Today Saturday, I
came to work at 9
am. Reviewed the
case of the Jack
Russell who had
passed away on the
op table yesterday.
This was a case of a
very poor prognosis
because
1. The bladder was
twisted. During
surgery, this
bladder was dark
red and bleeding
when seen from the
hernia side, only a
small portion of the
neck of the bladder
was the normal pink.
2. The associate vet
was not able to
catherise and lots
of dark red blood
inside the swollen
bladder leaked out).
3. In addition,
fresh blood leaked
out from the anus.
An emergency surgery
to reduce the
bladder size was
done but the
dog passed away
after the repair of
the right perineal
hernia. The owner
said that around 4
weeks ago, the dog
gave a loud cry as
the maid had hit
him. He was
frightened of the
maid since then.
"Did the backside
swelling disappear
after some time?" I
asked the father.
"Yes," he said. "I
could feel some
water inside the
swelling. It
disappears but
now it comes back
again and grows much
bigger."
So, was the maid's
hitting cause the
perineal hernias
(left and right) to
develop? It is a
possibility but I
don't think so. Old
male, not sterilised
dogs do develop
perineal hernias and
this Jack
Russell fitted the
picture. He was
around 10 years old,
not neutered and had
a large perineal
swelling that could
reduce. I diagnosed
perineal hernia.
The associate vet
(Vet 1) diagnosed
tumour e.g prostate
tumour as there was
too much bleeding
from the penis. "Are
you sure?" Vet 1
asked me. "Yes, I am
100% sure. I based
this on the history
of the backside
swelling increasing
in size and
disappearing when
pressed some 4 weeks
ago. Look at the big
swellings on the
backside." As
the dog came in
recumbent and not
able to stand up,
the perineal hernia
swellings were NOT
obvious. The profuse
bleeding from the
anus and the penis
distracted from the
not so obvious
perineal hernial
swelling especially
when the dog was so
ill and lying on his
die panting.
Therefore, I would
not expect Vet 1 to
miss the diagnosis
of perineal hernia
which was the main
problem. All
associate vet cases
are monitored by me
to ensure a high
standard of care and
all vets have to
learn from
experiences of
"challenging" cases
presented. A normal
standing dog will
show the perineal
hernia swelling but
this dog was down
and out and
therefore its
bilateral backside
swellings were not
obvious.
The father requested
an X-ray to confirm
the diagnosis of
tumour. "Normally,
no X-ray will be
done if it is a
perineal hernia," I
said to the vet.
"However, the owner
had requested X-ray
to confirm. It
should be done. In
any case, this dog
would die soon as he
could not stand up
and was in great
pain, passing blood
in the urine and
stools. This is
serious and the
owner has been told.
I had shown the
owner past case
images of perineal
hernia from
www.toapayohvets.com
and he understood
what the problem
was."
X-RAY
Showed a large
swollen bladder
trapped on the right
perineal side while
the left side was
swollen with
intestines filled
with stools
Blood test - the
owner did not want a
blood test.
SURGERY. The dog
passed away on the
operating table
after the bladder
was emptied of over
30 ml of fresh blood
and pushed back into
the abdomen and the
skin stitched. The
owners knew that the
chances of survival
was practically low
but wanted to take
the chance.
CONCLUSION. If
the perineal hernias
were discovered much
earlier, chances of
survival are good.
Male dogs are prone
to getting perineal
hernias and one
prevention is to get
the male dogs
neutered early in
his life. This may
appear "cruel" to
the internet
generation.
Therefore perineal
hernias and anal
tumours do present
in the some of the
older non-sterilised
males in old age.
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Toa
Payoh Vets