10 CLINICAL FELINE

Name: Andrew Greenwood

Approved Comments:

Date:

New Version

April 25, 2014

FOCUS LIV ER FLUKE LARGE ANIMAL

Veterinary TIMES

BILATERAL PERINEAL HERNIA IN

THREE CATS: CASE STUDIES
PERINEAL hernia is caused
by a failure of the pelvic
diaphragm muscles resulting in loss of support to
the colorectal junction and
rectum. It is a common condition in male entire dogs
and is generally considered
a disease of middle-aged
and older individuals.
It is much less commonly
documented in the cat where
it seems to occur mostly in
neutered animals and typically develops as a secondary
problem, rather than a primary one. However, numbers
reported in the literature are
too small to draw any firm
conclusions about relationships between specific primary conditions and perineal
hernia (Ashton, 1976; Benitah
and et al, 2004; Johnston and
Gourley, 1980; Galanty, 2005;
Pratschke, 2002; Rashbaum,
1965; Risselada et al, 2003;

KATHRYN PRATSCHKE

ABSTRACT

MVB, MVM, CertSAS, Dipl ECVS, MRCVS

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

present case studies that detail the problems

surrounding this condition, explaining diagnostic
approaches and surgical techniques carried out
Vnuk et al, 2005; Welches et
al, 1992). Bilateral herniation
is apparently more common
than unilateral (Welches et al,
1992). The following cases
describe perineal herniation linked with concurrent
anal sac/rectal disease and
potential inflammatory bowel
disease (IBD) in three cats.

Case 1

A four-year-old, male, neutered Burmese cat was

referred with a two-year

continued from page 8

lead to problems in younger animals that subsequently graze the land, says Mr Haslam. Treatment before cattle go out to grass will also
help take the pressure off the other available
flukicide treatments later in the year, he says.
Another veterinary medicine containing
34mg/ml oxyclozanide (Douvistome) is available in France and the treatment has a zero
milk withdrawal in that country. As a licensed
veterinary medicine containing an identical active ingredient (Zanil), with a clear milk
withdrawal identified in the SPC now available
in the UK, Douvistome should not be prescribed or dispensed for use in UK dairy cows.
Triclabendazole 24 per cent (Fasinex 240)
and 10 per cent (Endofluke 100mg/ml) are
licensed for the treatment of acute, subacute and chronic infection due to triclabendazole-susceptible Fasciola hepatica in
dairy cattle. Triclabendazole is highly effective against all stages of F hepatica from
two-week-old, early, immature forms to
adult fluke2, though triclabendazole-resistant parasite strains have been reported.
Fasinex 240 is not authorised for use in
lactating cattle producing milk for human
consumption and is not intended for use
within 48 days of calving. Milk for human
consumption may only be taken from 48
hours after calving. Should a cow calve earlier than 48 days after the last treatment,
milk for human consumption may only be
taken from 50 days after the last treatment.
Endofluke 100mg/ml oral suspension is
licensed for use in dairy cattle, although it is not
intended for use within 45 days of calving. If
calving occurs before 45 days after treatment,
milk for human consumption may only be taken
after day 45 plus 48 hours after the treatment.
Along with triclabendazole, albendazole and
oxyclozanide, a number of products are available for pre-turnout treatment of mature fluke
in adult beef cattle. These include products
containing closantel, nitroxynil and clorsulon.
When treating cattle after turnout, choosing the correct product is vital. No flukicide
has persistent action, so reinfection may occur

VT44.18 master.indd 10

history of recurrent rectal prolapse. Medical treatment with

laxatives and placement of
purse string sutures had been
attempted. Over the two-year
period, the prolapse became
progressively larger, with the
most recent episode resulting
in five centimetres of rectum
being prolapsed. The cat was
also receiving treatment with
prednisolone for feline asthma
and had been tentatively diagnosed with IBD in the past.
On presentation, the cat was

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
was convened to further the need for answers
and involved key research and industry bodies such as the Moredun Research Institute,
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

for a mildly increased urea

(11.6mmol/L; reference range
[RR] 2.7-9.2mmol/L) and
alanine transaminase (ALT;
45 U/L; RR <35 U/L). Ultrasonography showed prominent peristalsis, although the
lumen diameter, intestinal wall
thickness and layering were
normal. The entire colon was
filled with solid faecal mate-

rial. Rectal palpation under

anaesthesia confirmed severe
bilateral perineal hernias and
bilateral anal sac impactions.
Surgical correction of the
perineal hernias, combined
with colopexy for the recurrent rectal prolapse, was
recommended. The owners
were also advised the previous diagnosis of IBD should

