Today is Saturday, August 7, 2010. It is my day off but I better record my recent surgery on the right side of the backside of the Boston Terrier before I forget as there are so many things to do and read in Singapore as compared to Perth, Australia where the pace of life is much less hectic.   

"The backside lump keeps getting bigger," the young man and caregiver of the Boston Terrier phoned me in the first week of August 2010. "My dog can't poop normally. You need to operate on him."

I had repaired the left perineal hernia in a Boston Terrier in Jun 2010. The surgical outcome was excellent and I was glad. Surgeries take a long time and can result in complications.
 

"The swelling is the rectum full of stools. Part of the rectum had dropped into this perineal hernia and you can see it as a lump. It is therefore hard for the dog to pass motion. Use your finger to push the lump back into the abdomen so that he can poop and make an appointment for surgery," I had just neutered this dog 7 days ago. Neutering is reported to reduce the incidence of perineal hernias in the male dog. It was better late than never.

ANAESTHESIA
The owner is worried that his old dog may not survive a 3rd anaesthesia. The first two were for the repair of the left perineal hernia in June 2010 and neutering. Many dog owners in Singapore are aware of the risk of the dog dying on the operating table and the internet forums of such cases frighten them. In this dog, the only cure was to operate to close the big hole inside the right perineum as the dog had great difficulty and pain in pooping.

Domitor 0.2 ml IV and isoflurane gas. An I/V saline drip. No problem. I did not use Antisedan to wake up the dog as he would wake up naturally.

SURGERY
The hole was even larger than the left perineal hernia I did in June 2010. My assistant Mr Saw wore a glove and asked me: "Do you want me to dig out the stools?" I said: "It is better not to do it. The dog's rectum may be traumatised. In any case, it is not necessary to empty the stools from the rectum." I was never more mistaken.

Under anaesthesia, the solid stools started to pop out of the anus. My assistant removed them with a tissue paper. I had not plugged the anal opening with the syringe or something.

I used electro-incision to open a big curved incision of the skin. Fatty mass spilled out of the wound. I used the retractor to open widely and horizontally the herniated muscles.

I could not believe it. The whole defect was over 4 cm x 6 cm in diameter and very deep. As deep as 3 cm. There was not much muscle layer to stitch from the right lateral side to the anal sphincter. Would the stitches hold? There would be no second chances.

In this case, I could see the reddish right ventral wall of the rectum. I placed several layers of 2/0 absorbable stitches to close the gap. "The retractor is very useful," Mr Saw remarked. "Yes," I said. "It opens up the hole so that I can stitch up properly."

The whole area was a mess. I could see one big vein but not the nerve which was supposed to be present in theory.

POST-OP CARE
In theory, the dog should be crated for 14 days and given limited movements for another 14 days so that the stitches would not break down. To save money, the owner would take the dog home in 4 days and confine the dog himself.

CONCLUSION
Sometimes it is better to neuter the dog when he is young. For the past years, I have had not seen a case of perineal hernia in neutered dogs. The incidence in neutered and female dogs is very low. In just the past 2 months, I have had operated on 2 male not neutered dogs with perineal hernias.

One of the recent cases of a right perineal hernia in an 8-year-old Shih Tzu is at:
http://www.asiahomes.com/singaporetpvet/0514haematoma_perineal.htm

Perineal hernias are not common conditions in the sense that I don't see them every week. But they are commonly present in non-neutered dogs. When you see a swelling to the right or left of the anus, get your vet to quickly repair the perineal hernia rather than wait for a long time as it is extremely difficult to stitch up a big gap in the pelvic diaphragm compared to a small one.