Friday, August 3, 2012

1023. Did the maid cause the perineal hernia?

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 (images).
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 diagnosed tumour e.g prostate tumour as there was too much bleeding from the penis. "Are you sure?" the vet 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." 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 and he understood what the problem was."

Showed a large swollen bladder

Blood test - the owner did not want a blood test.


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