Main: Wetter weather

can mean increased
risk for cattle
and sheep. Inset:
Intermediate host
Galba truncatula.

many flocks. Before confirming resistance, vets

should be sure reinfection has not occurred,
the product was not faulty and has been stored
correctly, and ask if the dose was administered correctly and in the correct volume, said
Fiona Anderson of Novartis Animal Health.
Mr Broom believes following these three
simple rules has allowed him to control fluke
on his farm using triclabendazole, despite
many of the fluke risk factors being present. Attention to detail and weighing ewes
and lambs to ensure accurate dosing has
been the key to our success, he said.
With ever-changing weather patterns increasingly commonplace and the importance of
retaining the efficacy of the medicines available to the livestock practitioner, an understanding of the disease burden on farm, supported
by laboratory diagnosis of disease, will be vital
in choosing the correct treatment and ensure
the health, welfare and continuing productivity of all the cattle and sheep under our care.
References
1. Met Office data.
2. Dobbs M (2013). Current challenges in fluke control for
dairy producers, Vet Times 43(31): 6-10.
3. Bennet R and Ijpelaar J (2003). Economic assessment
of livestock diseases in Great Britain. Final report to Defra.
The Department of Agricultural and Food Economics,
University of Reading.
4. www.moredun.org.uk/research/
research-%40-moredun/parasitic-worms/liver-fluke

MATT DOBBS became a director

and vet with Westpoint Veterinary
Group in Sussex, after time in practice
in the West Country and as lecturer in
dairy practice at the University of Sydney and the RVC. His current research
and consultancy interests include animal health
policy and the law of livestock agriculture.
5. Armstrong D (2010). Liver fluke in cattle costs
and control. www.eblex.org.uk/wp/wp-content/
uploads/2013/06/Liver-fluke-in-cattle-costs-and-control.pdf
6. The University of Reading, Department of Agriculture
and Food Economics, The Economics of Fascioliasis.
7. Mezo et al (2011). Association between anti-F hepatica
antibody levels in milk and production losses in dairy
cows, Veterinary Parisitology 180(3-4): 237-242.
8. Taylor M A (2012). Emerging parasitic diseases of
sheep, Veterinary Parasitology 189(1): 2-7.
9. www.nadis.org.uk/parasite-forecast.aspx
10. www.farminguk.com/News/Liver-fluke-treatmentre-introduced-by-MSD_26331.html
11. www.defra.gov.uk/ahvla-en/2013/01/29/
ahvla-further-warning-flukes/
12. www.noahcompendium.co.uk/Virbac_Limited/Albenil_
Low_Dose_10_ACU-_w_v_oral_suspension/-57007.html
13. www.noahcompendium.co.uk/MSD_Animal_
Health/Zanil_Fluke_Drench_34_mg_ml_Oral_
Suspension/-61585.html
14. www.cattleparasites.org.uk/
15. www.noahcompendium.co.uk/Novartis_Animal_
Health_UK_Ltd/Fasinex_240__24_ACU-_Oral_
Suspension_for_cattle/-27805.html
16. Mezo et al (2003). Optimized serodiagnosis of sheep
fascioliasis by FPLC fractionation of Fasciola hepatica
excretory-secretory antigens, Journal of Parasitology 89:
843-849.

25/04/2014 12:23

Name: Andrew Greenwood

Approved Comments:

Date:

New Version

April 25, 2014

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-

Perineal hernia is an uncommon condition

in the cat. It is most often seen in neutered
animals and has most commonly been
reported as a secondary condition.

phone interview seven

months after surgery, the
owner reported excellent
results, stating the cat had a
changed life, a good regular
appetite and no apparent
difficulty or tenesmus when
defaecating. There had been
no recurrence of the rectal
prolapse since surgery.

Case 2

A 13-year-old female, neutered domestic shorthair (DSH)

was referred with a onemonth history of constipation.
The straining was so severe
that vomiting had occurred
and the cat had become distressed and lethargic. Weight
loss had occurred despite a
good appetite. Medical treatment had been attempted
with laxatives and enemas,
which helped transiently.
On presentation, the cat was
bright and alert with routine
parameters within normal
limits other than a high BCS
of 7/9. Abdominal palpation
revealed impacted faeces
in the colon and discomfort.
Haematology identified a
leukocytosis (22.7 109/L;
RR 5.5-15.5 109/L) with
neutrophilia (20.88 109/L;
RR 2.5-12.5 109/L). Viral
testing was negative for FeLV
and FIV, and the coronavirus
titre was zero. Ultrasonography showed a prominent
spleen with slightly hypoechoic parenchyma, but an
ultrasound-guided aspirate
showed no significant abnormalities. The ileocolic lymph
nodes were prominent and
reactive, and the surrounding mesentery hyperechoic.
Radiography showed a diffuse interstitial pattern in the
lungs, likely due to obesity.
Abdominal radiography was
unremarkable. Rectal palpation under sedation diagnosed
bilateral perineal hernias and
bilateral anal sac impactions.

