Perineal Protrusion Secondary to Imperforate Hymen and Hydrocolpos in an 8-Year-Old Spayed Female Dog

An 8-year-old female spayed Dachshund presented with an acute onset of dysuria, dyschezia, and painful perineal protrusion. A perineal hernia was ruled out on digital rectal examination, and blood work was unremarkable. An extremely dilated vagina was identified on computed tomography, and hydrocolpos was suspected. Endoscopic vaginal exam confirmed the diagnosis of imperforate hymen. The membrane was ruptured digitally and remnants were removed endoscopically, resulting in resolution of clinical signs. Imperforate hymen is a rare congenital abnormality that can result in extensive fluid accumulation within the vagina and subsequent compression of local structures or secondary infection. Treatment of hydrocolpos includes membrane perforation and removal.

Download Full-text

Jejunal strangulation and incarceration associated with bilateral perineal hernias in a neutered male dog

Journal of the American Veterinary Medical Association ◽

10.2460/javma.20.11.0627 ◽

2022 ◽

pp. 1-5

Author(s):

Ashley E. Iodence ◽

Michael Perlini ◽

Janet A. Grimes

Keyword(s):

Present Report ◽

Clinical Signs ◽

Digital Rectal Examination ◽

Perineal Hernia ◽

Jejunal Segment ◽

Rectal Examination ◽

Intestinal Strangulation ◽

Small Intestinal ◽

The Right ◽

Intestinal Incarceration

Abstract CASE DESCRIPTION An 8-year-old 6.8-kg neutered male Dachshund was presented for evaluation of vomiting, diarrhea, anorexia, and swelling over the right perineal region. The dog had a history of a bilateral perineal herniorrhaphy and castration 14 months prior to presentation. CLINICAL FINDINGS Bilateral perineal hernias were confirmed by digital rectal examination. Abdominal ultrasonography confirmed the presence of intestine within the right hernia. Three days after admission to the hospital, the region of the right perineal hernia became painful, erythematous, and edematous. Computed tomography revealed jejunal incarceration within the right hernia with dilation of 1 jejunal segment that indicated intestinal obstruction. TREATMENT AND OUTCOME Abdominal exploratory surgery was performed, during which irreducible small intestinal incarceration was confirmed. Intra-abdominal jejunal resection and anastomosis was performed, and an approximately 13-cm-long section of the jejunum was resected. Bilateral perineal herniorrhaphies with internal obturator and superficial gluteal muscle transposition were performed. Six months after surgery, digital rectal examination of the dog revealed that the repair was intact. The dog had no perineal hernia–related clinical signs at the time of the recheck examination. CLINICAL RELEVANCE For the dog of the present report, surgical management of small intestinal strangulation associated with a perineal hernia was successful. Although a portion of the small intestines can frequently be found within perineal hernias in dogs, perineal hernia-related small intestinal strangulation has not been previously described, to the authors’ knowledge. Veterinarians and clients should be aware of this potential complication secondary to perineal hernia and be prepared to perform an abdominal surgical procedure to address small intestinal incarceration in affected dogs.

Download Full-text

A Review of the Surgical Management of Perineal Hernias in Dogs

Journal of the American Animal Hospital Association ◽

10.5326/jaaha-ms-6490 ◽

2018 ◽

Vol 54 (4) ◽

pp. 179-187 ◽

Cited By ~ 3

Author(s):

Sukhjit Singh Gill ◽

Robert D. Barstad

Keyword(s):

