ISSN 2398-2969      

Perineum: rupture

icanis
Contributor(s):

James Simpson

Synonym(s): Perineal hernia


Introduction

  • Almost exclusive in males.
  • Cause: unclear; possibly associated with degenerative changes in muscles of pelvic diaphragm resulting from aberrant androgen secretion from ageing testicles.
  • Signs: fecal tenesmus, some large breeds, eg German Shepherd Dog, Great Dane, may have perineal herniation and otherwise remain asymptomatic.
  • Dysuria and stranguria associated with bladder herniation often indicate complete urethral obstruction and strangulation of the bladder.
  • Treatment: surgical - several techniques have been described.
  • Prognosis: post-operative complications: rectal eversion/prolapse, sciatic paralysis and recurrence.
Print off Hernias in dogs (perineal) Owner Factsheet to give to your client.

Pathogenesis

Etiology

  • Etiology remains unclear but is associated with the degenerative changes which occur in the muscles of the pelvic diaphragm in older entire animals.
  • There is little evidence to support the suggestion that the condition is encountered more frequently in docked breeds.

Predisposing factors

General

  • Sex.
  • Age.
  • Breed.

Pathophysiology

  • The rupture develops as a separation between the levator ani and coccygeus muscles and the anal sphincter muscle → increase rectal capacity.
  • Tissues herniate into space.
  • Separation between the levator ani and coccygeus muscles and the anal sphincter muscle → increase in the rectal capacity due to loss of lateral support.
  • Unilateral rectal enlargement is termed 'sacculation' or 'deviation' while the bilateral disease is termed 'dilatation'.
  • Herniated tissues usually include pelvic and peritoneal fat but occasionally loops of small intestine or omentum may become involved. The most serious complication is retroflexion of the bladder (with or without prostate gland) → (may) bladder rupture, azotemia or renal failure.
  • The formation of a rectal diverticulum is encountered only very rarely.

Timecourse

  • Chronic for hernia development.
  • Acute for herniation of organs.

Diagnosis

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Treatment

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Prevention

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Niles J D & Williams J M (1999) Perineal hernia with bladder retroflexion in a female cocker spaniel. JSAP 40 (2), 92-94 PubMed.

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