A standard midline exploratory coeliotomy was performed, which identified a

chain of enlarged ileocolic
lymph nodes. Two were
removed for histopathology,
one of which was abscessed.
A swab of the abscessed node
was also taken for bacteriology. Incisional full thickness
biopsies were taken of the
colon and jejunum and a liver
biopsy was collected. Bilateral
perineal herniorrhaphy was
then performed as described
in case one (Bellenger and
Canfield, 2003). The total surgery time was 135 minutes.
The cat received an epidural
prior to surgery, containing both morphine (0.1mg/
kg; Martindale) and bupivacaine (2.5mg/kg; AstraZeneca). Amoxicillin-clavulanic
acid (20mg/kg, Augmentin;
GlaxoSmithKline) was given
IV for perioperative antibacterial therapy, followed by
oral amoxicillin-clavulanic
acid (12.5mg/kg every 12
hours, Synulox; Pfizer) for
seven days. Analgesia was
provided postoperatively with
buprenorphine (0.01mg/kg
every six hours, Vetergesic;
Alstoe) and meloxicam
(0.05mg/kg every 24 hours,
Metacam; Boehringer). In
addition, ranitidine was provided for five days (2mg/kg
every 12 hours, Zantac; GlaxoSmithKline) and lactulose
(2ml every 12 hours; Sandoz).
The cat was discharged two
days after surgery with no
early complications and owners were advised on dietary
management with IBD.
Histopathology identified
cholangiohepatitis with a
lymphoplasmacytic infiltrate,
neutrophilic and lymphoplasmacytic colitis and lymphoplasmacytic enteritis. Lymphoid
hyperplasia, in addition to
severe necrotising and pyogranulomatous
page 12

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Figure 1. Incisional colopexy. B = bladder, C= colon, S = small intestine.

VT44.18 master.indd 11

25/04/2014 12:09

Name: Andrew Greenwood

Approved Comments:

Date:

New Version

April 25, 2014

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

A three-year-old male, neutered DSH was referred with

a three-month history of
rectal prolapse. A purse string
suture had previously been
placed, but the condition
recurred. Apart from occasional anal sac impactions,
the cat had no other history
of gastrointestinal problems.
On presentation, the cat
was bright and alert with
routine clinical parameters
within normal limits and no
abnormalities on abdominal
palpation. There was a small
area of everted rectal mucosa
in the left dorsal quadrant
of the anus. The tissue was
pink and looked healthy,
although the owners noted
it bled occasionally. Routine
haematology was unremarkable, but serum biochemistry
revealed mild elevations in
ALT levels (62U/L; RR<35U/L)
as well as urea (11mmol/L;
RR 2.7-9.2mmol/L) and
creatinine (181mol/L; RR
91-180mol/L), although
urine specific gravity was
within normal limits. Radiographs and ultrasonography scan of the abdomen
were unremarkable, but
rectal examination under
sedation revealed bilateral
perineal hernias, with bilateral anal sac impactions.
Perineal hernia repair, combined with colopexy, was
recommended, but in light of
the mild elevations in urea
and creatinine, it was recom-

