Outcome of surgical treatment of perineal hernia in cats: 36 cases (2013-2019).

OBJECTIVES: To report the clinical presentation, complications, and long-term outcomes of cats treated for perineal hernia with modified internal obturator muscle transposition. METHODS: The medical records of cats surgically treated for perineal hernia between 2013 and 2019 were reviewed and an owner questionnaire was conducted to determine long-term outcome. RESULTS: Thirty-six cats were included in the study: 34 had bilateral and two unilateral hernias. Of these 36, 24 (67%) were male neutered with a median age of 10 (range: 1 to 18) years. The complication rate was low, however, one cat experienced a major postoperative complication: rectal prolapse requiring revision surgery 48 hours postsurgery. Short-term outcomes were available for 32 of 36 (89%) cats. Of the 32, 23 were examined 6 weeks postoperatively, and a telephonic consultation was performed for an additional nine of 32. Of the 23 cats examined directly, none had recurrence. Overall 12 of 32 experienced short-term postoperative tenesmus which resolved in nine of 12 (75%). Long-term outcomes were available for 31 of 36 cats (86%), with a median of 18.5 (6 to 89) months follow-up. A good outcome was achieved in 23 of 31 (74%) whereas three of 31 (10%) had fair outcomes and five of 31 (16%) had a poor outcome. Of the five cats with a poor outcome, two required subtotal colectomy to manage clinical signs related to megacolon, two were euthanised following a return of clinical signs, and one developed unilateral recurrence. CLINICAL SIGNIFICANCE: Perineal hernia should be considered in cats presenting with tenesmus or recurrent obstipation. Surgical treatment of perineal hernias in cats can result in good owner-assessed long-term outcome.

Hydrocolpos in dogs: surgical treatment in two cases.

Two young female dogs were diagnosed with hydrocolpos as a result of a congenital vaginal obstruction. In one dog, hydrocolpos had led to faecal tenesmus; in the other, the condition was an incidental finding during laparotomy. Diagnostic tests included vaginoscopy, ultrasonography and retrograde vagino-urethrocystography. In both dogs, the obstruction was located at the junction between the caudal vagina and the vaginal vestibule. Anastomosis of the caudal vagina and vestibule through an episiotomy was successful in both cases.

Results of adrenalectomy in 36 dogs with hyperadrenocorticism caused by adreno-cortical tumour.

A total of 38 adrenocortical tumours were removed from 36 dogs with hyperadrenocorticism. The surgical approach was by way of a unilateral flank laparotomy (32 dogs; 14 left and 18 right), a bilateral flank laparotomy (3 dogs) or a midline celiotomy (1 dog). Two dogs were euthanized during surgery because their tumours could not be resected. Eight dogs died from post-operative complications. Pancreatic necrosis with peritonitis was the most common cause of death. Eight of the 26 dogs that survived had signs of recurrence of hyperadrenocorticism. Unsuppressible hyperadrenocorticism was found in four dogs; one dog had probably pre-existent pituitary-dependent hyperadrenocorticism, and adrenocortical function could not be re-examined in the remaining three dogs. Among the 37 tumours examined microscopically expansion of neoplastic tissue into blood vessels was found in 22 of them. Four adrenal glands with adrenocortical tumours also contained phaeochromocytomas. Necropsy was performed in eight dogs. Metastases were found in the lungs of two dogs and in the lungs and liver in one dog. In combination with the data of previous reports, it is suggested that histological findings in surgery specimens are not good predictors for the clinical outcome.

Electromyography of the pelvic diaphragm and anal sphincter in dogs with perineal hernia.

The innervation of the levator ani and coccygeal muscles and the external anal sphincter was studied by anatomic dissection in 6 clinically normal male dogs and by electrical stimulation in 5 clinically normal male dogs. Variations in innervation occasionally were found that were comparable to those reported in previous studies. Electromyographic recordings were made from the levator ani and coccygeal muscles and from the anal sphincter in 40 dogs during perineal hernia repair. Spontaneous potentials of 4 types were found in 35 dogs: fibrillation potentials, positive sharp waves, complex repetitive discharges, and fasciculations. Biopsy specimens of the cranial part of the levator ani muscle were taken in 12 dogs during perineal hernia repair. Histologic examination revealed atrophy in 7 specimens. Spontaneous potentials were recorded from all muscles with histologic evidence of atrophy. All examinations of the levator ani muscle concerned the cranial part of this muscle, because the caudal part was absent in all 40 dogs. From combined results of electromyography and histologic examination, it was concluded that atrophy of the muscles of the pelvic diaphragm, which develops in some dogs with perineal hernia, is likely to be of neurogenic origin. Nerve damage is localized in the sacral plexus proximal to the muscular branches of the pudendal nerve or in the muscular branches separately.

Congenital hypothyroidism in two cats due to defective organification: data suggesting loosely anchored thyroperoxidase.

Two cats with congenital hypothyroidism are described. In vivo discharge of accumulated labelled iodide by perchlorate administration revealed defective organification of iodide, which was complete in one cat and partial in the other. In the cat with the partial organification defect, thyroid tissue was obtained for biochemical studies. No membrane-bound peroxidase activity could be demonstrated. The activity was found in the 100,000 x g supernatant. It is suggested that the loose enzyme anchoring caused decreased availability of peroxidase and as a consequence reduced capacity for organic binding of trapped iodide.

Circulating thyroglobulin measurements by homologous radioimmunoassay in dogs with thyroid carcinoma.

