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KATHRYN PRATSCHKE
ABSTRACT
Two males and one female with bilateral perineal hernias were treated; all were neutered. Two
cases had a history of rectal prolapse, one had chronic constipation and all had recurrent anal
sac impaction. All cases were treated surgically with bilateral internal obturator muscle flap
transposition, plus incisional colopexy in the two with concurrent rectal prolapse. All had full
thickness intestinal biopsies and mesenteric lymph node biopsies.
LAURA MARTIN
BVM&S, MRCVS
Case 1
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soon after treatment. Each treatment is effective at killing a different range of larvae ages
and adult fluke, so dosing frequency should
be carefully observed. In addition, accurate
dosing is important, as underdosing may lead
to ineffective treatment or increase the risk of
resistance developing. Overdosing may have
toxic side effects. All cattle in the group should
be dosed according to the heaviest in the
group. If there is wide variation in bodyweight,
then the group may be split and cattle dosed
according to the heaviest in each sub-group.
With unpredictable weather patterns and
growing risk factors for liver fluke, many
sheep farmers are finding fasciolosis a serious problem. Help is desperately needed
to help increase understanding of different testing regimes and medicines and to
drive new diagnostics and testing options,
said NFU south-east livestock board member and Surrey farmer Hugh Broom.
Recently, a cross-industry working group
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the National Sheep Association, Sustainable
Control Of Parasites in Sheep, Defra, farmers
and vets. This group has started to talk about
solutions to the issues surrounding timely
diagnosis and triclabendazole resistance.
The challenges of diagnosis in sheep mirror
those in cattle, but with acute disease in sheep
caused by migrating immature parasites, an
early diagnosis is particularly important. Typically, faecal egg counts are not reliable with
intermittent and irregular shedding of ova
only occurring 10 to 12 weeks post-infection,
limiting the benefit of faecal egg counts.
A new Fasciola antigen ELISA detection kit
(Bio K 201) is available from BioX, which allows
the detection of specific anti-parasite circulating antibodies in faeces within three to five
weeks of initial infection1. This technique may
expedite diagnosis in the previously nave flock,
but its use may be limited in endemic fluke
areas, where antibody titres remain consistently
high with or without active parasite levels.
The concern around triclabendazole resistance
is always present, but this treatment can still
play an important part in the control of fluke in
Histological diagnosis was suggestive of inflammatory bowel disease, and two cases had
positive cultures for known intestinal pathogens. Postoperative outcome was good or excellent
with follow-up at least six months after surgery.
Keywords: perineal hernia, cat, anal sac, internal obturator muscle flap
transposition, colopexy.
bright and alert with routine
clinical parameters within
normal limits other than a
slightly low body condition
score (BCS) of 3/9. Abdominal palpation revealed faecal
balls within the colon and mild
discomfort. No rectal prolapse
was present at this time. Haematology and biochemistry
were unremarkable, except
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CLINICAL FELINE 11
May 5, 2014
be confirmed and accurately
characterised with full thickness intestinal biopsy samples.
At surgery, the liver appeared
grossly paler than normal,
with a mottled appearance,
so a hepatic biopsy was
taken in addition to jejunal and mesenteric lymph
node. An incisional colopexy
was performed as described
in the literature (Figure 1)
(Popovitch et al, 1994).
Bilateral perineal herniorrhaphy was then performed
with the internal obturator
elevation technique (Figures
2 and 3; Bellenger and Canfield, 2003). The overall surgery time was 150 minutes.
Perioperative analgesia was
provided with a constant rate
infusion of fentanyl (0.1g/
kg/min to 0.3g/kg/min; Martindale) and buprenorphine IM
(0.02mg/kg every six hours,
Vetergesic; Alstoe). Prophylactic antibacterial therapy was
provided with cefuroxime IV
(20mg/kg, Zinacef; GlaxoSmithKline). Postoperatively,
the cat received oral amoxicillin-clavulanate tablets (17mg/
kg every 12 hours, Synulox;
Pfizer) for seven days, meloxicam (0.05mg/kg every 24
hours, Metacam; Boehringer),
ranitidine for two days
(2.5mg/kg every 12 hours,
Zantac; GlaxoSmithKline)
and lactulose (2ml every 12
hours; Sandoz). Prednisolone was stopped temporarily while on treatment with
NSAIDs. The cat recovered
well from surgery, with no
early signs of recurrent prolapse and was discharged
five days after surgery.