Rectal Prolapse ◽

Rectal Wall ◽

Prostate Gland ◽

Clinical Signs ◽

Digital Rectal Examination ◽

Levator Ani ◽

Perineal Hernia ◽

Muscle Transposition ◽

Semitendinosus Muscle ◽

Pelvic Diaphragm

ABSTRACT Perineal hernia refers to the failure of the muscular pelvic diaphragm to support the rectal wall, resulting in herniation of pelvic and, occasionally, abdominal viscera into the subcutaneous perineal region. The proposed causes of pelvic diaphragm weakness include tenesmus associated with chronic prostatic disease or constipation, myopathy, rectal abnormalities, and gonadal hormonal imbalances. The most common presentation of perineal hernia in dogs is a unilateral or bilateral nonpainful swelling of the perineum. Clinical signs do occur, but not always. Clinical signs may include constipation, obstipation, dyschezia, tenesmus, rectal prolapse, stranguria, or anuria. The definitive diagnosis of perineal hernia is based on clinical signs and findings of weak pelvic diaphragm musculature during a digital rectal examination. In dogs, perineal hernias are mostly treated by surgical intervention. Appositional herniorrhaphy is sometimes difficult to perform as the levator ani and coccygeus muscles are atrophied and unsuitable for use. Internal obturator muscle transposition is the most commonly used technique. Additional techniques include superficial gluteal and semitendinosus muscle transposition, in addition to the use of synthetic implants and biomaterials. Pexy techniques may be used to prevent rectal prolapse and bladder and prostate gland displacement. Postoperative care involves analgesics, antibiotics, a low-residue diet, and stool softeners.

Download Full-text

Reinfection as a cause of complications and relapses in scarlet fever wards

Journal of Hygiene ◽

10.1017/s0022172400034896 ◽

1937 ◽

Vol 37 (2) ◽

pp. 153-171 ◽

Cited By ~ 41

Author(s):

V. D. Allison ◽

W. A. Brown

Keyword(s):

Scarlet Fever ◽

Primary Infection ◽

Secondary Infection ◽

Clinical Signs ◽

Late Complications ◽

Isolation Method ◽

Fever Patient ◽

The Third ◽

Serological Type ◽

Mode Of Transmission

1. The term “reinfection” has been defined as the secondary infection of a scarlet fever patient during hospitalization withStr. pyogenesbelonging to a serologically different type from that producing the primary infection.2. Of forty-seven scarlet fever patients nursed in a multiple-bed ward and swabbed twice weekly during their period of isolation, thirty-three (70.2 per cent) became reinfected with a serological type ofStr. pyogenesdifferent from that causing the primary disease.3. In fifteen out of the thirty-three patients reinfected, the reinfection was “latent”, i.e. gave rise to no clinical signs, while in the remaining eighteen the reinfection was “manifest”, i.e. was accompanied by clinical signs or complications.4. Patients nursed in cubicles or in a ward confined to infections with a single serological type did not show reinfection; their convalescence was progressive and there were no late complications.5. The majority of complications occurring during the third week of hospitalization and subsequently, in multiple-bed wards devoted to scarlet fever, are due to reinfection.6. Most reinfections occur during the third week in hospital at a time when patients are as a rule convalescent from their primary infection.7. The most frequent mode of transmission of reinfection appears to be by direct contact of patient with patient.8. Ten instances of “relapse” in scarlet fever (only three in the present series) are quoted; in all of them the patients were nursed in multiple-bed wards. In each instance the “relapse” coincided with the isolation of a fresh serological type ofStr. pyogenesfrom the throat, and must therefore be regarded as a second attack of scarlet fever.9. The various systems of nursing patients in isolation hospitals are discussed and it is suggested that scarlet fever patients should be cubicle-nursed if possible. Failing this they should be nursed by the bed-isolation method in multiple-bed wards. By setting aside small wards it might be possible to keep together patients who are all infected by the same serological type ofStr. pyogenes; the number of such wards would vary with the number (usually three or four) of epidemic types current at the time.

Download Full-text

Cerebellar peduncle abscess secondary to disseminated strangles in a six-week-old miniature foal

Veterinary Science Development ◽

10.4081/vsd.2011.3516 ◽

2011 ◽

Vol 1 (1) ◽

pp. 12

Author(s):

Brianne Henderson

Keyword(s):

