3100. A 16-year-old Maltese has a large left perineal hernia recurred some 7 years after repair.

Another case of a gigantic perineal hernia. The owners had consulted Vet 3 some months ago and was referred to a vet specialist who would be more costly.  So a friend referred them to me.

Some 7 years ago, Vet 1 had operated but the hernia recurred some months later. Vet 1 referred to Vet 2 who operated but the hernia recurred. So Vet 2 did muscle transposition surgery,cystopexy and colopexy. This last operation lasted around 6 years. The dog was neutered young and this is a rare case as 99% of the perineal hernias in male dogs are not neutered. The owners did not want to go back to Vet 2 for some reasons although his fees were reasonable at around $1,500 7 years ago.    


July 2017.
"Your dog is very old, at 16 years and has heart disease," I advised against any surgery to repair this hernia. "She can pee. She eats like a horse."
"But she cannot poop for the past 5 days," the mother and adult daughter said. "Her swelling is very painful too."
"She needs to be anaesthesized for me to evacuate the stools manually," I said there would be anaesthetic risks but the owner had no choice. She signed the consent form.  Anaesthesia would be short as I used fingers to extract the semi-hard stools from the rectum. Dog was OK and stayed one day inpatient.


X RAYS

NO SURGERY


"Your dog is not fit for surgery as he has heart disease," I said. "Surgery using mesh implant will take around one hour. He can live another 2 years or more if his heart disease is controlled by medication."


1. Reduce the swelling 6 times a day so that the rectum does not get trapped.
2. Give lactulose daily for 7 days, then alternate days for week 2 and 3.
3. Switch to Prescription Diet W/D as it has higher fibre content. If W/D works, no need to give lactulose.  
4. Heart disease medication daily for 2 weeks first and review.

FOLLOW UP
1. Much less coughing after heart medication is given
2. Oral 3 ml lactulose per day. Passed stools, not watery.
3. Swelling is there, but the dog is not constipated as before evacuation.

TIPS
The hernia had recurred some 6 years after the 2nd surgery but the dog was able to poop.
The vet refused to prescribe more lactulose without examination and so the dog got constipated after a while.