hernial Contents and Hernial Sac • Contents are contained in perineal fascia as perineal peritonium is usaully intact so it forms the true sac • Contents may include 1. Pelvic or retroperitneal fat 2. Peritonial fluid 3. A deviation, dilation or sacculation of the rectum 4. A rectal diverticulum 5. Prostrate gland 6. Urinary bladder 7. Small intestines
  • 15. Diagnosis • History – Affected animals usually are presented for treatment because of difficulty in defecation or urination – Some owners notice swelling lateral to the anus • Clinical signs – Perineal swelling – Constipation – Dyschezia – Tenesmus – Rectal prolapse – Stranguria – Anuria – Vomition – Fecal incontenance – Digital palpation of hernial ring
  • 16. Differential diagnosis • Perineal neoplasia • Perineal gland hyperplasia • Anal sacculitis • Anal sac neoplasm • Perineal fistula • Anal sac abscess • Rectal neoplasia • Anal trauma • Anal dermatitis
  • 17. Biochemical analysis • If urinary bladder is involved( stranguria,anurea) 1. Raised serum urea 2. Raised serum creatinine 3. Raised phosphate concentrations 4. Raised serum potassium concentrations- usually after 24 hrs. of obstruction.
  • 18. Diagnostic Imaging • Usually not required • Ultrasonography can be done to ascertain the presence of absence of small intestine, prostrate, U bladder • Positive contrast cytogram – U.B.
  • 19. Surgico-medicinal management • The goal of treatment is to relieve and prevent constipation, dysuria and organ strangulation 1. Conservative management • Causative factors should be corrected • Normal defection sometimes can be maintained using laxative , stool softeners , dietary changes , enema. • High fibre diet • Occasional enema or manual evacuation of faeces
  • 20. Cont….. 2. Surgical management • Herniorrhaphy should always be recommended. • Castration is recommended during herniorrhaphy because it has been reported to reduce recurrence • Non castrated dogs have a recurrence rate 2.7 times greater than castrated dogs.
  • 21. Surgical Management:- Techniques • Internal obturator transposition herniorraphy • Traditional Herniorapphy
  • 22. Schematics of the internal obturator muscle transposition procedure
  • 23. Suture placement for Internal Obturator Transposition herniorrhaphy (1, external anal sphincter; 2, coccygeus muscle; 3 superficial gluteal muscle; 4, ischial tuberosity; 5, internal obturator muscle; 6, retractor penis muscle)
  • 24. Post Operative Complications • Tenesmus • Neuropraxia • Urinary incontinence • Surgical wound infections
  • 25. Prognosis after surgery • Favourable- 15% reoccurance • Antibiotics, stool softeners, high fibre diet shall be given • Elizabethan collar • Dogs with bilateral hernia shall have one side repaired at a time
  • 26. CASE NO:- 1318 A Soft puffy swelling palpable of the left side in the perineal region just below the base of tail
  • 28. • History; – Constipation – Swelling on lateral side of anus from last 2 months – Loss of appetite • Clinical signs – Perineal swelling – Constipation – Dyschezia – Tenesmus
  • 29. Diagnosis Palpation of the affected site revealed hernial ring Based on history and clinical signs the case was diagnosed as perineal hernia and surgical intervention was advised
  • 30. Premedication & Anaesthesia • Atropine sulphate @ 0.04mg /kg b wt. i/m • Diazepam @ 0.5mg/kg b wt. i/v • Xylazine @ 2 mg/kg b wt. i/m • Ketamine Hydrochloride @ 10 mg./kg b wt. i/v
  • 36. Incision on the swelling
  • 41. Post operative care • Ceftriaxone @ 20 mg/kg b wt. i/m for 3 days • Melonex @ 0.5 mg/kg b wt. i/m for 3 days • CPM @ 0.25mg/kg b wt i/m for 3 days • Liquid diet for 5 days
  • 42. Post Operative Dressing of the Suture Line.

Editor's Notes

  1. Dressing of suture line