Animal Health ◽

Clinical Signs ◽

Acute Onset ◽

Abscess Formation ◽

Neurological Deficits ◽

Post Mortem ◽

Streptococcus Equi ◽

The Central Nervous System ◽

Cerebellar Peduncle ◽

The Right

During a strangles outbreak within a herd of minature horses, a six week old foal developed acute onset clinical signs of sepsis and neurological deficits. The foal was euthanized and submitted for post-mortem at the Animal Health Laboratories, Guelph Ontario. Gross post-mortem examination noted severe bronchopneumonia, hypopyon of the right eye and a singular cerebellar peduncle abscess. Culture of the lungs and cerebellum produced a pure growth of Streptococcus equi ssp. equi. Streptococcus equi ssp. equi, the causative agent of equine strangles, produces an acute pyrexia, purulent lymphadenopathy of submandibular and retropharyngeal lymph nodes. Commonly, lymph node abscesses rupture and resolve without complication. Rarely, complications may include: dissemination of the bacteria with diffuse abscess formation, immune mediated disease (purpura haemorrhagica), rarely abscess formation within the central nervous system (CNS) can occur. These can be managed medically with appropriate antibiotics and drugs to reduce intra-cranial pressure, however surgical drainage and debulking of the abscess has been attempted successfully in a few cases.

Download Full-text

Dynamic Magnetic Resonance Imaging Demonstrates the Integrity of Perineal Reconstruction following Cylindrical Abdominoperineal Excision with Reconstruction of the Pelvic Floor Using Porcine Collagen

Case Reports in Medicine ◽

10.1155/2012/752357 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5 ◽

Cited By ~ 6

Author(s):

D. O. Kavanagh ◽

H. Imran ◽

A. Almoudaris ◽

P. Ziprin ◽

O. Faiz

Keyword(s):

Pelvic Floor ◽

Clinical Evidence ◽

Digital Rectal Examination ◽

Dynamic Mri ◽

Posterior Wall ◽

Abdominoperineal Excision ◽

Perineal Hernia ◽

En Bloc ◽

Rectal Pain ◽

Radiological Staging

A 72-year-old female presented with a six-month history of increased frequency of defecation, rectal bleeding, and severe rectal pain. Digital rectal examination and endoscopy revealed a low rectal lesion lying anteriorly. This was confirmed histologically as adenocarcinoma. Radiological staging was consistent with a T3N2rectal tumour. Following long-course chemoradiotherapy repeat staging did not identify any metastatic disease. She underwent a laparoscopic cylindrical abdominoperineal excision withen blocresection of the coccyx and posterior wall of the vagina with a negative circumferential resection margin. The perineal defect was reconstructed with Permacol (biological implant, Covidien) mesh. She had no clinical evidence of a perineal hernia at serial followup. Dynamic MRI images of the pelvic floor obtained during valsalva at 10 months revealed an intact pelvic floor. A control case that had undergone a conventional abdominoperineal excision with primary perineal closure without clinical evidence of herniation was also imaged. This confirmed subclinical perineal herniation with significant downward migration of the bowel and bladder below the pubococcygeal line. We eagerly await further evidence supporting a role for dynamic MR imaging in assessing the integrity of a reconstructed pelvic floor following cylindrical abdominoperineal excision.

Download Full-text

Otitis with Aspergillus niger in a patient with SARS-CoV-2 and multiple comorbidities

Romanian Journal of Infectious Diseases ◽

10.37897/rjid.2021.3.2 ◽

2021 ◽

Vol 24 (3) ◽

pp. 137-140

Author(s):

Andreea Florentina Stoenescu ◽

◽

Geta Vancea ◽

Dana Ispas ◽

Nicoleta Voicu-Pârvu ◽

...

Keyword(s):