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VT44.18 master.indd 12

mended the procedures be

separated into two surgeries
rather than having one longer
anaesthetic episode. At surgery, a subjective assessment
was made that the small and
large intestinal walls were
thinner and more flaccid than
normal, with overall poor
motility throughout the gastrointestinal tract. Full thickness biopsies were taken from
the jejunum and the colon, as
well as the mesenteric lymph
nodes. Incisional colopexy was
then performed using a standard technique and surgery
lasted 50 minutes (Popovitch
et al, 1994). Perioperative
analgesia was provided with
a constant rate infusion of
remifentanil (0.2g/kg/min,
Ultiva; GlaxoSmithKline) plus
methadone (0.2mg/kg every
four hours for four doses; Martindale) followed by buprenorphine (0.01mg/kg every six
hours, Vetergesic; Alstoe). IV
fluid therapy with isotonic
crystalloids was continued
overnight at 4ml/kg due to
the raised renal parameters.
Amoxicillin-clavulanic acid
(20mg/kg every eight hours,
Augmentin; GlaxoSmithKline) was used for perioperative antibacterial therapy.
Two days after the initial
surgery, bilateral perineal
herniorrhaphy was performed,
as described previously, with
a surgery time of 60 minutes (Bellenger and Canfield,
2003). The cat received an
epidural with bupivacaine
(0.5mg/kg; AstraZeneca)
preoperatively. Biochemistry taken before anaesthesia showed the urea levels
had returned to within normal limits (8mmol/L; RR
2.7mmol/L to 9.2mmol/L),
but the creatinine levels had
increased further (204mol/L;
RR 91mol/L to 180mol/L),
again suggestive of renal
insufficiency. IV fluid therapy
was administered at 10ml/kg/
hr during surgery, maintained
at 4ml/kg/hr overnight and
urine output was monitored.
Perioperative analgesia and
antibacterial therapy were the
same as for the first operation
with postoperative buprenorphine (0.01mg/kg every six
hours, Vetergesic; Alstoe)
and metronidazole (10mg/

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paulimrie@vbd.uk.com
and include your name,
address and qualifications

kg every 12 hours, Flagyl

solution; Winthrop). The day
after surgery, the creatinine level had fallen slightly
(180mol/L; RR 91mol/L
to 180mol/L), but urea
was slightly raised further
(8.5mmol/L; RR 2.7mmol/L
to 9.2mmol/L) and management for renal insufficiency
was continued. Repeat bloods
two days later confirmed
both and urea (7.2mmol/L;
RR 2.7mmol/L to 9.2mmol/L)
and creatinine (157mol/L;
RR 91mol/L to 180mol/L)
were within normal limits
again. There was still a small
portion of protruding rectal
mucosa present, but the cat
was passing faeces without
difficulty at this stage and was
discharged four days after the
second surgery. The owners were advised to ensure
adequate fibre intake in the
diet to promote intestinal
motility and stool formation.
Histopathology showed a
neutrophilic, chronic-active,
diffuse colitis and enteritis.
The sample from the jejunum
was significantly more severe
than the colonic sample. Neurons were present in expected
numbers within the intestinal
samples and the architecture
was normal. The mesenteric
lymph node showed evidence
of active lymphoid hyperplasia. Bacteriology from this
node identified a non-haemolytic Escherichia coli. There
was no evidence of nematode eggs, cryptosporidium
oocysts or faecal protozoa
on faecal examination.
At telephone interview
12 months after surgery,
the owner reported good
improvement. The cat still
had occasional tenesmus and
a small persistent area of
mucosal prolapse, but the condition had improved markedly
in terms of severity since the
surgery and the owners felt it
was now readily manageable.

Discussion

Perineal hernia is an uncommon condition in the cat. It is

most often seen in neutered
animals as in the three cases
reported here and has most
commonly been reported
as a secondary condition.
Bilateral herniation has been
more commonly reported in
cats, as was the situation in
all three cases reported here
(Bellenger and Canfield, 2003;
Fossum, 2002; Welches et
al, 1992). It is tempting to
speculate the more private
nature of cats toilet habits
compared to dogs makes it
less likely a problem will be
noticed until the condition is
more advanced and the clinical signs are more obvious.
Potential causes of perineal
herniation in cats have been
reported to include previous perineal urethrostomy
surgery, megacolon, perineal
masses, chronic fibrosing
colitis, trauma and cutaneous asthenia (Bellenger and
Canfield, 2003; Benitah et al,

25/04/2014 12:09

Name: Andrew Greenwood

Approved Comments:

Date:

New Version

April 25, 2014

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

minimal clinical signs, hence

surgery is generally the preferred treatment choice, with
success rates of 73 per cent
reported in cats (Welches et
al, 1992). The internal obturator muscle flap transposition
technique (IOFT) was used in
all three cases here and aids
to fill the ventral defect in the
perineal diaphragm, which
can prove difficult with other
techniques (Bellenger and
Canfield, 2003; Hardie et al,
1983). The procedure follows
that for the dog and has been
described in previous reports
of perineal hernia repair in
cats. Our findings provide
further evidence the technique is an effective way of
managing the condition in cats
and that bilateral one-stage
repair can be safely performed
(Benitah, 2004; Galanty,
2005; Welches et al, 1992).
The traditional anatomic
repair, similar to the technique
described in dogs, has also
been used in the past, but
there are important species
differences to note. Cats have
no sacrotuberous ligament
and the muscles of the perineum are much less substantial than in the dog, meaning
this technique is likely to be
less satisfactory in the cat. As
it is already associated with a
significantly higher recurrence rate in dogs than IOFT,
it cannot be recommended
for routine use in cats in bilateral, chronic or large hernias
(Bellenger and Canfield, 2003;
Martin et al, 1974; Vnuk et al,
2008). There has been one
report documenting the use
of a semitendinosus muscle
flap technique in a cat with
a trauma-induced perineal
hernia, with the semitendinosus muscle being transected
at the mid-belly and rotated
ventrally beneath the anus to
fill the defect. The right semitendinosus muscle was used
to repair a left-sided traumatic
hernia with a good outcome
reported (Chambers and Rawlings, 1991; Vnuk et al, 2005).
Overall, perineal hernia is
an uncommon, but potentially
important, and very possibly
under-diagnosed, condition in
cats that can have a significant
adverse effect on the quality
of life. Although it does have
some similarities in presentation to dogs, it should be
noted it may present quite
differently and we suggest
cats presenting with tenesmus
and constipation all warrant
further investigation to rule
out perineal hernia and also

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that rectal examination should

be utilised more frequently
in cats with this type of presentation. Based on our cases,
clinicians should consider perineal hernia may be associated
with rectal prolapse, anal sac
impaction and IBD in cats, but
good outcomes are possible
with the appropriate diagnostic and surgical approach.
References
Ashton D G (1976). Perineal hernia
in the cat a description of two
cases, Journal of Small Animal
Practice 17(7): 473-477.
Bellenger C R and Canfield R
B (2003). Perineal Hernia. In
Slatter Textbook of Small Animal
Surgery (3rd edn), W B Saunders,
Philadelphia pp 487-498.
Benitah N, Matousek J L, Barnes R
F et al (2004). Diaphragmatic and
perineal hernias associated with
cutaneous asthenia in a cat, Journal
of the American Veterinary Medicine
Association 224(5): 706-709.
Chambers J N and Rawlings
C A (1991). Applications of a

semitendinosus muscle flap in

two dogs, Journal of the American
Veterinary Medicine Association
199: 84-86.
Fossum T W (2002). Surgery of the
digestive system in Small Animal
Surgery (2nd edn), Mosby, St Louis
pp 433-437.
Galanty M (2005). Perineal hernia in
3 cats, Polish Journal of Veterinary
Science 8: 165-168.
Hardie E M, Kolata R J, Earley T D
et al (1983). Evaluation of internal
obturator muscle transposition in
treatment of perineal hernia in dogs,
Veterinary Surgery 12: 69-72.
Johnson M S and Gourley I M
(1980). Perineal hernia in a cat: a
possible complication of perineal
urethrostomy, Veterinary Medicine
Small Animal Clinician 75: 241-243.
Martin W D, Fletcher T F and Bradley
W E (1974). Perineal musculature
in the cat, Anatomical Record 180:
3-14.
Matthiesen D T (1989). Diagnosis
and management of complications
occurring after perineal
herniorrhaphy in dogs, Compendium
of Continuing Education for the
Practicing Veterinarian 11: 797-822.
Popovitch C A, Holt D and Bright R
(1994). Colopexy as a treatment
for rectal prolapse in dogs and cats:

a retrospective study of 14 cases,

Veterinary Surgery 23: 115-118.
Pratschke K (2002). Management
of hernias and ruptures in small
animals, In Practice 24: 570-581.
Rashbaum R A (1965). Perineal
hernia in a cat, Journal of the
American Veterinary Medicine
Association 147: 514-515.
Risselada M, Kramer M and Van De
Velde B et al (2003). Retroflexion of
the urinary bladder associated with
a perineal hernia in a female cat,
Journal of Small Animal Practice 44:
508-510.
Vnuk D, Babic T, Stejskal M
et al (2005). Application of a
semitendinosus muscle flap in
the treatment of perineal hernia
in a cat, Veterinary Record 156:
182-184.
Vnuk D, Lipar M, Maticic D et al
(2008). Comparison of standard
perineal herniorrhaphy and
transposition of the internal
obturator muscle for perineal hernia
repair in the dog, Veterinary Archives
78: 197-207.
Welches C D, Scavelli T D, Aronsohn
M G et al (1992). Perineal hernia
in the cat: A retrospective study of
40 cases, Journal of the American
Animal Hospital Association 28:
431-438.

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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