Histopathology of the samples taken during surgery
showed vacuolar hepatopathy
of the liver, a likely consequence of glycogen accumulation due to the prednisolone medication for feline
asthma. The jejunal biopsy
showed mild chronic enteritis,
consistent with mild inflammatory disease previously
diagnosed. The mesenteric
lymph node showed lymphoid hyperplasia, consistent with a reactive node.
During a follow-up tele-
Case 2
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12 CLINICAL FELINE
Veterinary TIMES
continued from page 11
Figures 2
(left) and
3. Internal
obturator
muscle flap
elevation.
A = anus,
IOMF =
internal
obturator
muscle flap.
lymphadenitis, were also diagnosed. A pure growth of Streptococcus canis was cultured
from the abscessed node,
which was sensitive to the
antibiotics already dispensed.
At routine check-up, two
weeks after the surgery, the
cat was making very good
progress. Motions were being
passed without any difficulty daily, with no recurrent
pain or tenesmus. At telephone interview six months
after surgery, the owner
reported continued improvement. There was still minimal
tenesmus when defaecating,
but this was much improved
compared to before surgery.
F
EF ast U
A es K
Su t s
pp Se
le llin
m g
en
t1
Case 3
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Discussion
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CLINICAL FELINE 13
May 5, 2014
2004; Johnson and Gourley,
1980, Welches et al, 1992).
Two of the cases reported
here had a history of rectal
prolapse, all three had recurrent anal sac impaction and
one had chronic constipation
in addition to which all three
had histopathology results
that were suggestive of a
component of underlying IBD.
Anecdotally, recurrent anal
sac impaction is often seen
with perineal hernia in the
dog, presumably due to loss
of normal muscle contractions
at the rectocutaneous junction, compromising expression of anal sac contents. It
seems reasonable to assume
a similar phenomenon exists
in cats with perineal hernia. Once recurrent anal sac
impaction is present it will
then contribute to perineal
and rectal irritation, and could
potentially become a perpetuating factor. The finding
of rectal prolapse in two of
the cats supports previous
reports of its occurrence
alongside perineal hernia
(Welches et al, 1992). In
dogs, it is mainly reported
as a postoperative complication occurring because of
straining due to pain, from
sutures placed within the
rectal lumen or from nerve
damage during surgery (Bellenger and Canfield, 2003;
Matthiesen, 1989). The cases
seen in this study, however,
support the theory that rectal
prolapse may be an important predisposing cause for
perineal hernia development in cats. All three cases
had histopathology results
suggestive of IBD, and two
cases had positive cultures for
intestinal pathogens (S canis
and E coli) from mesenteric
lymph node biopsies. It could
be theorised the inflammatory intestinal disease in
these cats may have affected
normal gastrointestinal contractility, transit times and
peristalsis, thereby contributing to tenesmus and rectal
prolapse and thus further progression to perineal hernia.
Medical management is of
limited value as a sole method
in the treatment of perineal
hernias due to the progressive
nature of the condition and
as quality of life can become
affected by its presence. Longterm use is contraindicated,
as life-threatening visceral
entrapment and strangulation can occur (Fossum,
2002). It has its main use in
mild hernias and those with
KATHRYN
PRATSCHKE
graduated from
University College
Dublin in 1994, where she also
completed an internship and
residency training in small animal surgery. She was appointed
senior university clinician at the
University of Glasgow in April
2008 and has been head of
surgery since 2009. Kathryn is a
diplomate of the European College of Veterinary Surgeons and
an RCVS-recognised specialist
in small animal surgery.
LAURA MARTIN
graduated from
the Royal (Dick)
School of Veterinary
Studies in 2008. She worked
for two years in mixed practice
in Durham and then moved to
the University of Glasgow to
complete a small animal internship. She has remained in small
animal practice and works at
PDSA in Edinburgh.
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*YouGov survey. Total sample size was 2004 GB adults who own a cat or a dog. Fieldwork was undertaken between 2629 October 2013. The survey was carried out online.
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