Aspergillus Niger ◽

Antiviral Treatment ◽

Clinical Signs ◽

Acute Onset ◽

Suppurative Otitis Media ◽

Vein Thrombosis ◽

Significant Incidence ◽

Lower Lung ◽

History Of ◽

The Right

Introduction. COVID-19 is associated with a significant incidence of bacterial and fungal superinfections and with the exacerbation of pre-existing infections, representing a diagnostic and therapeutic challenge. Case presentation. A 64-year-old woman, confirmed with COVID-19 by the SARS-CoV-2 antigen test, is hospitalized accusing fatigue, nausea, watery stools, cough and vertigo started 10 days ago, aggravated 4 days before the presentation. It also reports recurrent episodes of otalgia and otorrheic pluriantibiotic treatment in the last 2 months. From the personal pathological antecedents we remember: hypothyroidism, dyslipidemia, hypertension, ischemic heart disease, history of deep vein thrombosis (DVT) and secondary pulmonary thromboembolism, in chronic anticoagulant treatment. Pathological clinical signs at admission: bilateral basal crackling rales. Biologically, inflammatory syndrome is detected, and radiologically, interstitial-alveolar infiltrates in the lower lung fields. On day 3 of hospitalization, the patient shows purulent secretion in the right external auditory canal and the ENT consultation confirms chronic suppurative otitis media in acute onset. Bacteriological examination of otic secretion reveals Aspergillus niger. Antiviral treatment with Remdesivir is initiated, antibiotic therapy initiated at home with Azithromycin is continued for one day, then escalated to Ceftriaxone i.v. (in the context of clinical-paraclinical aggravation), systemic corticotherapy, anticoagulation with Dalteparin in the prophylactic regime of DVT, systemic treatment with Voriconazole p.o. (according to the antifungal program) and topical (local) with a slow favorable evolution. Conclusions. The association of COVID-19 with otitis with Aspergillus is a rare and particular clinical picture.

Download Full-text

Fibrinolysis of an Acute Myocarditis Mimicking an Acute Myocardial Infarction

10.37191/mapsci-jccr-1(1)-004 ◽

2020 ◽

Author(s):

Safir Soukaina

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Differential Diagnosis ◽

Cardiac Magnetic Resonance ◽

Magnetic Resonance ◽

Acute Myocarditis ◽

Clinical Signs ◽

Acute Onset ◽

St Segment Elevation ◽

The Difference

Background: Acute myocarditis and acute myocardial infarction have frequently similar clinical presentations and poses an important clinical challenge in the differential diagnosis. In both cases, the electrocardiographic ST-T changes and an increase in troponins can be noted. Differential diagnosis may be very challenging and requires invasive assessment of coronary arteries and other investigations especially cardiac magnetic resonance. Case Presentation: In this report, we report a rare case of acute myocarditis misdiagnosed to an acute myocardial infarction in a patient presented to the emergency department for an acute onset of chest pain with ST-segment elevation on electrocardiogram for which he received urgent fibrinolysis. The confirmation of acute myocarditis was confirmed posteriori after a normal coronary angiogram using cardiac Magnetic Resonance Imaging cMRI. Conclusions: Clinical signs as long with Electrocardiogram may mimick a ST elevation myocardial infarction in the presence of an authentic acute myocarditis,Hence, cardiac magnetic resonance could present an intersting tools to make the difference even in acute phase.

Download Full-text

Frequency of molecular detection of equine coronavirus in faeces and nasal secretions in 277 horses with acute onset of fever

Veterinary Record ◽

10.1136/vr.104919 ◽

2019 ◽

Vol 184 (12) ◽

pp. 385-385 ◽

Cited By ~ 1

Author(s):

Nicola Pusterla ◽

Kaitlyn James ◽

Samantha Mapes ◽

Farifield Bain

Keyword(s):

