ZEYNEP PEKCAN, Ömer BEŞALTI, Yusuf Sinan ŞİRİN, MURAT ÇALIŞKAN

Clinical and surgical evaluation of perineal hernia in dogs: 41 cases

Bu çalışmanın amacı 41 köpekte perineal herni ve eşlik eden rektal patolojilerin klinik ve operatif bulgularını postoperatif ağrı skorları ile birlikte sunmaktır. Perineal herni tanısı konulan, yaşları 4.5 ile 16 arasında değişen 41 köpek çalışma kapsamına alındı. 11 köpekte bilateral, 30 köpekte unilateral (17 sağ, 13 sol) perineal herni tespit edildi. Klinik semptomlar perineal şişkinlik (n=41), şiddetli tenesmus (n=19), ağrılı defekasyon (n=9), proktitis (n=7), fekal inkontinens (n=4), stranguri(n=2) ve hematuri (n=1) idi. Bunlara eşlik eden rektal patolojiler divertikülasyon (n=15), dilatasyon (n=4), deviasyon (n=3) ve sakkulasyon (n=1) idi. Rektal divertikülasyon ekstraluminal plikasyon (n=12) veya rektal rezeksiyon (n=3) ile düzeltildi. Perineal herninin onarımında tüm olgularda internal obturator kas flebi kullanıldı. Postoperatif ağrı subjektif olarak değerlendirildi. Buna göre 10 olguda ağrının olmadığı, 28 olguda hafif ve 3 olguda orta düzeyde ağrı olduğu kaydedildi. Ortalama 27.3 aylık (4 ay-5 yıl) takip süresinde 3 olguda nüks tespit edildi. Sonuç olarak, internal obturator kas flebi ile perineal herninin onarılabileceği, aynı operasyonda rektal duvar patolojilerinin düzeltilebileceği ve bu operasyonlarda epidural morfin uygulamasının yeterli düzeyde analjezi sağladığı kaydedildi.

Anahtar Kelimeler:

ağrı kesiciler, hayvan patolojisi, klinik görünüm, köpek, ilaç tedavisi, fıtık, morfin, ağrı (tıp), perineum, ameliyat sonrası komplikasyonlar, rektum, nüks, rezeksiyon, cerrahi, cerrahi işlemler

Köpeklerde Perineal herninin klinik ve cerrahi değerlendirilmesi: 41 olgu

The purpose of the study was to report the clinical and surgical records of perineal hernia and associated rectal pathology with epidural morphine analgesia in 41 dogs. Fourty one dogs suffered from perineal hernia were included into the study with the age varied from 4.5 to 16 years. Eleven dogs had bilateral while the other 30 had unilateral (17 right, 13 left) perineal hernia. The clinical signs were perianal swelling (n=41), severe tenesmus (n=19), dyschesia (n=9), proctitis (n=7), fecal incontinence (n=4), stranguria (n=2) and hematuria (n=1). Associated rectal pathologies were diverticulation (n=15), dilatation (n=4), deviation (n=3) and sacculation (n=1). The rectal diverticulum was corrected by extraluminal plication (n=12) or rectal resection (n=3). Internal obturator muscle flap transposition was used to repair the hernia in all cases. Postoperative pain was subjectively evaluated and scores were “no pain” in 10 cases, mild in 28 cases, moderate in 3 cases. Mean follow-up time was 27.3 months (range 4 months to 5 years) and the recurrence was observed only in three cases postoperatively. In conclusion, combined perineal herniorraphy with internal obturator muscle transposition and rectal wall repairment can be carried out at the same time and epidural morphine administration provide adequate analgesia for these operations.

