4. Inspect for your old dog for backside swellings - Perineal hernias

I hope the 2nd year vet student from Murdoch University learnt some anatomy from observation of this surgery and find his anatomy of the back area more alive and interesting.

DOG. Pekinese X said to be 13 years old. Or 10-13 years old.

Dog is being looked after by the mother. The married daughter in her late thirties bring in the dog for vet treatment but she does not stay with her mother. She waited patiently and did not show an angry face. A soft spoken and gentle serene looking woman.

I had 2 long cases. A French lady with her ear scratching Golden Retriever needing its ear flushed. This took some time. Then another man who needed time to decide about putting his old Cocker Spaniel with a swollen ascites abdomen.


COMPLAINT. Constipation. The first vet treated for constipation some 19 days ago, yet the mother still complained about the dog having constipation. This dog has a full coat and the backside swelling was not obvious. Palpation of the abdomen was empty and so I declared, "No constipation."

Yet the mother had said there was difficulty in pooping. So, something must be wrong.
Taking the rectal temperature must be done as a routine even though the dog has excellent appetite. In this case, the dog cried. He farted when the anal sacs were expressed. Abnormal behaviour.

So, the anal region was clipped to check for wounds. The huge right perineal swelling manifested! There was also a small left perineal hernia! Inside the right swelling, hard faecal lumps could be felt. Fluid too. When pressed, the lump disappears and this impressed anybody. Like magic.

"You have the diagnosis of what's wrong with your dog," I said to the serene lady. "The rectum has diverted and turned into this swelling. So the dog had difficulty in pooping. Probably had some problems peeing if the bladder gets trapped inside this perineal hernia."

The sole complaint was constipation.

"What do do?" the lady asked as I told her that the dog also had heart disease and might die on the operating table as the heart failed. It would be a long operation lasting more than 45 minutes.

"You have to take the anaesthetic risk," I said. "If the dog can't poop, he will also die a painful death as the stools jam up."

The lady decided on surgery the next day. It would be Chinese New Year's eve. The vet student would be coming in the afternoon at around 3 p.m and I wanted to show him something of the backside anatomy he would not see on a live dog. He has a dead dog in the University shared by 4 students to study anatomy. But nothing as alive as a real case.

On Chinese New Year's eve, a Golden Retriever with diarrhoea came in at 3 pm. The owner could not locate the Surgery although she was supposed to be in before 2.30 pm as I would operate at 3 pm. I had the reunion dinner to attend at 6.30 pm and I did not want to be late as there is the "mingling of raw fish and vegetables" for good luck and every member of the family must be present to do it.

The dog was operated past 4 p.m. The two sides of the skin cut were retracted by forceps and the student saw a lot of blood tinged fluid and gel and some pieces of yellow fat on exposure. This fluid was drained.

I showed the student the muscles but I doubted he could see them or name them. We had gone through the anatomy of the backside before the surgery. He has an excellent memory if he is motivated to learn. But how to motivate a student about backside anatomy?

I pushed back the hernia sac into a big gap of over 10 cm long and 1.5 cm wide. "Pelvic diaphragm" I pointed to the muscle defect. I doubted he understood. There is a diaphragm (muscle) between the chest and abdomen. But a pelvic diaphgram. What is a pelvic diaphragm?

He could see the anal sphincter mucle. The coccygeal and internal obturator muscles were atrophied unlike the beautiful illustrations in the Vet Surgery book. The defect was closed by suturing.

It would be some years before he will see another perineal hernia repair. The dog was able to poop without problems the next 3 days and sent home to save on veterinary boarding expenses.

I reminded the owner to keep the Elizabethan collar on as the dog was discharged without the collar. Small omissions from my personnel makes me angry as the dog may lick and open up the big wound. Somehow the person seems to think that there is no need to use the e-collar. I empahsized to the lady that the dog had to be confined for at least 7 days. No jumping around.

Now, there is the left perineal hernia which seems to swell and disappear now and then. The owner had been informed.

I advised neutering the dog some time later as the male hormone seem to be a cause of the hernia formation according to the book. I don't know whether she would remember as she does not live with the dog. I did not neuter the dog at the same time as I wanted to shorten the anaesthetic time so as to be successful in bringing out a live dog at the end of surgery. The perineal surgery took more than 45 minutes. The dog was given 8% gas and then maintained at 2%. For a short while there was some movement and he was given 2.5%. Other than that anaesthesia was surprising smooth flowing as if the dog had a nice nap. Without tranquilisers given as I did not want the heart to be affected. No pain killers were given after surgery for the same reason. This dog recovered the next day.



It is extremely kind of her to take the time to bring the dog to the vet before it is too late. Before the dog collapsed and becomes toxic and so sickly that the anaesthetic risk increases from the 40% to zero percentage of survival on the operating table! A gentle client is always much appreciated by any veterinarian who usually has some nasty litigious pushy ones who think that "customer and their cash is the king".

No vet can have all gentle clients all the time! But this case was a pleasant and happy case and the dog lived to go back to a happy aged mother whom I will never meet!