Circulating thyroglobulin was measured in 20 dogs with thyroid cancer, using a homologous polyclonal radioimmunoassay. Plasma Tg levels exceeded the normal range in 14 (70%) dogs, and ranged from 6 to 2902 micrograms/l (median 608). Plasma Tg levels tended to decrease from follicular carcinomas to solid-follicular carcinomas, to solid carcinomas (p less than 0.05). Plasma Tg levels were also higher in scintigraphically hot tumours than in cold ones. Other relationships between circulating Tg and clinical, pathological, and functional parameters were not found, except a poor (R = 0.49) but significant (p = 0.04) correlation between Tg and T4 levels. Plasma Tg was measured before surgery and at least once during follow-up, in 9 dogs. After hemithyroidectomy, a decrease was observed in 8 dogs. In 7 of these 8 dogs, plasma Tg levels declined within the reference range at the first postoperative sample. In the ninth dog, where metastases were detected 14 months after surgical treatment, plasma Tg slightly increased, yet within normal range. It is concluded that measurement of plasma Tg levels might be useful for monitoring the postoperative course of the disease in individual dogs with thyroid cancer.

Flow-cytometric DNA ploidy analysis in primary and metastatic canine thyroid carcinomas.

DNA ploidy was measured by flow cytometry in 36 primary malignant thyroid neoplasms (including 6 bilateral tumours which were considered as separate neoplasms) from 30 dogs. In addition, DNA ploidy was determined in local recurrences in 3 dogs, and in 18 metastatic sites from 14 dogs. Aneuploidy was found in 21 of 36 (58%) primary sites. Eighteen of the 21 (86%) aneuploid tumours contained hypodiploid cell populations, with 12 having single hypodiploid peaks, and 6 being multiploid. Three other tumours had single aneuploid peaks with a DNA index (DI) greater than 1.0. The DIs in local recurrences were identical to those in the original neoplasms. Ploidy status (diploid vs. aneuploid) was identical in primary and metastatic sites in 10 out of the 14 dogs. Aneuploidy was more frequent in carcinomas from dogs with distant metastases (78%) than from dogs with less advanced stages of disease (53%), although this difference was not significant. There was no significant correlation between DNA ploidy and histopathological variables. From the strikingly high frequency of hypodiploidy in canine tumours, it is concluded that ploidy evolution in canine neoplasms may differ from that in human tumours.

[Perineal hernia in the dog: developments in its treatment and retrospective study in 197 patients]. / Hernia perinealis bij de hond: ontwikkelingen in de behandeling en retrospectief onderzoek bij 197 patiënten.

Perineal hernia repair by transposition of the internal obturator muscle and the results obtained with this method in 197 dogs are described. The most common breeds were the German shepherd, the Bouvier and the old English sheepdog, all of which were significantly over-represented when compared with the hospital population. A comparison of results obtained before 1982 with those from the period between 1985 and 1990 shows a significant decrease of the recurrence rate from 43% to 21%. There was no change in the percentage of patients with fecal incontinence. Wound infections occurred in 22% of the patients and were the most important complication. This implies a reduction of 50% compared with an earlier study of 100 patients. Eighty per cent of the owners classified the results of treatment as excellent or good. This is in accordance with results obtained in the United States with a similar method. The omittance of castration in dogs in which the prostate was of normal size did not result in an increased risk of recurrence and is considered to be justified.

Nephrotomography and ultrasonography for the localization of hyperfunctioning adrenocortical tumors in dogs.

Nephrotomography and ultrasonography were used in 11 dogs with hyperadrenocroticism to assess the value of these techniques for the localization of biochemically diagnosed hyperfunctioning adrenocortical tumors. Both techniques enabled accurate localization of a unilateral adrenal mass in each of the dogs. Cross-sectional diameters of the masses ranged from 1 to 4 cm. In 1 dog, expansion of tumor into the caudal vena cava was revealed by caudal venacavography and ultrasonography. Mineralization in the tumor mass in 2 dogs was easily recognized by nephrotomography, but not by ultrasonography. Paracostal laparotomy confirmed the presence of an adrenocortical tumor in each dog, and expansion of tumor into the caudal vena cava in 1 dog. Cross-sectional diameters of the tumors ranged from 1.2 to 4.5 cm and corresponded well with cross-sectional measurements by nephrotomography and ultrasonography. It was concluded that nephrotomography and ultrasonography have similar diagnostic accuracies for the detection and localization of hyperfunctioning adrenocortical tumors.

Thyroidal radioiodine uptake in hyperthyroid cats.

Thyroidal radioiodine uptake was measured in 10 healthy domestic cats and in 20 hyperthyroid cats. Compared with those in the healthy cats, the uptake curves in the hyperthyroid cats were characterised by elevated uptake and rapid thyroidal iodine turnover. For diagnostic purpose uptake measurements at 4 hours after administration of the tracer were found to be preferable to measurements at 24 hours or later.

Perineal hernia repair in the dog by transposition of the internal obturator muscle. II. Complications and results in 100 patients.

A modified technique for transposition of the internal obturator muscle was used to repair perineal hernias in 100 dogs. Complications and long-term results are described. The most important complications were wound infection (45%), faecal incontinence (15%), and perineal fistula (7%). These complications often occurred in combination. The recurrence rate of perineal hernia was 5%. Nine of the 15 patients with faecal incontinence had paresis of the external anal sphincter or faecal incontinence before surgery. We suggest that in numerous patients, faecal incontinence is a complication of the condition rather than a complication of treatment. The owner's assessment of the surgical result was good in 71% and moderate in 18% of the cases.