Keywords:

analgesics, animal pathology, clinical aspects, dogs, drug therapy, hernia, morphine, pain, perineum, postoperative complications, rectum, relapse, resection, surgery, surgical operations,

PDF

___

1.Dieterich HF: Perineal hernia repair in the canine. Vet Clin North Am: Small Anim Pract, 5, 383-399, 1975.
2.Sjollema BE, Haagen AJV, Sluijs FJ, Hartman F, Goedegebuure SA: Electromyography of the pelvic diaphragm and anal sphincter in dogs with perineal hernia. AJVR, 54, 185-190, 1993.
3.Stoll MR, Cook JL, Pope ER, Carson WL, Kreeger JM: The use of porcine small intestinal submucosa as a biomaterial for perineal herniorrhaphy in the dog. Vet Surg, 31, 379-390, 2002.
4.Head LL, Francis DA: Mineralized paraprostatic cyst as a potential contributing factor in the development of perineal hernias in a dog. JAVMA, 221, 533-535, 2002.
5.Gilley RS, Caywood DD, Lulich JP, Bowersox TS: Treatment with a combined cystopexy-colopexy for dysuria and rectal prolapse after bilateral perineal herniorrhaphy in a dog. JAVMA, 222, 1717-1721, 2003.
6.Bellenger CR, Canfield RB: Perineal hernia. In, Slatter D (Ed): Texbook of Small Animal Surgery. 3rd ed., pp. 487-498, Saunders Philadelphia, 2003.
7.Bongartz A, Carofiglio F, Balligand M, Heimann M, Hamaide A: Use of autogenous fascia lata graft for perineal herniorrhaphy in dogs. Vet Surg, 34, 405-413, 2005.
8.Niles JD, Williams JM: Perineal hernia with bladder retroflexion in a female cocker spaniel. JSAP, 40, 92-94, 1999.
9.Brissot HN, Dupre GP, Bouvy BM: Use of laparotomy in a staged approach for resolution of bilateral or complicated perineal hernia in 41 dogs. Vet Surg, 33, 412-421, 2004.
10.Vnuck D, Maticic D, Kreszinger M, Radisic B, Kos J, Lipar M, Babic T: A modified salvage technique in surgical repair of perineal hernia in dogs using polypropylene mesh. Vet Med-Czech, 51, 111-117, 2006.
11.Sjollema BE, Sluijs FJ: Perineal hernia repair in the dog by transposition of the internal obturator muscle. II. Complications and results in 100 patients. Vet Q, 11, 18-23, 1989.
12.Popovitch CA, Holt D, Bright R: Colopexy as a treatment for rectal prolapse in dogs and cats: A retrospective study of 14 cases. Vet Res, 23, 115-118, 1994.
13.Bilbrey SA, Smeak DD, DeHoff W: Fixation of the deferent ducts for the urinary bladder and prostate in canine perineal hernia. Vet Surg, 19, 24-27, 1990.
14.Niebauer GW, Shibly S, Seltenhammer M, Pirker A, Brandt S: Relaxin of prostatic origin might be linked to perineal hernia formation in dogs. Annals New York Acad Sci, 1041, 415-422, 2005.
15.Anderson MA, Constantinescu GM, Mann FA: Perineal hernia repair in the dog. In, Bojrab MJ (Ed): Current Techniques in Smal Animal Surgery. 4th ed. pp. 555-564, Williams & Wilkins Baltimore, 1998.
16.Özak A, Beşaltl Ö, Gökçe P, Can Z: Köpeklerde perineal herni’nin tanl ve sağaltlml (1999-2001). JTVS, 7 (3-4): 31-34, 2001.
17.Alkan Z, Bumin A, Öztürk S: Perineal hernili 3 köpekte divertikulum rekti olgusunun klinik, radyografik tanlsl ve şirurjikal sağaltlml. JTVS, 7 (3-4): 51-54, 2001.
18. Sluijs FJ, Sjollema BE: Perineal hernia repair in the dog by transposition of the internal obturator muscle. I. Surgical technique. Vet Q, 11, 12-17, 1989.
19. Chambers JN, Rawlings CA: Applications of a semitendinosus muscle flap in two dogs. JAVMA, 199, 84-86, 1991.
20. Frankland AL: Use of porcine dermal collagen in the repair of perineal hernia in dogs- a preliminary report. Vet Rec, 119, 13-14, 1986.
21. Larsen JS: Perineal herniorrhaphy in dogs. JAVMA, 149, 277-280, 1966.
22. Okumuş Z, Atalan G, Erdoğan HM, Güneş V: Bir köpekte divertikulum rekti olgusu. Kafkas Üniv Vet Fak Derg, 4 (1): 103-108, 1998.