Atresia ani

1. Dept. of Medicine , Surgery
and Obstetrics
A Presentation On
Anal Atresia
Rectovaginal fistula
Dermoid Cyst

2. Anal Atresia
Anal atresia is a
congenital anorectal
malformation (ARM)
where a normal anal
opening is absent at birth.
ARMs comprise of a broad spectrum
of defects ranging from minor (e.g.,
membranous covering) to complex
cloacal malformations involving the
urinary and genital tracts as well

3. Four types of atresia ani have been reported,
including:
 Congenital anal stenosis (Type I);
 Imperforate anus alone (Type II)
 Combined with more cranial termination
of the rectum as a blind pouch (Type III)
 Discontinuity of the proximal rectum with
normal anal and terminal rectal
development (Type IV).
Types of atresia ani

4. The cause is not known but may have a genetic component or may
be from an insult to the fetus in critical developmental stages in
utero. Environmental teratogens, plant toxins and a few viruses are
recognized complicating factors in calves. Atresia ani is the most
common intestinal defect in sheep and usually arises during the
embryonic period which results from autosomal recessive gene.
Etiology

5. Absence of an anal opening
Depression
Anorexia Colic
Marked gradual
abdominal distension
Tenesmus
Lack of feces.
Vomiting.
Clinical signs

6. Atresia ani can be diagnosed by
 simple visual examination
 By digital palpation and
 The clinical signs
Diagnosis

7. Surgical Procedure:
1. The Calf was placed in a lateral recumbency with its hind quarter raised high.
2. The perineal region was prepared for aseptic surgery.
Treatment

8. 3. For Local infiltration : 2% Lignocaine hydrochloride(4-5ml)/calf was done at
the perineal region below the tail. Low epidural anaesthesia (3ml).
4. A circular incision was made on the bulge of the anus to remove a circular
piece of skin.
5. The rectum was exposed by separation of the perineal muscles.
6. Hold the rectum with stay suture and remove the feces using dushcane ( a pipe
containing water source , use to remove debris ).
Treatment

9. 7.Suture ( simple interrupted ) the rectum with skin
like urethrostomy.
4 interrupted suture – ventral, dorsal, right, left
8. The new opening line should be cleaned with
finger using coconut oil 2-3 times per day to
prevent auto healing
Treatment

10. POST OPERATIVE CARE
The animal was administered Enrofloxacin @
5mg/kg for five days.
Meloxicam @0.5 ml for 3 days
Routine dressing with povidone iodine
ointment and application of topicure spray as a
fly repellant.
The calf showed normal in defecation with
minimum tenesmus and active in nature on the
3rd postoperative day and therefore the sutures
were removed on 10th post-operative day and
the animal made a noticeable recovery.

11.  Fecal incontinence
 Persistent megacolon
 Anal stricture
 recurrent cystitis.
Complications after
surgery

12. in
Rectovaginal fistula
A rectovaginal fistula in a cow
is a rare condition where there is
an abnormal connection or
passage way between the rectum
and the vagina.This can lead to
the passage of fecal material into
the reproductive tract and can
result in health issues for the
cow.

13. 1.Congenital
2.Local infection
3.Traumatic :
A)Post-partum
B) Secondary to surgery :
• following low anterior rectal resection
• following procedures for pelvic floor
dysfunction
• following haemorrhoid surgery
• following drainage of local infection.
Etiology

14. C)Resulting from violent acts.
4.Chronic inflammatory bowel disease :
-crohn's disease
-ulcerative colitis
-indeterminate colitis
5.following radiation therapy of tumors in the
lesser pelvis
6.resulting from carcinoma
Etiology

15. CLINICAL SIGNS
• 1.passage of gas or stool from vagina
• 2. Foul smelling vaginal discharge
• 3.chronic vaginal infection
• 4.pain during intercourse
• 5.incontinence
• 6.tenesmus
• 7.abdominal distention
• 8.irritation of the vulva

16. Diagnosis
Diagnosis of a rectovaginal fistula is typically made by
the history of the passage of stool and/or gas from the
vagina, in addition to a physical exam.
A vaginal exam with a speculum and a rectal exam
should be performed.
Ultrasound
CT scan
MRI

17. Treatment
Surgical techniques:
A)In case of internal attachment of rectum
to vagina:
1.After adequate restraint and preparation, a
transverse incision is made between the
rectum and vagina.
2. By using a combination of sharp and
blunt dissection in a horizontal plane, the
fistula is exposed.

18. Treatment
3 .Ideally, two thirds of the thickness of the shelf
should be with the rectum and one third with the
vaginal shelf.
4. Most fistulas measure 3 to 5 cm. Dissection is
continued 3 to 4 cm rostral to the fistula.
5.The rectal defect is closed transversely by using
No. 0 or 1 absorbable sutures in a simple interrupted
pattern placed in the submucosa.

19. Treatment
6.The first suture should divide the defect in half ,the next
two sutures should be placed to bisect the halves, and so
on.
Alternatively, one can pre place the sutures.
7.The vaginal defect is closed next. A continuous
horizontal mattress pattern in a longitudinal direction is
used so that the two suture rows are at right angles to each
other and the vaginal mucosa is everted.
8.The incised perineal body is closed with multiple
interrupted sutures of 2-0 suture; the skin is closed
routinely.