Clinical Signs ◽

Acute Onset ◽

Molecular Diagnostic ◽

Nasal Discharge ◽

Respiratory Pathogens ◽

Sample Collection ◽

Diagnostic Laboratory ◽

Study Results ◽

Streptococcus Equi ◽

Nasal Secretions

ContextDue to the inconsistent development of enteric signs associated with ECoV infection in adult horses, many practitioners collect nasal secretions rather than feces for the molecular diagnostic work-up of such horses.Main conclusionECoV infection should be considered in horses presenting with acute onset of fever, especially when nasal discharge is absent as one of the cardinal clinical sign.ApproachA total of 277 adult horses with acute onset of fever were enrolled in this study. Feces were tested for ECoV and nasal secretions for common respiratory pathogens (equine herpesvirus (EHV)-1, EHV-4, equine influenza virus (EIV), equine rhinitis viruses (ERVs) and Streptococcus equi ss. equi) and ECoV by qPCR. Each submission was accompanied by a questionnaire requesting information pertaining to signalment, use, recent transportation, number of affected horses on the premise and presence of clinical signs at the time of sample collection.ResultsThe total number of horses testing qPCR-positive for ECoV in feces was 20 (7.2%), 4 of which also tested qPCR-positive for ECoV in nasal secretions. In the same population 9.0% of horses tested qPCR-positive for EHV-4, 6.1% for EIV, 4.3% for Streptococcus equi ss. equi, 3.2% for ERVs and 0.7% for EHV-1. Draft horses, pleasure use, multiple horses affected on a premise and lack of nasal discharge were significantly associated with ECoV qPCR-positive horses.InterpretationThe present study results showed that 7.2% of horses with acute onset of fever tested qPCR-positive for ECoV in feces, highlighting the importance of testing such horses for ECoV in feces. The various prevalence factors associated with ECoV qPCR-positive status likely relate to the high infectious nature of ECoV and breed-specific differences in management and husbandry practices.Significance of findingsECoV infection should be suspected and tested for in horses presenting with acute onset of fever, lethargy and anorexia with no respiratory signs. A two-step approach should be consider in which respiratory secretions and feces should be collected from such horses and submitted to a diagnostic laboratory. If the respiratory secretions test negative by qPCR for a panel of respiratory pathogens, feces already submitted to the laboratory should be tested for ECoV.

Download Full-text

Just the facts: Risk stratifying nontraumatic back pain for Cauda Equina Syndrome in the emergency department

CJEM ◽

10.1017/cem.2020.382 ◽

2020 ◽

Vol 22 (5) ◽

pp. 652-654

Author(s):

Zoe Polsky ◽

Margriet Greidanus ◽

Anjali Pandya ◽

W. Bradley Jacobs

Keyword(s):

Emergency Department ◽

Back Pain ◽

Cauda Equina Syndrome ◽

Bowel Movement ◽

Chronic Back Pain ◽

Cauda Equina ◽

Digital Rectal Examination ◽

Acute Onset ◽

Clinical Exam ◽

History Of

A 43-year-old male, with a history of chronic back pain, presents to the emergency department (ED) with acute onset chronic pain. He states he “tweaked something” and has been debilitated by back pain, radiating down both his legs, for 24 hours. He has not had a bowel movement but denies noticing any “saddle anesthesia.” His clinical exam is limited by pain, and it is difficult to determine if he has objective weakness. His perineal sensation is intact, as is his sensation upon digital rectal examination. The patient has a post-void residual of 250 mL, but you are unsure how to interpret this value. As an emergency physician, when should you suspect, and how should you evaluate cauda equina syndrome?

Download Full-text

Limber tail syndrome in German shepherd dog

Veterinary Science Development ◽

10.4081/vsd.2015.5831 ◽

2015 ◽

Vol 5 (1) ◽

Author(s):

Ghazanfar Abbas ◽

Muhammad Saqib ◽

Mudassar Niaz Mughal ◽

Asif Ali But ◽

Ghulam Muhammad

Keyword(s):

Cold Water ◽

Clinical Signs ◽

Acute Onset ◽

Water Recovery ◽

German Shepherd ◽

German Shepherd Dog ◽

Inflammatory Drugs ◽

Anti Inflammatory ◽

Freeze Water

A 3-year-old intact female German shepherd dog weighing 25 kg was evaluated for acute onset of staggering gait and flaccid (dropped) tail following immersion in freeze water. Clinical signs included staggering gait, aggressive behavior, postural pain and flaccid tail. Clinical signs progressed in severity for 2-3 hours following immersion in freeze water. The dog was treated using anti-inflammatory medication along with warm fomentation of the affected portion of the tail and complete rest. Dog uneventfully recovered on day 7 of initiation of treatment and no reoccurrence was observed during one month follow up period. Limber tail syndrome is an uncommonly reported condition in German shepherd dogs that should be considered when sudden staggering gait and dropped tail is observed after immersion in too cold water. Recovery is possible with anti-inflammatory drugs and rest.

Download Full-text