20. Treatment
B) In case of secondary complication of Atrisia anii
surgery:
1.Animal is restrained laterally by the owner and low
epidural anesthesia is performed using 2% lignocaine
HCl.
2.Then clean the opening with water.
3 .Make a stretch over the visceral part of the skin
area to make a fresh wound that will induce the
healing quickly.
4.Then the rectal wall is closed with purse string
suture using 3/0 catgut.

21. Post operative care:
Antibiotics -The animal was administered Ciprofloxacin
@ 5mg/kg for five days.
Meloxicam @0.5 ml for 3 days
Stop movement of heifers for 2-3 day
Clear the opening of rectum 4-5 times daily with
coconut oil to make sure that the rectum doesn’t get
closed.

22. Dermoid cyst
Dermoid cysts are a
relatively rare congenital
anomaly in cattle.
Dermoid cysts are congenital
cysts and occur due to failure of
the embryonic cavity to close or
defective epidermal closure

23. Location
Dermoid cysts are reported in many species of animals at
different anatomical location: Tail, Neck, Skull, Nasal cavity
• But ocular dermoid are common in ruminants and they may
be present unilaterally or bilaterally.
• Usually dermoids are located in limbus, cornea.
conjunctiva, corneo-conjunctiva they have also been
noticed in membrana nictitans
• eyelid

24. Age of predisposition
 Congenital, thus usually noticed in young
animals
 But may occur also in large adult animals.

25. Breed/species predisposition
 May affect all breeds.
 Has been reported in Hereford and Jersey cattle
as well as Holstein crossbred

26. Etiology
 Failure of the embryonic cavity to close or defective epidermal closure.
 Degenerative changes in hair follicles
 Cystic changes in ducts or cells of sebaceous glands
 Traumatic displacement of epidermal fragments.
 Cysts originated from incarceration and subsequent growth of embryonic
epithelial cells during the closure of neural tube and therefore most of these
lesions occur along the median line.

27. Classification of dermoid cyst
Ventrolateral corneo-conjunctival dermoid,
Supero-temporal corneal limbal dermoid,
Medial canthal dermoid
Membrana nictitans dermoid
ocular dermoid in dairy cattle include: Corneal dermoid, corneo-scleral dermoid,
corneo-conjunctival dermoid and conjunctival dermoid

28. PATHOLOGY & PATHOGENESIS
• Dermoid cysts are composed of keratinized stratified squamous epithelium with
dermal appendages and adnexal structures, including hair follicles, sebaceous
glands, sweat glands, smooth muscle, and fibro adipose tissue. The lumen
contains keratin and hair. Cysts that are only lined with epithelium without
adnexal elements are termed epidermoid cysts
• Dermoid cyst arises from the entrapped embryonal ectodermal cells during the
fetal development and are generally formed in the embryonic lines of fusion.

29. CLINICAL SIGNS
Mass on/near eye
Blepharospasm
Lacrimation
Visual impairment
Tearing
Inflammation
Irritation in the eye
Corneal opacity in Holstein crossbred

30. DIAGNOSIS
1. Physical Examination: Painless swelling that
may be freely mobile or fixed to the skin &
deeper structure.
2. Radiological Examination:
MRI,ULTRASOUND,CT SCAN

31. SURGICAL TREATMENT
1. Restraining: The animal should be controlled in lateral recumbency by casting.
The animal should be sedated with 0.1mg/kg Xylazine intramuscularly.
2. Anaesthesia: Local analgesia was performed by 2% Lignocaine HCl. The
anaesthetic was injected through the stalk after fixing eyelid with eye speculum.
Then Ketamine HCl @ 5 to 6 mg/kg body weight was injected through IM.
3. Operative Procedure:
o The dermoid cyst should be lifted as much as possible and curved artery forceps
was used to hold the stalk.

32. SURGICAL TREATMENT
o A chromic catgut is used to ligate the blood vessels along with the stalk by anchoring it. Sometimes two
horizontal mattress stiches may be required.
o Excision of the dermoid cyst or stalk is made after crushing with artery forceps.
o Cauterization: For excision electric thermocauterizer is used worldwide,it will help to perform the
surgery with less bleeding.
o Keratectomy: In this procedure,eyelashes was trimmed with scissors and whole eye washed with 0.9%
povidone iodine to remove contaminates. After attainment of adequate sedation superficial keratectomy
was performed. Then the mass of dermoid was grasped with forceps gently and the tissue mass was
completely excised by surgical blade. Bleeding from surgical wound was stopped by applying povidone
ointment.

33. Fig: Dermoid cyst mass after surgery
Fig: Performing the surgery

34. POST OPERATIVE CARE
Ciprofloxacin eye drop T.I.D in a day for 5 days.
Gentamicin 4mg /kg intra muscular for 6 days.
Meloxicam 0.4mg /kg intramuscular for 3 days.
Boric acid 0.3% solution should be used for eye wash
Ointment: Chloramphenicol or Neobacterin 3 times in
a day up to recovery.